Women, Younger Docs Prime Burnout Targets

The poster child for a burned-out physician is a young woman practicing in primary care, according to a new study of more than 1300 clinicians.

The study, published today in Jama Network Open, investigated patterns in physician burnout among 1373 physicians at Massachusetts General Physicians Organization, a hospital-owned group practice. It assessed burnout in 3 years: 2017, 2019, and 2021.

Rates of burnout appear to be worsening; they increased from 44% to 50% between 2017 and 2021. Respondents were queried about their satisfaction with their career and compensation, as well as their well-being, administrative workload, and leadership and diversity.

Female physicians exhibited a higher burnout rate than male physicians (odds ratio [OR], 1.47; 95% CI, 1.02 – 2.12), while among primary care physicians (PCPs), the burnout rate was almost three times higher than among those in internal medicine (OR, 2.82; 95% CI, 1.76 – 4.50). Among physicians with 30 or more years of experience, the burnout rate was lower than among those with 10 years of experience or less (OR, 0.21; 95% CI, 0.13 – 0.35).

The fact that burnout disproportionately affects female physicians could reflect the additional household and family obligations women are often expected to handle, as well as their desire to form relationships with their patients, according to Timothy Hoff, PhD, a professor of management, healthcare systems, and health policy at Northeastern University, in Boston.

“Female physicians tend to practice differently than their male counterparts,” said Hoff, who studies primary care. “They may focus more on the relational aspects of care, and that could lead to a higher rate of burnout.”

The study used the Maslach Burnout Inventory and three burnout subscales: exhaustion, cynicism, and reduced personal efficacy. The cohort was composed of 50% men, 67% White respondents, and 87% non-Hispanic respondents. A little over two thirds of physicians had from 11 to 20 years of experience.

About 93% of those surveyed responded; by comparison, response rates were between 27% and 32% in previous analyses of physician burnout, the study authors say. They attribute this high participation rate to the fact that they compensated each participant with $850, more than is usually offered.

Hilton Gomes, MD, a partner at a concierge primary care practice in Miami ― who has been practicing medicine for more than 15 years ― said the increased rates of burnout among his younger colleagues are partly the result of a recent shift in what is considered the ideal work-life balance.

“Younger generations of doctors enter the profession with a strong desire for a better work-life balance. Unfortunately, medicine does not typically lend itself to achieving this balance,” he said.

Gomes recalled a time in medical school when he tried to visit his former pediatrician, who couldn’t be found at home.

“His wife informed me that he was tending to an urgent sick visit at the hospital, while his wife had to deal with their own grandson’s fracture being treated at urgent care,” Gomes said. “This illustrates, in my experience, how older generations of physicians accepted the demands of the profession as part of their commitment, and this often involved putting our own families second.”

Gomes, like many other PCPs who have converted to concierge medicine, previously worked at a practice where he saw nearly two dozen patients a day for a maximum of 15 minutes each.

“The structure of managed care often results in primary care physicians spending less time with patients and more time on paperwork, which is not the reason why physicians enter the field of medicine,” Gomes said.

Physicians are not alone in their feelings of physical and mental exhaustion. In the Medscape Physician Assistant Burnout Report 2023, 16% of respondents said the burnout they experienced was so severe that they were thinking of leaving medicine.

In 2022, PCP burnout cost the United States $260 million in excess healthcare expenditures. Burnout has also increased rates of physician suicide over the past 50 years and has led to a rise in medical errors.

Physicians say that programs that teach them to perform yoga and take deep breaths ― which are offered by their employers ― are not the solution.

“We sort of know what the realities of physician burnout are now; the imperative is to address it,” Hoff said. “We need studies that focus on the concepts of sustainability.”

The study was funded by the Massachusetts General Physicians Organization. A co-author reports receiving a grant from the American Heart Association. No other disclosures were reported.

JAMA Netw Open. Published online October 6, 2023. Full text

Marcella McCarthy is a Brazilian-American freelance journalist based in Miami. She focuses on health, medical, and technology reporting.

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