Over 60% of physicians experienced at least one symptom of burnout in 2021, and fewer physicians reported being satisfied with their careers compared to before the pandemic, according to a nationwide study published in Mayo Clinic Proceedings.

Study details and key findings

For the study, researchers surveyed 2,440 U.S. physicians between Dec. 9, 2021, and Jan. 24, 2022, to assess their feelings of burnout, depression, work-life integration, and professional fulfillment. Similar surveys had been conducted in 2011, 2014, 2017, and 2020.

To assess burnout, the researchers used the emotional exhaustion and depersonalization domains of the Maslach Burnout Inventory. Depression was assessed using the NIH PROMIS measure, and professional fulfillment was assessment using the professional fulfillment sub-scale of the Stanford Professional Fulfillment Index.

Overall, the researchers found that physicians' mean emotional exhaustion and depersonalization scores were high in 2021 than any other year the survey was conducted. Compared to 2020, mean emotional exhaustion scores were 38.6%, and mean depersonalization scores were 60.7% higher.

Based on the full scales for both measures, 62.8% of physicians experienced at least one manifestation of burnout in 2021, up from 38.2% in 2020 and 44% in 2017. According to the researchers, the significant increase in burnout appeared to be largely due to "occupational distress," since mean scores for depression only increased by a modest 6.1%.

"It's just so stark how dramatically the scores have increased over the last 12 months," said Tait Shanafelt, an oncologist at Stanford University who led the study.

When asked about their satisfaction with their work-life balance, only 30.3% of physicians said they agreed or strongly agreed that their work schedule gave them enough time for their personal/family life, down from 46.1% who said the same in 2020.

Physicians' feelings of professional fulfillment also significantly decreased between 2020 and 2021. Although 40% of physicians reported high/favorable professional fulfillment scores, only 22.4% did the same in 2021.

Career satisfaction among physicians also declined in 2021 compared to other years. In 2021, only 57.1% of physicians said they would choose to become a physician again if given the choice, a significant decrease from the 72.2% who said the same in 2020.

Commentary

According to the New York Times, the study findings show that burnout rates, which were already high before the pandemic, have now "risen to alarming levels."

"This is the biggest increase of emotional exhaustion that I've ever seen, anywhere in the literature," said Bryan Sexton, director of Duke University's Center for Healthcare Safety and Quality, who was not involved in the study.

In May, U.S. Surgeon General Vivek Murthy released an advisory about the growing crisis of burnout among health care workers. "Covid-19 has been a uniquely traumatic experience for the health work force and for their families," Murthy wrote, adding that "if we fail to act, we will place our nation's health at risk."

According to Shanafelt, a combination of old and new problems likely contributed to the increase in burnout among physicians. For example, the high number of messages related to patients' EHRs that doctors received was already closely linked to burnout prior to the pandemic, but after the pandemic, these messages increased by 157%.

In addition, physicians said the politicization of science, labor shortages, and health care workers being vilified were significant issues they faced. According to a 2021 survey, 23% of physicians said they had been bullied, harassed, or threatened by patients in the past year.

However, Sexton said that "[o]n a hopeful note, we know that there are simple interventions that can have as much a positive effect on well-being as the pandemic had a negative effect. So, yes, things are worse during the pandemic, but they're not so bad that we don't know how to fix it."

Colin West, a physician at the Mayo Clinic and one of the study's authors, said his research on how to combat burnout among health care workers found that "all the solutions run through a common pathway," which is to connect people to activities that are meaningful to them.

"What that means is it's less important what the specific tactic is," West said, "and more important to make sure that, whatever the solution is, it's aligned with our basic, fundamental goals."

Overall, West emphasized that data was necessary to understand the prevalence of burnout and how to combat it. The study "really provides a 30,000-foot view pulse check," he said. "So that we're not just guided by our feelings and our intuition." (Whang, New York Times, 9/29; Shanafelt et al., Mayo Clinic Proceedings, 9/13)