Primary care physicians at high risk for burnout, Mayo Clinic study shows

Primary care physicians (PCPs) are among the types of doctors most at-risk for burnout, a wide-ranging and "alarming" problem that threatens the foundation of the U.S. medical system, according to a new study led by Mayo Clinic.

The problem could worsen as 30 million more patients gain health insurance under the federal health overhaul and PCPs are stretched even further, according to the study's lead author.

"How is an already very taxed PCP workforce going to be able to deal with that increased workload?" says Tait Shanafelt, MD, a hematologist and oncologist with Minnesota-based Mayo.

"There's a lot of fear that, with increasing administrative requirements and changes to the reimbursement model, this is getting worse rather than getting better," Shanafelt says.

Because they're at the "front lines" of patient care and grapple with all the stress that that entails, PCPs are more susceptible to the feelings of emotional exhaustion and cynicism that characterize burnout, the study says.

Burnout is no small problem. Nearly 46% of the 7,288 physicians who responded to the survey were experiencing at least one symptom of burnout, which suggests that "the origins of this problem are rooted in the environment and care delivery system," the authors of the study note.

Emergency medicine physicians are the most likely to experience burnout, with about 65% reporting one symptom. General internists and family physicians didn't fare much better, as more than half of the doctors in each of those areas suffered some form of burnout.

Dermatologists - as well as physicians who practice preventive, environmental and occupational medicine - reported the lowest levels of burnout.

The consequences of physician burnout include lower quality of care, as well as reduced hours and early retirement, which the U.S. health system can ill afford as it stares down a physician shortage.

"Docs who are burned out are more likely to make mistakes," Shanafelt says.

Shanafelt notes two novel aspects of the study: First, it compares burnout across different specialties. Second, it compares rates of physician burnout with those of the general population, and that comparison doesn't look too rosy for physicians.

By a disparity of about 10 percentage points, doctors were more likely than the general population to experience burnout. When it comes to professional/personal life balance, the disparity is even greater, with 40% of physicians reporting dissatisfaction, compared with just 23% for the general population.

The study uncovers another notable anomaly: The more educated a worker, the less likely he or she is to experience burnout - unless he or she is a doctor.

"A higher level of education is protective of burnout, but only outside of medicine," Shanafelt said.

How to relieve physician burnout is an open question. The authors note that, although "extensive literature" suggests factors contributing to burnout include excessive workload and loss of autonomy, "few interventions have been tested."

Answering that question could be critical to the future of the U.S. health system, the authors warn.

"Policy makers and health care organizations must address the problem of physician burnout for the sake of physicians and their patients," they write.

The study was published online in the Archives of Internal Medicine.

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