Studies, numbers, facts (and several opinions) about Physician Burnout
Monday, March 2, 2015
In the last Blog Post (you can read it here), we talked about a year’s worth of personal experience, with the promise of facts coming next. Below are a few facts, and a few thoughts/ideas/opinions sprinkled in.
Recently, when a friend of mine discovered I was developing an interest (dare I say “passion?”) in the phenomenon of physician burnout and it’s related side effects, she sent me a study performed in Norway a few years back. I’ll get to that after we look through some basic facts about the health care arena.
Some cold, hard facts to set the stage:
– There are 5,686 Registered hospitals in the US (according to the American Hospital Association)
– Most GPs carry a patient load of about 2,200 – 2,500 patients (based on a computer program that models optimal practice size, written by Dr. Sergei V. Savin, PhD, Columbia School of Business). This is at 83% average appointment utilization rate. That equates to 70 patient visits per 5-day week, and 20 appointments per day. Doctors normally take 155 working days away from the office annually (including weekends)
– The US now spends about $3 trillion per year on healthcare – 17% of the GDP
– American physicians conduct about 1.2 billion patient visits in aggregate (according to a survey of 13,575 physicians by The Physicians Foundation in September of 2012)
– Physicians are working 5.9 fewer hours per week this year; less than they did in 2008 – roughly equal to 44,250 Full-Time Equivalents (FTEs) being removed from the physician workforce (at the same time that the ACA is showing more and more patients are signing up for coverage)
– The average debt load of a graduating doctor is $156,456 (according to this Physicians Foundation study, and according to the Association of American Medical Colleges)
– There are over 130,000 pages of regulations that doctors must abide by (by comparison, the US Tax code is about 75,000 pages long).
Now some opinions:
– 77.4% of doctors surveyed in this report are “pessimistic” or “very pessimistic” about the future of the medical profession
– 84% of the docs surveyed agree that the medical profession is in decline
– 57.9% would NOT recommend medicine as a career to their children or other young people
– Over 33% would NOT choose medicine if they had the opportunity to “do over” their career choice
So what does all this mean? I have my thoughts, a few of which I’ll share here, but I am much more interested in hearing yours. Please comment in the box provided, below.
My one big question about all this is also tied to an observation – in today’s world, why is it that anyone, much less a doctor – why are those that seek help from a mental-health professional still seen as having a personality defect?
What many doctors do (as anecdotally reported) is see a mental-health professional from another town, several miles away.
They make the appointment under an assumed name.
And they pay in cash in avoid the paper trail.
The Norwegian Study
Meanwhile, “A Three-Year Cohort Study of the Relationships between Coping, Job Stress and Burnout after a Counselling Intervention for Help-seeking Physicians” by Karin E. Isakssson Ro, Reidar Tyssen, Asle Hoffart, Harold Sexton, Olaf G. Assland, Tore Gude | BMC Public Health 2010; 10(213)” is available on-line here: (http://www.medscape.com/viewarticle/723595).
This study was recently performed in Norway, following a counseling intervention for those docs seeking help. It found that they were doing better after learning strategies, tools, and techniques to fight the job/stress issue. The gains realized at the first follow up (one year later) were also maintained three-years later.
Those gains were significant, as you’ll see if you read the study. I’ll also include some of the ideas here.
Perhaps that tells us that Europe is ahead of the U.S. in the realization that those who need mental health assistance and guidance… well… that type of help is just as “real” as is the help we would look for when we need physical-body help (treatment for a broken arm, a major cut, etc.).
And it doesn’t (it shouldn’t, anyway) mean those people who seek mental health assistance have any sort of personality defect because they seek that help.
The study provides data from self-reported assessments at baseline, one-year, and three-year follow-ups. Reading through the study, I learned that there were significant improvements at year-one, and those that answered the survey again at the three-year follow-up (81% did continue to participate) point, reported that these gains were still holding true.
The main gains were in reduction of emotional exhaustion, job stress, and emotion-focused coping strategies. And neuroticism. (It appears that neuroticism is the personality trait most associated with emotional exhaustion; therefore, neuroticism is the personality trait on which many of these workshops are based.)
A few studies that are US-focused seem to show an association between the number of hours worked and physician burnout. That makes sense on the face of it, but many European-based studies have failed to support that. Is that because they work fewer hours than US-based docs do?
In 2003, US work-hour limitations for residents seems to have helped, but when coupled with stress-management workshops during their educational careers, several gains were seen. When surveyed 6 weeks and one year after the workshops, these gains seem to have been maintained. But after 2 years, however, without further interventions and coping workshops, these gains slipped backwards. Again – this is for the US-based resident, not the Norwegian study we’re about to review here.
More on the Norwegian Study
The Resource Centre for Health Personnel, Villa Sana in Norway, is funded by the Norwegian Medical Association, and is located at a psychiatric facility, Modum Bad.
The counseling intervention program was focused on two major areas:
1) Mapping and discussing the physician’s current life situation – the work-home interface (as the study authors call it)
2) Identifying and challenging them on their coping strategies
Baseline data showed that those that need help (and sought it) were helped, and at the one-year follow-up, the improvements they made were still intact. At a three-year follow up survey point, those gains were still seen.
According to the authors of this study, there were no previous data on coping strategies for this cohort, prior to this study.
A 5-point scale (1= does not fit; 5= fits very well) was used to generate Maslach’s Burnout Inventory (MBI) for this study, rather than the standard 7-point scale, due to criticism that has shown that the 7-point scale could provide a couple of categories that would not show mutual exclusivity.
227 physicians took part in the initial survey, and 81% (184 – 83 males, 101 females) took part in the three-year follow-up studies. Average age was 46.9 years old. Several physicians that took the study were preparing to become specialists at baseline, and had completed those studies by the three-year follow up.
The following is Figure 3 from the research study. As you can see, on a 5-point scale, at baseline, the average level of emotional exhaustion reported was 3.0. At the three-year follow up, the average was 2.4. Reported level of job stress at baseline was 2.4, and at 3 years, it was 1.9.
– The results for emotion-focused coping was 2.9 at baseline, and 2.5 at year 3
– The level of neuroticism reported at baseline was 2.6, and at year 3, it was 2.0.
– Tangibly, the number of weeks taken for full-time sick leave/rehab benefits dropped from 4.4 to 3.2.
– The average work hours per week at baseline was 43.2, and at year three, it was 39.6.
All of these results are significant in their impact on the quality of the doctor’s life!
This all leads me to believe that those that seek help and take it seriously seem to gain much from that help. May we next assume that those doctors that actually seek and receive help, and then implement the coping strategies in their lives create better outcomes for patients?
Healthier doctors should also equate to healthier patients, it appears. Very nice side-effect.
Please leave your comments in the box below – I look forward to reading your thoughts. They may also spark another blog post…
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