Disclosures: Goroll reports no relevant financial disclosures. One study author reports royalties from the Well-Being Index from Med Ed Solutions outside the submitted work; another study author reports a patent to the Physician Well-being Index with royalties paid. West reports no relevant financial disclosures.
July 06, 2020
2 min read
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Physicians resilient, but still suffer burnout

Disclosures: Goroll reports no relevant financial disclosures. One study author reports royalties from the Well-Being Index from Med Ed Solutions outside the submitted work; another study author reports a patent to the Physician Well-being Index with royalties paid. West reports no relevant financial disclosures.
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Physicians appeared more likely to exhibit resilience than the general U.S. working population, according to results of a national survey study published in JAMA Network Open.

Moreover, researchers observed an inverse association with burnout symptoms; however, even among the most resilient physicians, burnout rates were substantial.

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“Burnout is highly prevalent among physicians, with negative effects on physicians, patients and the entire health care system,” Colin P. West, MD. PhD, of the department of general internal medicine at Mayo Clinic, told Healio Psychiatry. “Commonly studied and recommended approaches to promote physician well-being and reduce burnout involve training to optimize resilience. However, it was largely unknown how resilient physicians might already be relative to other groups. Given physicians’ rigorous training and skills in dealing with stressful situations, we thought physicians were likely already highly resilient. We wanted to assess the relationship between resilience and burnout for physicians, and determine how physician resilience compares with resilience in the general public.”

Colin P. West

Evidence from prior studies supported the hypothesis that physicians may have higher levels of resilience using data of 584 U.S. and 247 U.K. physicians; however, these studies included physicians in training and had no concurrent population comparators. Data is lacking for large-scale evaluation of physician resilience compared with the general working population, as well as for the association between burnout and resilience among practicing physicians.

To address this research gap, West and colleagues conducted a cross-sectional national survey study of 5,445 U.S. physicians and a probability-based sample of 5198 individuals in the U.S. working population. They used the two-item Connor-Davidson Resilience Scale, which featured scores ranging from zero to eight, to measure resilience and the full Maslach Burnout Inventory to measure overall burnout according to a score of 27 or greater on the zero to 54 emotional exhaustion subscale and/or 10 or greater on the depersonalization subscale. For both instruments, higher scores indicated greater resilience or burnout.

The investigators received completed surveys from 5,445 physicians, of whom 62.1% were men and for whom the median age was 53 years. Multivariable analysis revealed higher mean resilience scores among physicians vs. the general working population, for an adjusted mean difference of 0.25 points (95% CI, 0.19-0.32). Resilience was associated with burnout among physicians, and those without overall burnout exhibited higher mean resilience scores than those with burnout, for an adjusted mean difference of 0.68 points (95% CI, 0.61-0.76). A one-point increase in resilience score was associated with 36% lower odds of overall burnout (OR = 0.64; 95% CI, 0.6-0.67); however, 29% of physicians with the highest possible resilience score had burnout.

“Patient care is optimized when health care professionals are themselves well,” West told Healio Psychiatry. “Understanding that resilience alone cannot prevent burnout is critical, as efforts to help physicians need to move beyond individual-focused efforts and strive to improve the environments within which physicians work on behalf of their patients.”

In a related editorial, Allan H. Goroll, MD, of the general internal medicine unit at Massachusetts General Hospital, contextualized the study findings in light of current events.

“The importance of the practice environment is underscored during the coronavirus pandemic by the consequences of acute shortages of respirators and personal protective equipment for physician well-being and morale,” Goroll wrote. “Attempts to boost physician resilience without correcting these shortages borders on the disingenuous.

“Prioritizing attention to these powerful but eminently correctible external factors bearing down on U.S. physicians today should help us reconnect with patients and experience the immense personal gratification that comes from their saying ‘thank you’ — the very best cure for burnout. As noted in the National Academy of Medicine’s report: ‘Burnout comes from loss of connection to our patients ... what our patients want and what we truly crave is to feel connected.’”