Five-Minute Paper: Academic MD Burnout
Almost 1/3 of physicians in a university-medical setting say they want to quit
Dear Readers,
I’ve written previously about the shortage of faculty in veterinary colleges, including the lively breakout session on the “Exodus from Academia” at the 2023 ACVP conference last fall. A recently published study in the Journal of the American Medical Association investigated the same phenomenon among academic physicians, and I walk through their findings in this week’s “Five-Minute Paper.”
The Study:
Ligibel JA, Goularte N, Berliner JI, et al. Well-Being Parameters and Intention to Leave Current Institution Among Academic Physicians. JAMA Netw Open. 2023;6(12):e2347894
Key Points
Question: What proportion of academic physicians intend to leave their current institution within the next 2 years, and what factors are associated with intention to leave?
Findings: In this cross-sectional study of 18, 719 academic physicians, approximately one-third reported moderate or greater intention to leave. Burnout, lack of professional fulfillment, and other personal and organizational factors were associated with intention to leave.
Meaning: In this study, intention to leave was prevalent in academic physicians and was associated with numerous well-being factors; a comprehensive approach will be needed to reduce physician turnover.
What is this study about?
The study investigates well-being parameters, including burnout and professional fulfillment, among academic physicians. It specifically looks at their intention to leave their current institution and how various personal and institutional factors influence this decision.
Who did the research?
The research was conducted by a multi-institutional group of authors from the Dana-Farber Cancer Institute, Stanford University School of Medicine, University of Pittsburgh School of Medicine, UMass Chan Medical School, Rutgers Biomedical and Health Sciences, Boston University Chobanian & Avedisian School of Medicine, and the Perelman School of Medicine of the University of Pennsylvania.
Who paid for it? Any conflicts of interest?
This work was self-funded by the Healthcare Professional Well-being Academic Consortium (PWAC), a group of university and non-profit medical institutions that studies quality of life issues in human medicine. Dr. Berliner is a voting member of the PWAC. Dr. Rowe received grants from the American Medical Association related to burnout and electronic health record use. Dr. Trockel reported consulting fees from Marvin Behavioral Health Inc. that did not include this research. There were no other disclosures.
What did they do?
The study involved a national cross-sectional survey of over 18,000 academic medical center-affiliated attending physicians across 53 specialties. It assessed burnout, professional fulfillment, intention to leave, and various individual and organizational factors.
What did they find?
Approximately one-third of respondents reported moderate or higher intention to leave (ITL) within two years. The highest ITL was anesthesiology (46.8%), followed by gastroenterology, thoracic surgery, neurosurgery, and critical care (see Figure 1). My own specialty of pathology/lab medicine was slightly below average at 30%, although that still strikes me as quite high in absolute terms.
The prevalence of burnout was 37.9%, and professional fulfillment was 39.3%. Of particular note in Figure 2 was the group of specialties in the lower right quadrant simultaneously experiencing high levels of burnout and low professional satisfaction, including anesthesiology, pulmonary disease, family medicine, and emergency medicine. This should not be surprising as part of the survey period included the early covid-19 pandemic, and these specialties are historically high-stress and modest pay (compared to procedure-heavy specialties with better compensation and lighter schedules). This also provides context for the increasing rate of unfilled residency slots for emergency & critical care doctors (which we are seeing in veterinary medicine as well).
Factors such as burnout, lack of professional fulfillment, supportive leadership behaviors, personal-organizational values alignment, peer support, perceived gratitude, COVID-19 organizational support, and EHR (electronic health record) helpfulness were significantly associated with the intention to leave.
What are the take-home messages?
This study provides valuable insights into the factors influencing academic physicians' decisions to stay or leave their current institutions, pointing to broader implications for healthcare workforce stability and quality of patient care. In particular, it highlights the critical importance of physician well-being in academic settings, emphasizing the need for supportive leadership and organizational structures. It suggests that improving professional fulfillment and addressing burnout can significantly impact physicians' intentions to stay at their institutions. The findings underscore the need for comprehensive approaches that consider burnout, professional fulfillment, and other organizational and individual-level well-being factors to help prevent physician turnover.
All I can say, is yup.
But more constructively, a lot of the physicians in my medical group cut down to 0.75 FTE status, which still feels like more than full-time work with all of the time spent on patient messages, test, results, coordination of care, etc. Telemedicine has helped, A pay raise this year with RVU rebalancing a little towards better primary care reimbursement has helped. But people are still leaving in droves. it really is a combination of all the factors listed and probably that we are no longer as well respected, as evidenced by a lot of the comments you’ll find on Twitter, frivolous lawsuits, people teeing off on the FDA, Anthony Fauci, etc. It’s a kind of social cannibalism. People will put up with a lot if they feel appreciated, valued, and even revered as the doctors of old seem to have been. Anyway, just dictating so sorry if this comes out garbled!
Ha, just read this from the journal of the American Board of Family Medicine:
Abstract
Purpose: This survey evaluated whether the COVID-19 pandemic was a traumatic stress event for family physicians associated with burnout, changes in life priorities, and intentions to retreat from clinical practice.
Methods: We report on 683 clinically active family physicians surveyed through the Council of Academic Family Medicine’s Educational Research Alliance (CERA) in the fall of 2021.
Results: Overall, 35.2% of family physicians experienced the pandemic as a traumatic stress like event. This was associated with changing life priorities (OR 2.6, CI 1.8-3.9), burnout (OR 1.6, CI 1.1 to 2.4), and withdrawal from clinical practice in various ways. Those who changed their priorities in life were more likely to restrict scope of practice (OR 3.9, CI 2.6-5.9), reduce clinical work effort (OR 3.4, 2.3 to 5.1), relocate (OR 3.1, CI 2.0 to 4.8), retire (OR 2.7, CI 1.4-4.9), reroute their career away from patient care (OR 2.1, CI 1.4-3.1) and less likely to avoid redesigning the practice to improve well-being (OR 0.3, CI 0.2-0.7). Those who experienced burnout were more likely to retire (OR 5.5, CI 2.8 to 10.5), reduce clinical work effort (OR 4.2, CI 2.9-6.1), reroute their career away from patient care (OR 3.9, CI 2.6-5.8), relocate (OR 3.8, CI 2.4 to 5.9), and restrict scope of practice (OR 3.3, CI 2.3 to 4.9). Overall, 48.5% of family physicians expressed some intention to retreat from clinical practice.
Conclusion: The COVID-19 pandemic impacted family physician’s career plans. Remedying burnout is a high-yield opportunity for retaining clinically active family physicians. Physicians retreating from clinical medicine related to changing life’s priorities needs further exploration.