Physician Burnout and Well-Being: A Systematic Review and Framework for Action

BACKGROUND: Physician burnout in the United States has reached epidemic proportions and is rising rapidly, although burnout in other occupations is stable. Its negative impact is far reaching and includes harm to the burned-out physician, as well as patients, coworkers, family members, close friends, and healthcare organizations. OBJECTIVE: The purpose of this review is to provide an accurate, current summary of what is known about physician burnout and to develop a framework to reverse its current negative impact, decrease its prevalence, and implement effective organizational and personal interventions. DATA SOURCES: I completed a comprehensive MEDLINE search of the medical literature from January 1, 2000, through December 28, 2016, related to medical student and physician burnout, stress, depression, suicide ideation, suicide, resiliency, wellness, and well-being. In addition, I selectively reviewed secondary articles, books addressing the relevant issues, and oral presentations at national professional meetings since 2013. STUDY SELECTION: Healthcare organizations within the United States were studied. RESULTS: The literature review is presented in 5 sections covering the basics of defining and measuring burnout; its impact, incidence, and causes; and interventions and remediation strategies. CONCLUSIONS: All US medical students, physicians in training, and practicing physicians are at significant risk of burnout. Its prevalence now exceeds 50%. Burnout is the unintended net result of multiple, highly disruptive changes in society at large, the medical profession, and the healthcare system. Both individual and organizational strategies have been only partially successful in mitigating burnout and in developing resiliency and well-being among physicians. Two highly effective strategies are aligning personal and organizational values and enabling physicians to devote 20% of their work activities to the part of their medical practice that is especially meaningful to them. More research is needed.

[1]  P. O'Carroll,et al.  Attempted suicide among young adults: progress toward a meaningful estimate of prevalence. , 1992, The American journal of psychiatry.

[2]  T. Shanafelt,et al.  Executive Leadership and Physician Well‐being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout , 2017, Mayo Clinic proceedings.

[3]  D. Safran,et al.  Doctor discontent. A comparison of physician satisfaction in different delivery system settings, 1986 and 1997. , 2001, Journal of general internal medicine.

[4]  E. Frank,et al.  Mortality rates and causes among U.S. physicians. , 2000, American journal of preventive medicine.

[5]  A. Medford,et al.  Burnout in physicians. , 2015, The journal of the Royal College of Physicians of Edinburgh.

[6]  Thomas Bodenheimer,et al.  In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices , 2013, The Annals of Family Medicine.

[7]  W. Schaufeli,et al.  Job burnout. , 2001, Annual review of psychology.

[8]  N. Powe,et al.  Primary care physician job satisfaction and turnover. , 2001, The American journal of managed care.

[9]  M Linzer,et al.  Predicting and preventing physician burnout: results from the United States and the Netherlands. , 2001, The American journal of medicine.

[10]  A. Eshelman,et al.  A national study of burnout among American transplant surgeons. , 2005, Transplantation proceedings.

[11]  Eric S. Williams,et al.  Managed care, time pressure, and physician job satisfaction: Results from the physician worklife study , 2000, Journal of General Internal Medicine.

[12]  Robert Michels,et al.  Confronting depression and suicide in physicians: a consensus statement. , 2003, JAMA.

[13]  H. Rakatansky.  Physician suicide. , 2005, The New England journal of medicine.

[14]  Tait D. Shanafelt,et al.  Interventions to Prevent and Reduce Physician Burnout: A Systematic Review and Meta-analysis , 2017 .

[15]  S. Singletary,et al.  Career Satisfaction, Practice Patterns and Burnout among Surgical Oncologists: Report on the Quality of Life of Members of the Society of Surgical Oncology , 2007, Annals of Surgical Oncology.

[16]  David Blumenthal,et al.  Leaving Medicine: The Consequences of Physician Dissatisfaction , 2006, Medical care.

[17]  J. Freischlag,et al.  Distress and Career Satisfaction Among 14 Surgical Specialties, Comparing Academic and Private Practice Settings , 2011, Annals of surgery.

