Burnout Among Physicians Compared With Individuals With a Professional or Doctoral Degree in a Field Outside of Medicine - Mayo Clinic Proceedings

Physician burnout has become the 21st Century indicator for physician dissatisfaction. How accurate is that statement comparing physician burnout with executive burnout, CEOs, and the military command structure?

For one thing, the different professions attract far different personalities. The personality traits of a physician are far different than those of attornies or corporate executives.

In the past patients were aware of the challenge of being a 'doctor'.  Today in the 21st century there are now measurements and data points to prove the vulnerability of a physician.

When a patient enters the examination room, how often does the patient wonder, "Is my doctor burned out?" A normal-appearing doctor may be compensating by substance abuse and/or self-medication and may appear to function quite well.

In a study by 

Tait D. Shanafelt, MD
Stanford University, Palo Alto, CA
Christine Sinsky, MD
American Medical Association, Chicago, IL
Lotte N. Dyrbye, MD, MHPE
Mayo Clinic, Rochester, MN
Mickey Trockel, MD, PhD
Stanford University, Palo Alto, CA
Colin P. West, MD, PhD
Mayo Clinic, Rochester, MN

published in the Proceedings of the Mayo Clinic, the authors state,

"Medicine is a demanding profession with a long and arduous training process. Once physicians complete training, they engage in meaningful and professionally fulfilling work. They also typically work long hours and deal with a number of profession-specific challenges (eg, dealing with medical errors, risk of malpractice suits, frequent exposure to human suffering, and a rigorous maintenance of the certification process). In recent years, a host of regulatory changes and the more widespread use of electronic health records have increased clerical burden and changed the nature of the physician’s workday.1 Collectively, these and other challenges contribute to professional burnout, a syndrome characterized by emotional exhaustion, cynicism (depersonalization), and a decreased sense of efficacy.2

Since 2011, we have conducted a series of studies evaluating the point prevalence of burnout among physicians as well as US workers in other fields.3, 4, 5 These studies have consistently found physicians to be at higher risk for burnout than workers in other fields, even after adjusting for age, sex, relationship status, and work hours. Notably, although increasing levels of education have a protective effect on the risk of burnout among workers in general, this is not true of physicians.3

Although we have previously reported associations between the level of education and the risk of burnout, we have not previously performed a focused analysis comparing physicians with individuals with a professional (eg, JD) or doctoral level (eg, Ph.D.) degree in another discipline. Although the precise nature of their work may differ, these professionals have an educational journey more analogous to that of physicians and may have a more similar set of expectations with respect to work hours and responsibility.

Since 2011, we have conducted a series of studies evaluating the point prevalence of burnout among physicians as well as US workers in other fields.3, 4, 5 These studies have consistently found physicians to be at higher risk for burnout than workers in other fields, even after adjusting for age, sex, relationship status, and work hours. Notably, although increasing levels of education have a protective effect on the risk of burnout among workers in general, this is not true of physicians.3
Although we have previously reported associations between the level of education and the risk of burnout, we have not previously performed a focused analysis comparing physicians with individuals with a professional (eg, JD) or doctoral level (eg, Ph.D.) degree in another discipline. Although the precise nature of their work may differ, these professionals have an educational journey more analogous to that of physicians and may have a more similar set of expectations with respect to work hours and responsibility.

To explore this, we used data from our 2017 survey of physicians and US workers in other fields.5 The methods for this study have been described previously. Among the 5198 employed US workers in the study, 285 (5.5%) had a professional degree or doctoral-level degree in a field outside of medicine. A comparison of the demographic characteristics, work hours, satisfaction with work-life integration (WLI), and symptoms of burnout among these individuals and the 3971 employed physicians in the study from the same age range (age, 29-65 years) is shown in Table 1. Physicians worked more hours per week, were less satisfied with WLI, and were more likely to experience symptoms of professional burnout. The higher rates of burnout and decreased satisfaction with WLI in physicians persisted in a multivariable analysis adjusted for age, sex, relationship status, and hours worked per week (Table 2).

Table 1

Comparison of Employed Physicians in the Sample Aged 29 to 65 y With Employed US Adults Aged 29 to 65 y With a Doctoral Level Degree in a Field Outside of Medicinea

Characteristic Physicians (n=3971) Adults with a PhD/doctoral degree outside of medicine (n=285) P value

Sex
 Male 2279 (57.5) 158 (55.4) .47
 Female 1674 (42.2) 127 (44.6)
 Other 11 (0.3) –
Age
 Median 50.0 51.0 .51
Relationship status
 Single 498 (12.7) 55 (19.3) <.001
 Married 3233 (82.2) 203 (71.2)
 Partnered 168 (4.3) 20 (7.0)
 Widowed/widower 35 (0.9) 7 (2.5)
 Missing 37 0
Hours worked per week <.001
 Mean ± SD 52.6±16.1 44.5±11.7
 Median 50.0 40.0
 <40 h="" span="" style="white-space: pre;">
569 (14.6) 43 (15.1) <.001 40-49 h 801 (20.5) 140 (49.3)
 50-59 h 1017 (26.0) 65 (22.9)
 60-69 h 887 (22.7) 26 (9.2)
 70-79 h 323 (8.3) 7 (2.5)
 ≥80 h 309 (7.9) 3 (1.1)
 Missing 65 1

Distress

Burnout
Emotional exhaustionb P.001
Never 473 (12.0) 29 (10.2)
A few times a year 863 (21.9) 68 (23.9)
Once a month or less 553 (14.0) 59 (20.7)
A few times a month 618 (15.7) 57 (20.0)
Once a week 390 (9.9) 21 (7.4)
A few times a week 585 (14.8) 33 (11.6)
Every day 462 (11.7) 18 (6.3)
Missing 27 0
% High scorec 1437 (36.4) 72 (25.3) <.001

Depersonalization .46
Never 1435 (36.4) 119 (41.8)
A few times a year 917 (23.3) 67 (23.5)
Once a month or less 462 (11.7) 32 (11.2)
A few times a month 417 (10.6) 29 (10.2)
Once a week 209 (5.3) 12 (4.2)
A few times a week 299 (7.6) 14 (4.9)
Every day 199 (5.1) 12 (4.2)
Missing 33 0
% High scored 707 (18.0) 38 (13.3) .05
Burnoute 1566 (39.8) 82 (28.8) P;.001
 
Satisfaction with work-life integration
Work schedule leaves me enough time for my personal/family life:
Strongly agree 422 (10.7) 58 (20.4) <.001
Agree 1157 (29.3) 103 (36.3)
Neutral 641 (16.2) 55 (19.4)
Disagree 1103 (27.9) 57 (20.1)
Strongly disagree 626 (15.9) 11 (3.9)
Missing 22 1







Burnout Among Physicians Compared With Individuals With a Professional or Doctoral Degree in a Field Outside of Medicine - Mayo Clinic Proceedings: range