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Physician Burnout at Different Career Stages

Physician burnout is often discussed in broad terms as if it affects everyone equally. But research a few years ago indicates some significant differences based on a physician’s career stage.

The study was conducted by a group of researchers in the summer of 2011 and designed to gauge the differences in terms of burnout among early career (10 years or less of practice, middle career (11-20 years), and late career physicians (20 years or more) in the U.S. More than 7,200 physicians completed the survey – 22% and 23% were early and middle career, while 54% were late career. In addition, the sample included a wide variety of specialties, including primary care, surgery, dermatology, emergency medicine, radiology and others.

What did the results show?

Overall, the middle stage of one’s career appeared to be the most challenging time for physicians. Middle career physicians worked more hours, took more overnight calls, had the lowest satisfaction with their specialty choice and work-life balance, and had the highest rates of emotional exhaustion and burnout.

But some other results stood out as well.

Work-Life Balance

Despite working fewer hours, early career physicians were more likely to have experienced a work-home conflict and were least likely to have been able to resolve the conflict in a manner that allowed both home and work responsibilities to be met.

Researchers suggest that these conflicts often result from the fact that many early career-stage physicians have younger children, which increases the likelihood of conflicts. In addition, a greater proportion of early career physicians were women and often experience more work-home conflicts than men.

Middle career physicians worked more hours, took more overnight calls, had the lowest satisfaction with their specialty choice and work-life balance, and had the highest rates of emotional exhaustion and burnout.

Burnout

Middle career physicians were more likely to have high emotional exhaustion and be burned out than early or late career physicians. Depersonalization, on the other hand, which is the psychological withdrawal from relationships, was found to be highest among early career physicians and then decreased incrementally in prevalence among middle and later career doctors.

Career Satisfaction

Satisfaction overall with their career choice was lowest among early career physicians and highest among later career doctors. It was also lowest regardless of gender and showed no difference for those who worked in private practice compared to academia and veterans’ hospitals. Satisfaction levels were lowest among primary care physicians and surgeons, but lowest among middle career physicians for internal medicine and the pediatric subspecialty.

Intent to Reduce Workload

In terms of planning to reduce clinical work or leaving medicine, late career physicians were most likely to report that they intended to reduce their clinical hours in the next 12 months. The reasons for reducing clinical time varied by career stage. Younger physicians, for example, wanted to spend more time with their families or pursue research or, if they decided to leave their current environment, it was to relocate to a new practice. Middle career physicians, on the other hand, wanted to reduce hours because of frustration with Medicare or insurance reimbursements. Middle career physicians were also more likely to consider leaving medicine all together.

Researchers pointed out that the implications of middle career physicians reducing clinical time or leaving medicine were significant. For example, the middle section of a physician’s career is often the most productive, plus the organizational costs of replacing a physician can be enormous. Some studies suggest that a single physician can cost $115,000 to $587,000 to replace, depending on the specialty.

Mayo Clin Proc. 2013 Dec;88(12):1358-67. doi: 10.1016/j.mayocp.2013.07.016.
Physician satisfaction and burnout at different career stages.
Dyrbye LN1Varkey PBoone SLSatele DVSloan JAShanafelt TD.