Heavy workloads, long hours and excessive tech-based tasks are leading to more burnout among physicians, according to a recent study by WebMD subsidiary Medscape. It's even causing doctors have deeper biases against certain patient groups.
Burnout, as defined by Medscape, is a loss of enthusiasm for work, depersonalization, and a low sense of personal accomplishment. It's become so common it's even got its own ICD-10 code, described in that classification system as a "state of vital exhaustion."
Dr. Michael Smith, chief medical editor for Medscape, said the findings match those of a number of studies released over the past several years.
"It just boils down to fatigue, dissatisfaction on the job, unhappiness, all of those factors," he said. "And it really continues to grow year after year. It ranged from 40 to 55 percent across the medical specialities that we looked at. Those specialities were all under 40 percent last year, so the severity of burnout continues to rise."
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The percentages reflect physicians who reported at least one of the burnout symptoms as defined by Medscape.
Intensivists and neurologists had the highest average severity ratings among the disciplines studied. Last year, neurologists and cardiologists were the top two, although the scores for both increased this year. "It is notable that the severity of burnout reported by these two specialties last year -- the worst among all specialties -- was lower than the severity reported by the top two specialist 'winners' this year," according to the report.
The lowest severity of burnout was reported by psychiatrists and rheumatologists.
Another distressing finding is that, while burnout rates among most physician specialties are on the rise, so is the intensity of the burnout, which respondents to the survey were asked to rank on a scale of 1 to 7, where 1 equals "It does not interfere with my life," and 7 equals "It is so severe that I am thinking of leaving medicine altogether."
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This year, intensivists and neurologists had the highest average severity ratings (4.74 and 4.42, respectively). Last year, nephrologists at 4.30 and cardiologists at 4.29 were the top two, although their scores were lower than they were this year (4.39 and 4.37, respectively).
The second-lowest severity rating this year was reported by rheumatologists (3.91), who reported the lowest severity of burnout last year. "However," the report stated, "consistent with virtually all of physician specialties, the reported severity of burnout in this specialty was higher than last year's score (3.66)." Psychiatrists, at 3.86 this year, brought up the rear, and were one of the only specialties to have reported lower severity than in 2015.
Smith was able to identify a few root causes of this severity spike: "Too many bureaucratic tasks, too many hours, and an increase in computerization," he said, noting that as a reason for burnout, computerization ranked higher among older physicians than younger ones.
Lower down on the list was a physician's sense that they were just one part of a larger machine. Smith said that even though this ranked lower than other factors, such as work hours, the fact that it ranked at all is concerning.
"I find it particularly troubling when I hear physicians say they're just a cog in the wheel," said Smith. "It was fifth, but it's significant."
Burnout wasn't the only area examined by the survey. Physicians were also asked whether they believed they had biases toward specific types or groups of patients. Overall, 40 percent of physicians admitted that they did.
"Within the top 10 of those who expressed some degree of bias were physicians who had the most direct contact with patients: emergency medicine physicians (62 percent), orthopedists (50 percent), and psychiatrists (48 percent), followed by family physicians and ob/gyns (47 percent)," according to the survey. "Two of the specialties least likely to report bias were those also least likely to be directly involved with patients: pathologists (10 percent) and radiologists (22 percent)."
Physicians reported their highest levels of bias against patients with emotional problems, weight issues, and lack of intelligence.
Of course, Smith admitted that conscious versus unconscious bias makes it hard to track and analyze statistics, especially in a survey with respondents reporting the bias themselves. But in examining the numbers, the possibility exists that there's a correlation between burnout and bias.
"Difficult patients have been found to increase the chance of not only bias but also burnout," according to the survey. "Emergency medicine physicians may be at particular risk.
Emergency medicine physicians represented the highest percentage among physicians reporting bias, and were also in the top three of burned-out specialists. One survey found that a high percentage of emergency medicine physicians were burned out from treating patients who repeatedly used the emergency department inappropriately -- "for primary care or prescriptions, or as social centers." Three quarters of emergency medicine physicians expressed bias against these patients, and 59 percent had less empathy.
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Bias isn't the only factor on which burnout can have an effect. Smith said there may be a chance that a hospital, practice, or the physician herself may be impacted financially.
"A burned-out physician is going to be less productive," said Smith. "And there's a higher chance of them leaving their career for something else."
He said solutions to the issue may lie in investing time and money into one's well-being.
"It really boils down to this: Physicians need to take care of themselves," said Smith. "And it's just something we're not great at, given the nature of our jobs. We're focused on taking care of the patient."
Hospitals and practices that invest in their physicians -- through programs that involve wellness techniques such as massage, meditation and mindfulness training -- have found that those physicians reported significantly decreased levels of burnout even a few months after the program had ended. That, in combination with giving the physician more control over their work hours, seem to be promising methods of addressing the issue.
But Smith said the issue could continue to grow if these methods aren't implemented.
"We know it's a problem," he said. "There's no sign of it getting better."
Twitter: @JELagasse