Burnout remains a major challenge for physicians; it affects happiness, personal relationships, career satisfaction, and patient care. This issue has gained major attention in recent years, although many doctors say they have seen little improvement. In this year's report, Medscape looks at how different generations experience and respond to the pressures they face. We compare millennials (25-39 years old), Generation X (40-54 years old), and baby boomers (55-73 years old). While values, attitudes, and life experiences differ, healthcare's predicaments are universal. More than 15,000 physicians in over 29 specialties responded to our survey. (Note: Some totals in this presentation do not equal 100% due to rounding.) This year, 42% of physicians reported that they are burned out, down from 46% 5 years ago. Specialties that have been among the top in burnout over the past 5 years include critical care, emergency medicine, family medicine, internal medicine, neurology, and urology. Burnout has been described as long-term, unresolvable job-related stress that leads to exhaustion, cynicism, feelings of detachment from one's job responsibilities, and lack of a sense of personal accomplishment. "The percentage of physicians feeling burned out remains fairly consistent. The leading cause is administrative burden, as driven by the workplace and organizational culture," says Frank John Ninivaggi, MD, a physician at Yale New Haven Hospital and author of Learned Mindfulness: Physician Engagement and MD Wellness. Generation X physicians report noticeably more burnout than other groups. "Mid-career is typically the time of highest burnout, which is where Ger Xers are in their career trajectories," says Carol A. Bernstein MD, vice chair for faculty development and well-being, Montefiore Medical Center/Albert Einstein College of Medicine. "In addition, I suspect that group is juggling multiple roles outside of work, including caring for children as well as elderly parents, and working as well as planning for retirement. Role strain and transition periods also increase stress." Women have consistently reported higher percentages of burnout than men over the years. In 2015, a greater proportion of women (51%) than men (43%) said they were burned out. "Harvard Business Review published some pieces on the idea that women take on more work at work," says Halee Fischer-Wright, MD, CEO of the Medical Group Management Association. "They take on more 'non-promotable' work and they carry more of the weight in collaborative work. There are lots of reasons for this, but one is that they tend to care more about the collective, such as the well-being of their colleagues or the success of the business." Long hours, overwhelming workload, and lack of support are among the factors pushing many physicians to the bursting point. These top causes of burnout have not changed over the years. "I have to catch up with charting, even at home. I'm worrying about always being behind. The pressure from my employer about not seeing enough patients is very stressful. There's no work-life balance." -Gastroenterologist "My quality markers are tied to things I cannot control, ie, patients don't take medication and they get worse." -Endocrinologist "Increasing EHR data requirements turns us into technicians." -Family physician The challenges in healthcare are generally universal, although one factor that varies by generation is the stress of using an EHR. Only the boomer generation mentioned "increasing computerization of practice (EHRs)" as one of the top three factors contributing to burnout. For millennials, EHR use was second lowest on a list of 10 potential factors, while too many bureaucratic tasks was cited most often by all three groups. Of the physicians who said they were burned out, baby boomers more often replied that they are severely affected by it. They have gone through major changes in medical practice, such as the trend from self-employment to employment; and from a lifetime of using paper records to the demands for more and more EHR reporting. Gen X physicians also feel more severe impacts from burnout. Burnout has affected relationships for millennials the most, but it plays a role in relationships for all physicians. "Burnout makes one frustrated with lots of things in life. It takes a toll on my personal life: stress eating, weight gain, poor sleep, to name just a few things as a result of burnout." -Ob/Gyn "Because of burnout, I have become estranged from my family, had substance and alcohol abuse, failed relationships, and chronic back pain which adds to my symptoms. No vacation. Being put under a microscope when I want refills of my medications by my doctor." -General surgeon "Burnout has affected my loving relationship with my spouse (I'm grumpy and exhausted when I finally come home from work). I'm unable to visit friends and family because of work demands." -Anesthesiologist Physicians are more likely to use positive coping mechanisms rather than "escape" or self-medicating activities to deal with burnout. However, Wendy Dean, MD, psychiatrist and cofounder of Morallnjury.healthcare, an organization devoted to building advocacy to end moral injury in the healthcare professions, notes, "Healthcare systems have looked for fixes for physician distress, focusing on wellness (yoga, retreats, and self-care lessons), but finding solutions requires that we address the problem for what it really is: a challenge inherent in the structure of the healthcare industry." Sleep is favored by millennials to help ease burnout; Generation X and baby boomers are most likely to exercise or isolate themselves. It's a powerful statement: Overall, 49% of physicians in all generations would accept less money in exchange for more free time. "Expectations of what a career as a physician is in the 2020's are changing," says Fischer-Wright. "Physicians recognize that seeing a smaller number of patients may give them more time with patients and the ability to practice medicine at the height of their license, reducing non-clinical hours and enhancing personal satisfaction, which ultimately may decrease burnout and extend their career life." A higher percentage of women physicians would take a salary reduction than would men. That's not surprising, as women typically still spend more time than men on childcare and domestic responsibilities. Doctors are clearly crying out for more time. Of those who said they would give up salary to gain a better work-life balance, about a third of each generational group would give up from $10,001 to $20,000. More baby boomers than other generations would give up from $20,001 to $50,000, possibly because they're earning more and so the drop is less meaningful, or because they are preparing for a retirement lifestyle. Solo practice has been declining over the years and now comprises only about 15% of physicians. Still, some say that running one's own practice helps prevent burnout because those physicians are in charge of what they do, how they do it, and how productive they choose to be. Burnout and depression are not the same, although burnout may lead to depression. Similar percentages of each generational group said they were depressed. For each generational group of physicians citing depression, about two thirds considered it "colloquial" depression (feeling down, sad, or blue) while less than one third described it as "clinical" depression (prolonged severe depression not caused by a grief-associated event). "I feel hopelessness, anger, family and marital strife, a lack of retirement ability, resentment of non-physician business leaders, and increased cynicism. It just shouldn't be that way." -Critical care physician The large majority of physicians who said that they were depressed have never considered suicide. However, about 1% have attempted suicide. These percentages were similar for male and female physicians. Sadly, an estimated 300-400 physicians commit suicide each year. A little more than a quarter (28%) of physicians say their workplaces offer stress reduction programs, while half say their workplaces don't. Another 22% overall (higher among millennials) don't know whether such programs are available to them. Half of all physicians said their symptoms were not severe enough to seek professional help; others said they could deal with it on their own or were too busy. Respondents could choose more than one answer. Source
