What Causes Physician Burnout? The Medscape Survey

Although I left medicine at a young age, I never felt that burnout was a primary motivating factor in that choice. I wasn’t desperate to get out. I simply realized I had financial freedom and the options that go along with it.

As I did more self-reflection in my final working years, I realized I had some low level symptoms. Depersonalization is not uncommon in the OR; it’s honestly an effective coping mechanism. A bit of emotional detachment makes it easier to simply do what’s medically best and appropriate for each and every patient.

A lack of autonomy is known to be a cause of burnout, and it’s also in the job description of an anesthesiologist. We don’t decide what to do or where and when it needs to be done. We are at the beck and call of every surgeon, nurse, and pre-surgical, post-surgical, or laboring patient.

Interestingly and surprisingly, I found that the little annoyances were magnified once I realized that I was financially independent. Most report an increase in work satisfaction post-FI, but I just found myself questioning why I subjected myself to the infuriating electronic health record and jumped through the unnecessary hoops of MOC.

So yeah, I was feeling at least a little bit of burnout. Let’s see what other physicians are feeling and why. This article originally appeared on The Physician Philosopher.

What Causes Physician Burnout? The Medscape Survey

 

In the 2018 Medscape Survey on Physician Burnout and Depression, over 15,500 physicians were surveyed.  The Medscape survey was aimed at answering some vital questions, such as “What causes physician burnout?” and “What are some ways to fix physician burnout?” The results were interesting, and I think worth discussing.

Today, we will highlight some of the results and how these facts might impact our decisions around burnout at work.

 

Physician Burnout Basics

 

Of the more than 15,500 surveyed, 61% were men and 39% were women.  The survey was collected over a four month period (July to October) and it was sent to both Medscape members and non-member physicians practicing medicine only in the United States.

Interestingly, the percentage of physicians that were burned out was 42% regardless of whether they worked as an employed physician or were self-employed.

What is the prevalence of burnout in each specialty?  Here are the numbers:

 

Burnout by SpecialtyIn all, over 26 specialties had a burnout rate of 33% or higher.  In essence, one in three colleagues were burned out.  This went as high as almost one in every two for critical care and neurology.

One finding that surprised me from the prevalence results was how high the numbers were for specialties that are often considered “less stressful” (i.e. family medicine, PM&R, etc).  As we look at the causes of burnout below, it might not be so surprising anymore.

Big Picture Causes of Depression

 

The respondents were asked to determine various big picture etiologies of their depression from several different categories.  These results are below.  Unsurprisingly, the number one cause was their job.

 

Burnout causes

Interestingly, the number 2 cause was finances.

Given that the purpose of this website is to help combat burnout through the tools taught by financial independence, this didn’t surprise me… but it was nice to see the thought validated in a survey.

Causes of Burnout and Ways to Reduce It

 

Now, this was the most interesting information from the entire study.  Physicians were asked to determine the causes of burnout. Then, they were encouraged to label some ways that burnout/depression might be reduced.

We already determined from the above information that the second leading cause of depression seems to be financial.  That said, when asked about specifics at work that caused or led to burnout this is what the respondents said:

 

burnout contributors

You would think from the top two causes (too much bureaucratic work and spending too much time in the workplace) that the obvious ways to help minimize these problems would be for physicians to ask for secretarial help, scribes to help them chart, and to work part-time (to allow more time away from work).

 

 

But, that’s not at all what the people responding to this survey said.

In typical physician fashion, they demanded more pay to compensate for their stress. Apparently, doctors don’t make enough money. So that I avoid putting words in their mouth I’ll show you what they said and then discuss my thoughts below:

 

What reduces burnout

What do you think about the responses?  Over a third of the doctors in this study thought that being paid more would lead to less burnout.  This is despite the causes that listed above where money isn’t mentioned until the fifth cause for burnout.

My Thoughts

 

I think this survey can be broken up into two difference sources of frustration: the big picture (work-life balance) and the little picture (causes of burnout at work).

 

The Big Picture

 

In the big picture, finances seem to play a large role.  We see this twice.  First in the causes of depression where finances are listed as the number 2 cause only behind the workplace.  This goes to show that finances can be directly linked to depression and burnout.

The solution to this problem isn’t to pay physicians more, but to give them a higher financial literacy coming out of training so that they know what to do with the money that they receive.  Financial Independence can help solve a lot of these problems, if only physicians were taught about this stuff.

What kind of stuff? Well, like the fact that physicians have a spending problem.  When burnout comes raging into the physician life, a lot of people think the answer is to spend money to find the happiness that is missing.  This is like adding water to a grease fire.

Yet, when physicians were asked what could solve the burnout problem, the number one solution provided was to increase their pay.  My gut feeling is that most doctors would not feel this way if they knew how to handle their money.