[18]  D. Ariely,et al.  Disturbing Trends in Physician Burnout and Satisfaction With Work-Life Balance: Dealing With Malady Among the Nation's Healers. , 2015, Mayo Clinic proceedings.

[19]  S. Jackson,et al.  The Measurement of experienced burnout , 1981 .

[20]  T. Rummans,et al.  Career fit and burnout among academic faculty. , 2009, Archives of internal medicine.

[21]  Christine A. Sinsky,et al.  From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider , 2014, The Annals of Family Medicine.

[22]  Ebbe Villadsen,et al.  The Copenhagen Burnout Inventory: A new tool for the assessment of burnout , 2005 .

[23]  D. Jeffe,et al.  National Survey of Burnout among US General Surgery Residents. , 2016, Journal of the American College of Surgeons.

[24]  J. Ware,et al.  A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. , 1996, Medical care.

[25]  Steven J Durning,et al.  Relationship between burnout and professional conduct and attitudes among US medical students. , 2010, JAMA.

[26]  J. Sloan,et al.  Burnout and satisfaction with work-life balance among US physicians relative to the general US population. , 2012, Archives of internal medicine.

[27]  Christine A. Sinsky,et al.  Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction. , 2016, Mayo Clinic proceedings.

[28]  J. Stoller,et al.  The impact on revenue of physician turnover: an assessment model and experience in a large healthcare center. , 2006, The Journal of medical practice management : MPM.

[29]  E. Copeland.  Special Report: Suicidal Ideation Among American Surgeons , 2012 .

[30]  K. Grumbach,et al.  No exit: an evaluation of measures of physician attrition. , 2004, Health services research.

[31]  W. Browner,et al.  Case-finding instruments for depression. Two questions are as good as many. , 1997, Journal of general internal medicine.

[32]  Mark D Schwartz,et al.  Working conditions in primary care: physician reactions and care quality. , 2009, Annals of internal medicine.

[33]  J. Freischlag,et al.  Burnout and Career Satisfaction Among American Surgeons , 2009, Annals of surgery.

[34]  J. Freischlag,et al.  Surgeon distress as calibrated by hours worked and nights on call. , 2010, Journal of the American College of Surgeons.

[35]  H. Freudenberger.  Staff burn-out , 1974 .

[36]  E. Demerouti,et al.  Measurement of Burnout ( and Engagement ) 1 Running head : MEASUREMENT OF BURNOUT AND ENGAGEMENT The Oldenburg Burnout Inventory : A Good Alternative to Measure Burnout ( and Engagement ) , 2007 .

[37]  S. Swensen,et al.  Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort. , 2016, Mayo Clinic proceedings.

[38]  Christine A. Sinsky,et al.  Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties , 2016, Annals of Internal Medicine.

[39]  D. Berwick,et al.  The triple aim: care, health, and cost. , 2008, Health affairs.

[40]  J. Freischlag,et al.  Burnout and Medical Errors Among American Surgeons , 2010, Annals of surgery.

[41]  Jennifer S. Haas,et al.  Is the professional satisfaction of general internists associated with patient satisfaction? , 2000, Journal of General Internal Medicine.

[42]  Christine A. Sinsky,et al.  Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. , 2015, Mayo Clinic proceedings.

[43]  N. Powe,et al.  Estimates of costs of primary care physician turnover. , 1999, The American journal of managed care.

[44]  Robert Perry,et al.  Burnout in medical students: a systematic review , 2013, The clinical teacher.

[45]  J. Stoller,et al.  A Review of Physician Turnover: Rates, Causes, and Consequences , 2004, American journal of medical quality : the official journal of the American College of Medical Quality.

[46]  C. Balch,et al.  Combating stress and burnout in surgical practice: a review. , 2010, Advances in surgery.

[47]  W. Browner,et al.  Case-finding instruments for depression , 1997, Journal of General Internal Medicine.

[48]  Mark Linzer,et al.  The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: Results from the MEMO study , 2007, Health care management review.