Despite its importance to our patients, understanding mental health in physicians and other healthcare providers is equally relevant. Although different psychological constructs,¹ burnout, and depression are exceedingly common among physicians and have important consequences on personal well-being as well as quality of care and patient satisfaction.^2,3 Physician burnout is characterized by exhaustion, cynicism, and reduced effectiveness and is considered an occupational distress syndrome rather than a clinical psychiatric diagnosis. It is associated with a variety of destructive behaviors including impaired personal relationships, interpersonal conflicts, substance abuse, and reduced quality of life.⁴ A survey of 6880 physicians found at least one symptom of burnout in 54.4%, depression in 39.8%, and suicidal ideation in 6.4% of respondents.² Burnout was significantly more common among those < 35 years old, female physicians, and those in private versus academic practice and increased by more than 10% in all specialties between 2011 and 2014. In comparison to the general population, physicians were at two-fold increased risk of burnout. Physician suicide rates are also substantially higher than in the general population – 1.5 to 3.8 times higher in males and 3.7 to 4.5 times higher in females.⁴

In addition to its health consequences, burnout is associated with the deterioration of work performance and medical errors. In a survey of 7905 surgeons, major medical errors within the last three months were reported by 8.9% and were highly associated with burnout and symptoms of depression.⁵ Others have similarly reported burnout to be associated with a 44% to 48% greater odds of self-reported medical errors. The health economic implications of burnout are also not trivial as it is estimated that replacing a physician costs two times the physician’s annual salary.³

Burnout is frequently related to characteristics of the work environment. (Menon, JAMA 2020) Although there are many organizational and personal approaches to avoiding physician burnout, physicians spending > 20% of their time on the clinical activities most meaningful to them are significantly less likely to have burnout. ³

References

1. Menon NK, Shanafelt TD, Sinsky CA, Linzer M, Carlasare L, Brady KJS, Stillman MJ and Trockel MT. Association of Physician Burnout With Suicidal Ideation and Medical Errors. JAMA Netw Open. 2020;3:e2028780.
2. Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, and West CP. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic proceedings Mayo Clinic. 2015;90:1600-13.
3. Shanafelt TD and Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic proceedings Mayo Clinic. 2017;92:129-146.
4. Rothenberger DA. Physician Burnout and Well-Being: A Systematic Review and Framework for Action. Dis Colon Rectum. 2017;60:567-576.
5. Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, Collicott P, Novotny PJ, Sloan J and Freischlag J. Burnout and medical errors among American surgeons. Ann Surg. 2010;251:995-1000.