Though, to be clear, I am not arguing that paying physicians more is a bad idea – I just don’t think it would solve the problem of burnout.

 

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The Little Picture

 

I could have been a doc surveyed with the question “What contributes to physician burnout?”  I would have given similar answers.

The fact is that non-physician tasks have continued to creep into the workplace for doctors.  We have more charting, more electronic billing, more administrative creep, and less time taking care of patients.  Many doctors also do not have work-life balance as they spend too much time at work.  Hospital administrators who refuse to eat last don’t help either.

These answers make sense. They are definite contributors to burnout.  As physicians, our job is to take really good care of people, to bill them for their care (to keep the doors open), and  – if you are in academia – to teach and to perform research.

Anything that is not inherently involved in those tasks should be supported by work staff who can help contribute to a decreased physician work-load.  Personally, I’ve felt the burn lately and it mostly results from an ever growing “to-do” list that I can’t seem to get done.

Ironically, though, these same doctors filling out this survey said that getting paid more would remedy these problems. How does getting paid decrease meaningless tasks, lessen work demands, or give you more support from administration?

This is a prime example of people who don’t understand The Tale of Two Doctors. They’ve likely financed a life that they cannot afford in an attempt to make them happy.  In other words, it seems like a lot of Dr. Jones’ filled out this survey.

Take Home

 

Looking into the prevalence and causes of burnout among physicians is a really important task.  While it seems that we have done a good job of determining causes, we did not do the best job highlighting what the best fixes might be for the problems we face.

In the end, I maintain that teaching financial literacy to medical students, residents, and early career attending physicians will help prevent a lot of the financial causes of burnout.  Also, It will allow these physicians to have a better work-life balance as they approach financial independence and have more options.

 

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If you are a physician, would you say you feel some level of burnout? What’s the biggest reason? What, in your opinion, would best alleviate physician burnout?

6 comments

  • I wonder if the flip side of the argument is true: If financial issues contribute to burnout, are those who are prone to saving a lot (ok, cheap) less likely to burn out?

    I’m cheap yet burnt to a crisp in residency… Anecdotes aren’t data…

    • GasFIRE

      My experience was the same as yours, attaining what I considered to be FI didn’t lessen but worsened my burnout. From that point in my life the motivation to accept the lack of autonomy essentially disappeared. Call was no longer in inconvenience but became an unnecessary intrusion. As you noted more money doesn’t fix this type of problem, the next dollar wasn’t going to help me hate call less. While the transition was not easy, thankfully I’m now in a part-time position, actual enjoy my job, make less than half what I was making but consider myself twice as happy. Kudos for discussing this important topic.

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  • Lordosis

    If you pay more you could theoretically work less and achieve a better balance. However I think people would work just about the same causing just as much burnout symptoms. They would just increase their lifestyle accordingly.

    Few of us regulars here would likely be able to take good advantage of it and achieve financial Independence much sooner and possibly retire early.

  • bill

    //If you are a physician, would you say you feel some level of burnout? What’s the biggest reason? What, in your opinion, would best alleviate physician burnout?//. I do not think money has much to do with burnout. The main force driving burnout is loss of autonomy. Docs are making more money than they ever did historically. It is not money. BTW i have no solution for this. Just an observation.

  • Scott

    Getting paid more, to me, means getting reimbursed better for things like uncompensated phone calls, consultation about extended family problems beyond the office visit, deliveries in the middle of the night in addition to your regular practice time, responding to things even when you are not on call, administrative tasks that don’t add anything to the care of patients, let alone your bottom line, house calls and hospital visits done after hours because it is the right thin to do, you get the idea. End of the year bottom line might be fine but it is the abuse that leads to burnout. This may be why Family Physicians are more burned out than Plastic Surgeons or Dermatologists where pay is based on procedure rather than time or cognitive efforts.

  • Julie Patel

    Getting paid more would mean I could hire more assistants, scribes, IT consultants, administrators to do all the bureaucratic work and I could focus on practicing medicine. Right now I’m stuck. As a solo physician, I am seeing maximum number of patients I can see from 7am to 7pm but we just cannot keep up with the prior authorizations, appeals, peer to peers, pre certifications, claims processing errors by insurance companies, MIPS/MACRA, IT risk assements, multiple IT problems with the EMR/network/windows updates gone wrong, massive garbage “care recommendations” from PBM’s and specialty pharmacies, FMLA paperwork, short term disability paperwork, massive amounts of pharma patient assistance forms, etc. I simply cannot earn enough to hire enough staff to take care of the paperwork. Meanwhile employees need raises, my reimbursement from insurance companies does not go up and rent and utilities keep going up. This is unsustainable

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