Physician burnout: independent physicians also burning out

5. May 2014
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So far, the myth still persists that clinicians have a higher risk of burnout than physicians working in their own independent practice. Daniel Roberts and colleagues from the Mayo Clinic have now shown that hospital based physicians and doctors in private practices are equally affected.

A burnout affects the whole of life – nothing works any more. The psychoanalyst Herbert Freudenberger (1927-1999) coined the term “burnout syndrome” for the first time in 1974. Whoever burns out becomes cynical, isolated and no longer works effectively. This can especially for the medical profession have serious consequences.

Clinicians in particular are often subject to unpredictable working times. They work with very ill patients and those concerned with the patients. The doctors’ private life is sometimes considerably curtailed. High volumes of working time correlate with the rate of burnout illness occurring with internists, general practitioners, palliative care physicians, young junior doctors and radiologists, as one study has showed. In addition, clinician physicians are often young and inexperienced, which increases their stress. The well-defined hierarchies in the hospital and pressure from above adds to this. Studies have shown that younger doctors due to their inexperience are actually more commonly sufferers of burnout than older colleagues. Clinician physicians were seen in studies to also be more worried about suffering from a burnout than independent praxis-based doctors.

On the other hand, working at the hospital in many ways serves to protect against burnout: When rosters are well organised and maintained, they act as a reliable framework. The social relationships with colleagues protect against effects of isolation. Also, the possibility of doing studies, teaching and pursuing further education reduces the risk of burnout.

Burnout and job dissatisfaction are not the same thing

Daniel Roberts and colleagues presented the hypothesis based on previous findings: Clinician physicians are more often affected by burnout than doctors working in their own practice. They collected studies on burnout happening among physicians all around the world. From over 1800 articles they selected 54 studies which were suitable to test their hypothesis. They emphasise that “burnout” must not be equated with “depression”: while burnout usually affects one area, such as work, a depression takes in all aspects of life. Also, “job dissatisfaction” is not equivalent to “burnout”: one study of operative ENT physicians showed that 97 percent of them were satisfied with their job. From the same group however, 34 percent felt burned out.

Questionnaires capture burnout

In order to detect a burnout, there are several questionnaires available. Currently in common use is the Maslach Burnout Inventory (MBI), consisting of 22 items, which includes the three components “emotional exhaustion, depersonalisation and preparedness to put in personal effort/capacity to perform”. The Copenhagen Burnout Inventory is also frequently used: it consists of 19 items and inquires into the components “personal burnout, work-related burnout and client-related burnout”. The “Arbeitsbezogene Verhaltens- und Erlebensmuster (“work-related patterns of behaviour and experience”) test program is a comprehensive 66 item questionnaire which inquires into professional employment, resistance to stress and emotional well-being.

Both physician groups compared

The authors finally evaluated 54 appropriate studies. 15 of these studies compared hospital and outpatient physicians directly. 22 studies focused on private independent practices and 17 studies on doctors in larger clinics and hospitals.

The authors compared among other things nine studies directly with one another. These trials included 1390 small private practice-based and 899 larger clinic-based doctors. Clinician physicians and small private practice-based physicians were according to these equally affected by emotional exhaustion: on a 54-point scale the values differed by only 0.11 points on average. The two physician groups suffered approximately equally frequently from “depersonalisation”, ie. from the feeling of no longer being themselves. Likewise, the two physician groups did not differ in terms of their personal performance capacity and their commitment to work. Some studies indeed showed that the emotional stress of doctors working in their own independent practice was higher than that of clinician physicians, which especially applied to U.S. physicians. However when the authors statistically drew their various studies together, there was no more difference to be seen.

So Daniel Roberts and colleagues disproved their own hypothesis. They were able to show that hospital doctors and general practitioners in their own practice have an approximately equal high risk of suffering from burnout.

 

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Medicine, Psychiatry, Studies

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2 comments:

Mr Ramanan Vadivelu
Mr Ramanan Vadivelu

very nice and eye opening – applies to every medical person

#2 |
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Dr. Subodh Shivde
Dr. Subodh Shivde

Very interesting article for all practicing physicians.
Dr. Subodh Shivde
India

#1 |
  1


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