Physician Burnout: Time Spent On Meaningful Pursuits May Cut Risk

"Physicians are responsible for caring for the nation's sick, promoting the public health, advancing the science of medicine and passing the torch of knowledge to the next generation of physicians," the authors write as background information in the article. "Unfortunately, despite the value and importance of these pursuits, an expanding body of literature reports growing personal distress among physicians and a decrease in their satisfaction with the practice of medicine. Specifically, numerous studies have documented high rates of burnout and poor mental health among U.S. physicians and have suggested that physician distress can have a profound impact on patient quality of care as well as on a physician's personal health."

In addition to factors affecting all physicians, such as increased administrative work and less time with patients, academic faculty must navigate a variety of requirements that compete for their time. Each individual physician derives varying levels of satisfaction from these components, which include research, education and administrative responsibilities. To better understand how career fit—the extent to which an individual is able to focus on those aspects they find they most meaningful—influences burnout, Tait D. Shanafelt, M.D., and colleagues at Mayo Clinic, Rochester, Minn., conducted a survey of faculty physicians in the Department of Internal Medicine at a large academic medical center in the fall of 2007.

Of 556 physicians selected to participate, 465 (84 percent) returned surveys. When asked which aspect of work they found most meaningful, most (68 percent) reported patient care, whereas 19 percent selected research, 9 percent education and 3 percent administration. Overall, 34 percent of faculty members met criteria for burnout, which include emotional exhaustion, depersonalization and low personal accomplishment.

A total of 385 of 437 physicians (88 percent) spent at least 20 percent (about one day per week) of their effort on the activity they reported to be most personally meaningful; those who did had about half the rate of burnout as those who spent less than 20 percent of their time on this activity (29.9 percent vs. 53.8 percent). "The association between time spent in the most meaningful activity and burnout was strong and was the largest predictor of burnout on multivariate analysis after other factors were controlled for," the authors write.

"These findings have important implications for the administrative leadership and department chairs at academic medical centers. These centers are responsible for training the next generation of physicians, for serving as the primary origin of scientific discovery and advances in the fields of medicine and health care delivery, and for providing tertiary medical care to patients with complex and unusual health care problems. Their physician faculty is the most critical resource for academic medical centers to discharge these responsibilities to society," they conclude. "Efforts to optimize career fit may promote physician satisfaction and help to reduce attrition among academic faculty physicians."

Editorial: Career Fit Should Be a Goal of Academic Leaders

"The high prevalence of burnout in the academic setting (34 percent of surveyed physicians) noted by Shanafelt and colleagues requires that we pay attention," writes Mark Linzer, M.D., from the University of Wisconsin, Madison, in an accompanying editorial. "In this issue of the Archives, Shanafelt and colleagues introduce a new method to prevent burnout: maximizing career fit. How well do physicians' career aspirations match their actual workday?"

"Determining the presence or absence of career fit in annual review meetings with faculty members is a necessary first step. Once we, as leaders, know what is required, we will need to find ways to finance the investment," Dr. Linzer concludes. "Although formal cost-effectiveness analyses have yet to be performed, Shanafelt and colleagues' data suggest that providing an additional 10 percent of time to allow faculty physicians to pursue their career goals could have strikingly positive consequences not only for the physicians and their families but also for their learners and potentially their patients as well as for the bottom line."