Problems of Sensationalistic Claims of Physician Burnout

Sensationalistic claims about doctor burnout abound. Here is a very small sample of survey reports:



  1. “One-Third of Emergency Physicians Suffer From Burnout” American College of Emergency Physicians1

  2. “Overall, 45.7% of Canadian physicians and 48.6 to 55.5% of Alberta physicians were classified as being in the advanced phases of burnout.”2

  3. Surveys of burnout among physicians report dramatic percentages: “Of 115 responding residents, 87 (76%) met the criteria for burnout.”3


Reports of widespread burnout (the second study on this list actually used the term, pandemic!) set the diagnostic bar pretty low. Using the term, burnout, to refer to fairly ordinary states of fatigue weakens the term’s significance. If everyone is burned out then no one is burned out.


Burnout is associated with health and performance deficits. The third study cited asserted that even a one point difference in the scores associated with burnout would beget an 11% difference in error rate. Sounds impressive, but these are self-reported, and thus unreliable, error rates. Although evidence supports a direct relationship of burnout with error rates, the levels of burnout that prompt serious errors remain unknown.


Studies like these, however, could lead patients to assume they have a 50% chance of receiving treatment from a burnt out, highly error-prone physician. This conclusion would be both wrong and damaging to the doctor-patient relationship but it is essentially the result of a measurement problem.


The gold standard for measuring burnout is the Maslach Burnout Inventory4 that produces distinct scores for exhaustion, cynicism, and efficacy, defining burnout as being on the negative end of all three scales. But it does not take a stand on where exactly to draw a line between burnout and almost burned out. So, the major instrument for measuring burnout, lacks a definitive diagnosis for burnout!


Lacking a clear-cut diagnosis of burnout, the term becomes a more subjective matter of judgment. Ideally, wise judgment prevails but the studies shown here indicate that there might be an inclination to take an alarmist view of the diagnosis.




  1. It casts doubt upon physicians’ competence,

  2. It undermines patients’ confidence in their physician,

  3. It suggests a problem of such scale that it defies intervention


Accurate discussion of physician burnout is constructive:



  1. Burnout is a real problem of a small percentage of physicians.

  2. It can be seriously debilitating and it can last a long time.

  3. It is treatable through changes in the physicians’ work patterns and lifestyle.



What to Do



  1. Use the term “burnout” more sparingly to refer a serious breakdown in the capacity to work.

  2. Conduct rigorous research to align scores on burnout measures with performance and health.

  3. Use contemporary norms for the MBI—HSS and the MBI—GS.

  4. Report information from intervention programs that address physicians’ work patterns and lifestyle.



References



  1. http://www.acep.org/pressroom.aspx?id=44050

  2. Boudreau, R., et al. (2006). Canadian Journal of Community Mental Health, 25, 71-88.

  3. http://www.annals.org/content/136/5/358.full.pdf

  4. Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). Maslach Burnout Inventory Manual (3rd ed.). Palo Alto, CA: Consulting Psychologists Press.


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