JAMA had a great article this month on burnout. As far as I (or the authors know) this is the only scientific study of burnout among physicians. They used validated instruments that measure burnout (who knew they even existed) and then surveyed doctors in many specialties. The results are illuminating, depressing, and even a little scary.
46% of physicians have at least one symptom of burnout.
Compared to other working adults, physicians are more likely to have symptoms of burnout (38% vs 28%) and to be dissatisfied with their work-life balance (40% vs 23%).
Compared to a high school graduate, a person with an advanced degree was less likely to have symptoms of burnout, UNLESS that degree was an MD or DO!
Here’s the most important chart from the article:
So much for emergency medicine being a “lifestyle specialty”! Burnout has often been discussed with regards to emergency medicine, but those of us in the specialty have always scoffed, saying something to that effect that EM’s reputation as a burnout specialty came from those who, decades ago, migrated to the ER after flunking out of other specialties. No wonder they burned out of EM! They were never trained in it and didn’t ever really want to do it. But this survey gives us all pause that perhaps there is more to it than that. At least we still score above average in “satisfaction with work-life balance.” Work hard, play hard, right?
It is interesting to see that the “burnout specialties” are not only “front-line specialties” such as EM, IM, and OB-GYN, but also include the “lifestyle specialties” such as anesthesiology and radiology. In fact, the only thing I see that the specialties that are above average in burnout have in common is that most of them often work at night. How ENT and PM&R landed that high on the list is beyond me.
What is Burnout?
The article defines burnout as
a syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a low sense of personal accomplishment. Although difficult to fully measure and quantify, findings of recent studies suggest that burnout may erode professionalism, influence quality of care, increase the risk for medical errors, and promote early retirement. Burnout also seems to have adverse personal consequences for physicians, including contributions to broken relationships, problematic alcohol use, and suicidal ideation.
Here are my completely non-scientific suggestions for preventing burnout.
1) Frugal Lifestyle Eliminate your NEED to work. Any job is more fun when you don’t absolutely have to do it, just ask my kids when they’re doing chores. What causes us to need to work? Servicing large debts (including a mortgage or two), high spending habits, and lack of an “F.U. Fund” (AKA emergency fund) are at the top of the list. Guess what? The less you spend each month the less you need your job.
2) Early Retirement On that same note, being in a position to retire early does two things for you. First, it allows you to retire early if you become burned out. Taking a sabbatical or working part-time can do wonders for burnout and are options available to those who save early and often. Second, if you are independently wealthy, you no longer HAVE to go to work. That by itself makes work more enjoyable.
3) Work Less There are a myriad of pressures to get us to work more. Residents who work a mere 80 hours a week are often looked down upon, especially by those who worked 100+ hours a week as residents. There are always more patients to be seen, more people to help, and more money to be made. Whatever your motivation to practice medicine at your career stage (and for most of us it is some combination of the above), there is always pressure to spend more time working.
I do not find it surprising at all that working more than, say, 60 hours a week easily leads to burnout. There is nothing in life that I enjoy enough to do for 60+ hours a week. That includes my job and each of my many hobbies. The enjoyment of life comes from the variety of experiences available to us. Or maybe I just have an undiagnosed case of ADHD. At any rate, I’m quite confident that the best way to avoid burnout is to work less. There’s a reason the average emergency doc only works something like 1500 hours a year (<30 hours a week). It’s because after just a few months of trying to work 50+ hours per week rotating shifts in a busy emergency department, you realize it just isn’t possible to sustain that kind of pace long-term. Now, depending on your specialty and practice, you might not feel burnt out at 50 hours a week or even 70 hours a week. But there is a limit at which you will feel burnt out and it won’t take you long to figure out what it is. Respect it!
4) Sleep More I learned a long time ago while mountaineering that if you can just get a decent night’s sleep, you can do anything all day long. Unfortunately, many of us either work rotating shifts including nights, weekends, or holidays or take frequent call, either in-hospital or at home. We have two wonderful neurologists at my hospital, but it is a pretty unusual night in our ED when the one on-call isn’t woken up at least once. That takes a toll after a while. You must find a balance that works for you. In our EM group, many doctors accept lower compensation in order to avoid night shifts. You may be able to do the same to avoid weekends or call responsibilities. Yes, you have an obligation to help patients, but you cannot help them if you are burnt out all the time, and certainly not if you have to end your career after a mere decade. Moderation in all things. Sometimes it isn’t work that’s keeping us from sleeping more. I often find myself burning the candle at both ends for reasons that have nothing to do with work. Prioritizing sleep makes for a happier life.
5) Choose Longevity over Income Whenever you have to make a decision about your practice, don’t just consider which decision will lead to a better income. Perhaps more importantly, choose the option that will allow you to practice longer. I know an older primary doctor who loves his practice…because he’s fired all the patients that wear him out. Now he spends his entire day with friends! An emergency medicine group that chooses to staff at a level that allows them to see less than 2 patients per hour is promoting longevity compared to a group running a skeleton crew trying to see 2.5-3 patients an hour.
6) Develop a Life Outside of Medicine
Spending time with family or friends and developing a hobby or two provides a lot of balance to your life. When all there is to life is work, it’s much easier to get despondent when work sucks. If there’s something else going on that night, the next day or this weekend, then it’s easier to overlook your crappy EMR, drug-addicted patients, and abusive administrators.
Beware of burnout. It’s real. It’s common. Take steps early on in your career to allow you to enjoy work for decades.
Image Credit: Steve Jurvetson, via Wikimedia, cc-by-sa