Physician Burnout Study is Completed

During the fall of 1996, the consultants interviewed 20 individual physicians, conducted 5 focus group sessions in Sacramento and El Dorado counties and mailed a survey to 1296 active members. A total of 455 physicians, or 35 percent of the 1296 active members, returned their surveys for tabulation. This return rate was lower than previous surveys conducted by SEDMS, which were in the range of 40-50 percent.

The burnout survey asked a series of seven questions and allowed the physicians to rank their responses on a 7-point scale, with 1 being low, 4 medium and 7 high. Two additional questions (using the 7-point scale) contained 17 identical factors known to contribute to career burnout. One of these questions measured the degree of current burnout. The second measured the degree of burnout three years ago, thereby allowing a comparison of burnout over time.

The survey instrument included a one page information sheet defining and discussing burnout. The definition used was, **a syndrome of physical and emotional exhaustion resulting from prolonged chronic pressures and characterized by the development of a negative self-concept and negative attitudes toward work, life and other people."¹

Results of the mail survey

The questions and the average responses, on a scale of 1-7, are noted below:

• Q. To what degree do you consider yourself experiencing burnout?
  The average response was 3.50; 49 were in the 6-7 (high) range.
  
  
• Q. To what degree is your experience of burnout greater now than it was three years ago?
  The average response was 4.20; 104 were in the 6-7 range.
  
  
• Q. To what degree do you think physician burnout poses a current problem to the physicians in Sacramento-El Dorado Counties?
  The average response was 5.03; 220 were in the 6-7 range.
  
  
• Q. To what degree do you think physician burnout poses a current problem to your medical group or practice?
  The average response was 4.46; 143 were in the 6-7 range.
  
  
• Q. To what degree do you think physician burnout poses a current problem to patient satisfaction in your medical group or practice?
  The average response was 4.80; 164 were in the 6-7 range.
  
  
• Q. What level of interest do you have in your group taking action to address the issues and problems related to burnout?
  The average response was 4.40; 141 were in the 6-7 range.
  
  
• Q. What level of interest do you have in participating in actions to address problems of burnout?
  The average response was 3.87; 90 were in the 6-7 range.
  
  

The degree to which physicians reported increased levels of burnout today as opposed to three years go increased only slightly among the 17 factors. Of the seventeen factors presented, six were identified in descending order as those most responsible for contributing to burnout:(1)autonomy/managed care, (2) ability to impact work environment, (3) long hours,(4) control over own time, (5) workload,(6)juggling personal and professional life.

Respondents were also given the opportunity to write in their own "other" factors. The three most frequently mentioned were financial concerns, career uncertainty and paperwork.

Physicians in the 43-48 age range working in multispecialty groups with 8-11 years in practice seemed to be the most interested in participating in potential educational programs. Women were slightly more interested then men. There appears to have been little difference between medical specialties.

Why burnout is a concern

Now that the facts from the study have been presented, one might wonder aloud, "So Big Deal," what's wrong with a few burned-out physicians? If you double the number of physicians who responded in the 6-7 ranges, you would be close to the potential number of physicians who may be experiencing severe burnout. The number is probably much higher as many physicians may have been to busy or stressed to even respond. Perhaps that's why our response rate was lower than it was in earlier member surveys.

The point is that many physicians are experiencing extreme frustration with their professional careers and personal lives. Many may be totally unaware of their situation and the impact it has on others. Burnout spills out into their relationships with patients, their colleagues and their families. It is a problem. Without a magic lantern, there is no easy fix. We are an organization concerned about physician well-being that represents physicians, and this is an issue we should attempt to address. Clearly, the fix is not ours alone but belongs to everyone - our medical groups, our office staffs and families, the HMOs, our hospital medical staffs, our patients and, of course, the physicians themselves.

What's Next?

SEDMS is now in the process of identifying a variety of educational programs that could be offered with CME credit to Society members and nonmembers in cooperation with medical groups, hospitals and others.

In addition to educational programs, the report also contained a number of recommendations that will be pursued by the Society. These recommendations include such items as support groups for physicians and their spouses, career counseling and mentoring opportunities, programs to improve office and time management skills, promoting sharing of common interests between physicians and between medical groups. It was also clear from the survey, interviews and focus groups that our members want SEDMS and organized medicine to continue functioning as a "moral force" in assuring quality of care, pursuing legislative and legal action regarding managed care issues, and promoting greater dialogue with the public regarding physician concerns.

The Society Board of Directors reviewed the report at its annual planning retreat in March and is evaluating the recommendations.

1. Pines, A, Kafry D, Etzion D., "Burnout in Helping Professions."