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Physician burnout taking center stage

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The medical establishment may finally be coming to grips with the issue of physician burnout. The evidence: two studies published in the American Medical Association journal JAMA.

One study found that nearly half of junior physicians were having burnout symptoms at least one day a week.

The other underscored how hard it is to assess the problem. After reviewing previous studies, researchers found huge variations in definitions of burnout and estimated rates among doctors, which ranged from 0 to 80 percent.

“With two lead articles in one of the most prominent medical journals in the world, it means that burnout is now being taken seriously by the medical mainstream,” said Albert W. Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

“It is being endorsed at an alarming rate by physicians who range from trainees to seasoned veterans, and it is accompanied by other disturbing correlates that include a high rate of suicidal ideation, regret about one’s job choice and an acknowledgment of not being one’s best self in practicing medicine,” Wu said. “This represents a crisis in slow motion.”

Doctors’ workloads have changed considerably over the years. Today, they spend less time with patients. Instead, “physicians are spending a lot of time trying to get authorizations for treatment that they know their patients need and insurance companies won’t pay for,” Wu said. “Insurance companies and others have discovered the way to get doctors to order fewer tests and medications is to make it a huge hassle to get them.”

Nearly 50 percent of young doctors in training programs called residencies reported burnout symptoms at least one day a week. And a large number said they felt they had made a mistake in choosing a subspecialty, such as pathology or anesthesiology, or even medicine in general as a ­profession.

That study followed 3,588 physicians who were surveyed during their last year of medical school and again in their second year of residency. Along with a host of demographic questions, the doctors were asked to rate themselves on two statements: “I feel burned out from my work” and “I’ve become more callous toward people since I started this job.”

Overall, 45 percent of residents reported at least one symptom of burnout — such as exhaustion — at least once a week, while 14 percent reported regret over career choice.

While once a week may not sound like a lot, physicians who feel burnout this often are more likely than others to report thinking about suicide, making a major medical error and wanting to leave medicine, said lead author Lotte Dyrbye, who co-directs the physician well-being program at the Mayo Clinic in Rochester, Minn.

The problem is especially prevalent among physicians, Dyrbye said, noting that although doctors may have close to a 50 percent burnout rate, among other U.S. workers the rate is under 30 percent.

Still, Dyrbye said, “we need more research in the field with good attention to method.”

The authors of the other JAMA study originally planned to analyze data combined from previous studies. But after gathering 182 reports involving 109,628 physicians from 45 countries, they determined that the definitions of burnout and the study methods were so disparate that it was impossible to draw any conclusions.

For example, “some studies will label someone as burned out if they feel exhausted one day out of the week,” said co-author Douglas Mata of the Brigham and Women’s Hospital and Harvard Medical School in Boston. “Others . . . only label you as burned out if you are exhausted and feel depersonalized and have a low sense of personal accomplishment every day.”

— Reuters