Ten years of data from a nationwide survey of physicians confirm another trend that’s worsened through the pandemic: Burnout rates among doctors in the United States, which were already high a decade ago, have risen to alarming levels.
Results released this month and published in Mayo Clinic Proceedings, a peer-reviewed journal, show that 63 percent of physicians surveyed reported at least one symptom of burnout at the end of 2021 and the beginning of 2022, an increase from 44 percent in 2017 and 46 percent in 2011. Only 30 percent felt satisfied with their work-life balance, compared with 43 percent five years earlier.
“This is the biggest increase of emotional exhaustion that I’ve ever seen, anywhere in the literature,” said Bryan Sexton, the director of Duke University’s Center for Healthcare Safety and Quality, who was not involved in the survey efforts.
The most recent numbers also compare starkly with data from 2020, when the survey was run during the early stages of the pandemic. Then, 38 percent of doctors surveyed reported one or more symptoms of burnout while 46 percent were satisfied with their work-life balance.
“It’s just so stark how dramatically the scores have increased over the last 12 months,” said Dr. Tait Shanafelt, an oncologist at Stanford University who has led the research efforts.
Burnout among physicians has been linked to higher rates of alcohol abuse and suicidal ideation, as well as increased medical errors and worse patient outcomes. In May, the U.S. Surgeon General, Dr. Vivek Murthy, issued an advisory.
“Covid-19 has been a uniquely traumatic experience for the health work force and for their families,” he said, adding, “if we fail to act, we will place our nation’s health at risk.”
Dr. Shanafelt noted that most of the studies on burnout among physicians and health care workers at this stage of the pandemic have been focused on certain specialties and geographic hot spots, not on the profession as a whole. With the new data set, he said, “We have, for the first time, real context.”
While the idea of burnout has become ubiquitous, the condition has a definition in medical literature. The Maslach Burnout Inventory, first published in 1981, measures burnout on three dimensions: emotional exhaustion, depersonalization from work and sense of personal accomplishment.
When the metric was first proposed, a widely held belief was that burnout could be blamed on the dispositions of individual physicians — “that these are just weaklings,” explained Dr. Colin West, a physician at the Mayo Clinic who helped conceive of the survey efforts. Over time, though, the problem persisted and that belief became outdated.
“This couldn’t just be pawned off as a handful of people who couldn’t handle the career,” Dr. West said.
In 2019, the National Academy of Medicine released a 312-page report on physician burnout, carefully laying out the current understanding of the issue and steps that people in the medical profession could take to address it. Dr. Shanafelt, who helped write the report, said that evidence suggested that many doctors’ dissatisfaction with their work could be caused by an incongruence between what they cared about and what they were incentivized to do by the health care system.
“We cared about quality of patients’ experience, building relationships with them, and then there were all these things we got paid for,” Dr. Shanafelt said. A doctor may stop looking forward to patient visits if each one is accompanied by a large amount of paperwork; they may feel as if their time is being wasted by an inefficient process.
“Even something that was once a good thing can become tarnished,” he added.
The researchers noted that the most recent survey’s broad scope has limitations. About 2,500 physicians participated by responding to a mass email, a fraction of the estimated one million practicing physicians in the United States. And the factors that might lead someone to complete a survey on burnout — such as the need for an outlet to express frustration or the lack of time to complete one — could have had complicating effects.
Doctors also exist within an ecosystem of other health workers. Dr. Sexton published a study of more than 70 hospitals this month that showed burnout is often a local phenomenon. “A lot of a person’s exhaustion score is connected to who they work with,” he said. “There’s a social contagion in burnout. If your colleagues are fried and you’re not, give it six months and you’ll look just like them.”
Doctors were unevenly affected by the early stages of the pandemic. While emergency physicians and family physicians worked around the clock, constantly exposed to Covid-19, many physicians in other specialties were able to reach their patients through telehealth appointments and spend more time with their families. Combined with a possible optimism that the worst of the pandemic was over, the rise of remote work might explain why emotional exhaustion rates actually fell among surveyed physicians in mid-2020 to the lowest point since the survey began in 2011.
But two and a half years into the pandemic, the most recent survey pointed to an overall decline in mental health.
The survey also suggested that some physicians were at higher risk of burnout, including those practicing emergency medicine, family medicine and pediatrics, as well as women physicians in general. Dr. Shanafelt said this might be because of the shortage of mental health services. “They’ve got 10 minutes to take care of their patients. There’s no psychiatrist or therapist to refer them to because our health care system is overwhelmed,” he said.
The increase in burnout is most likely a mix of new problems and exacerbated old ones, Dr. Shanafelt said. For instance, the high number of messages doctors received about patients’ electronic health records was closely linked to increased burnout before the pandemic. After the pandemic, the number of messages from patients coming into physicians’ In Baskets, a health care closed messaging system, increased by 157 percent.
And physicians pointed to the politicization of science, labor shortages and the vilification of health care workers as significant issues. In one survey published in 2021, 23 percent of physicians reported being bullied, threatened or harassed by their patients at work in the past year.
Dr. Sexton added: “On a hopeful note, we know that there are simple interventions that can have as much a positive effect on well-being as the pandemic had a negative effect. So, yes, things are worse during the pandemic, but they’re not so bad that we don’t know how to fix it.”
Dr. West, who has done research on how to combat burnout among health care workers, said that “all the solutions run through a common pathway”: They connect people with their most meaningful activities.
“What that means is it’s less important what the specific tactic is,” he said, “and more important to make sure that, whatever the solution is, it’s aligned with our basic, fundamental goals.”
But Dr. West emphasized the need for data to know the prevalence of burnout and how to combat it.
“This really provides a 30,000-foot view pulse check,” he said of the survey. “So that we’re not just guided by our feelings and our intuition.”