Burnout a Common Denominator for Top American Physician Specialties

The news is troubling, but one of the nation’s foremost voices in psychiatry is glad that a spotlight is at least being shone on the issue.  

Their work may be vastly different, but physicians who fall under the definitions of half a dozen of the nation’s top specialties share one key attribute in common – burnout. 

The American Medical Association (AMA) recently published a summary of the results of a survey involving more than 13,000 responses from physicians and nonphysician providers across 30 states in more than 70 health systems, clearly illustrating the scope of the problems inherent to, as they put it, “the harrowing consequences of excessive stress, long hours, and emotional exhaustion.”  

The survey found that six specialties in particular exceeded the troubling 50-percent rate of reporting burnout, including the top figure for emergency medicine (62 percent), followed by hospital medicine (59 percent), family medicine (58 percent), pediatrics (55 percent), obstetrics and gynecology (54 percent), and internal medicine (52 percent).

Those are five of the six most common specialties in the country, according to a January 2023 report by Becker’s outlining the Association of American Medical Colleges 2022 Physician Specialty Data Report. Internal medicine was listed as the specialty with the most active physicians, at slightly more than 120,000, followed by family medicine (118,000+), pediatrics (60,000+), emergency medicine (46,000+), and obstetrics and gynecology (42,000+).

Extrapolate the results of the survey to these national totals and you get a combined minimum of more than 215,000 physicians in the top five specialties nationwide feeling burned out – an average of 4,300 for every state.

Thoroughly publicizing the scope of the issue is key to drumming up sufficient momentum for identifying viable solutions, according to renowned psychiatrist H. Steven Moffic, MD, longtime RACmonitor and ICD10monitor contributor and one of three editors of Combating Physician Burnout: A Guide for Psychiatrists, published in 2019.

“It is so important that the AMA is once again paying attention to the epidemic of physician burnout, not only because it is continuing at epidemic levels, but that so many physicians by now seem to be in a state of ‘learned helplessness’ and just come to accept the burning out as part of normal clinical life nowadays,” Moffic said. “That is a grave mistake, because not only will physicians continue to suffer and even commit suicide, but patient quality of care and outcomes are adversely impacted too.”

Moffic added that the AMA survey results closely parallel that of a yearly survey conducted by Medscape, reinforcing their validity.

“If truth be told, any percentage hovering anywhere near the epidemic cutoff percentage of 50 percent is cause for great concern,” he said. “We also know that after some slow decrease in the burnout percentages, they rose again to record highs during the pandemic.”

The AMA’s survey was part of its uniquely named Organizational Biopsy initiative, involving an assessment tool and set of services developed and offered by the Association to support providers in “holistically measuring and taking action to improve the health of their organization.” Each assessment focuses on four domains:

• Organizational Culture (leadership, teamwork, trust, etc.);
• Practice Efficiency (team structure, team stability, workflows, etc.);
• Self-Care (post-traumatic stress, post-traumatic growth, work-life balance, etc.); and
• Retention (work intentions).

Following each assessment, organizations receive an executive summary of key findings and access to the data through an online reporting platform that also includes national comparison data. The AMA then provides guidance on interventions, research, and convening opportunities in support of ongoing improvement efforts.

The assessments come free of charge and are available to organizations with at least 50 physicians and/or advanced practice providers.

“Although administrators have the challenge to make the system better once again for physicians, they too are at higher risk for burning out,” Moffic noted. “They need support from the highest organization levels and the politicians that are responsible for our fragmented, disjointed, and business-controlled medical systems.”

AMA did point to what it labeled “exceptions that provide hope,” specifically, Dayton’s Children Hospital in Ohio, where “only” (quotation marks their own) 36 percent of pediatricians – more than a third, but nearly 20 percentage points lower than the national average – reported burnout.

“Dayton Children’s has done an amazing job of supporting the physicians throughout COVID and (the) return to normalcy,” said Sean Antosh, MD, a pediatric anesthesiologist and the hospital’s chief medical wellness and engagement officer. “Pediatrics had a whole different experience during COVID than the adult population. We were very slow for a while, and then all of a sudden it hit the pediatric population. But then we also had all the respiratory disorders coming at the same time.”

Echoing guidance found in many other sources, Antosh said no one measure is enough to mitigate burnout.

“From an organizational perspective, it was a multitiered approach to realize that things were going to get bad quickly, and how we could support those providers?” he said. “So, a lot of it was using other departments and other divisions to help offload some of that from our emergency rooms and our urgent cares. Our primary care physicians took a little bit more of those acutely sick kids who weren’t meeting criteria to be seen at a higher level.”

To learn more about the AMA’s Organizational Biopsy, including how to request an assessment, send an email to Practice.Transformation@ama-assn.org.

To read the AMA’s article about the survey in its entirety, go to https://www.ama-assn.org/practice-management/physician-health/these-6-physician-specialties-have-most-burnout.