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Causes of physician burnout differ by generation; so do coping strategies

The bureaucratic demands of medical practice topped the list of reasons for burnout for all generations, followed by long hours.

Jeff Lagasse, Associate Editor

The issue of burnout and depression continues to have a significant impact on physicians' personal and professional lives, and Generation X physicians are more likely to experience it than their older and younger colleagues.

A new Medscape report on physician burnout, depression and suicide found that overall burnout rates have dipped slightly, from 46% in 2015 to 42% this year. But the issue continues to have an impact on physicians' happiness, personal relationships, and career satisfaction.

When viewed by generation, 48% of all Gen X physicians reported burnout, as compared with 38% of millennials and 39% of baby boomer physicians. Female physicians overall are 25% more likely to report burnout (48%, vs. 37% of men), and one in five Gen X women report depression.

Burnout is described as long-term, unresolved, job-related stress leading to exhaustion, cynicism, detachment from job responsibilities, and lacking a sense of personal accomplishment.

More than 15,000 physicians across 29 specialties responded to the survey. Millennials were defined as physicians ages 25-39; Gen Xers, ages 40-54; and boomers, ages 55-73.

Burnout was highest among urologists (54%), neurologists (50%), and nephrologists (49%). Lowest levels of burnout were reported by orthopedists (34%), ophthalmologists (30%), and public health and preventive medicine specialists (29%).


While the bureaucratic demands of medical practice, such as charting and paperwork, topped the list of reasons for burnout for all generations, followed by long hours, the electronic health record -- often cited as a primary culprit for professional dissatisfaction and burnout -- was a factor only for boomers. More than 40% of boomers said the EHR was a primary reason for burnout, but millennial physicians ranked it close to the bottom of their concerns.

Physicians' coping mechanisms differ by generation as well, with millennials far more likely to sleep (56%) and talk to close friends or family (53%). Conversely, Gen X physicians and boomers reported isolating themselves from others (45% and 44%, respectively) and exercising (46% and 45%).

More than two-thirds of all physicians said their personal relationships have been negatively affected by burnout, and nearly one in five say they are depressed, with the highest rate (18%) reported by Gen X physicians.

Nearly 40% of all physicians who report depression say it leads them to be easily exasperated with patients, and 16% in all age groups said depression results in them making errors they would otherwise not make.

One in five Gen X physicians who said they were depressed have had thoughts of suicide, with rates slightly lower for millennials and boomers who reported feeling depressed, although very few said they had attempted. Around 40% sought help from a therapist, but about the same percentages reported their suicidal thoughts to no one.

Half of all physicians said they would take a salary reduction of up to $20,000 per year for reduced hours and more work-life balance, including millennials who are among the lowest earners.


The Medscape report echoes findings from the National Academy of Medicine, which found in October that clinician burnout is affecting between one-third and one-half of all of U.S. nurses and physicians, and 45 to 60% of medical students and residents.

It found a direct connection between clinician burnout and quality and safety in healthcare. Clinician burnout isn't a new problem, but it appears to be getting worse due to factors that are inherent in today's healthcare system.

Physicians and nurses have been struggling with burnout for a while now, driven largely by worsening shortages in both fields. But they're not the only ones feeling besieged by stress. A 2018 poll from the Medical Group Management Association finds that 73% of healthcare leaders feel at least some degree of burnout.

Twitter: @JELagasse

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