Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014
By Tait D. Shanafelt, MD; Omar Hasan, MBBS, MPH; Lotte N. Dyrbye, MD, MHPE; Christine Sinsky, MD; Daniel Satele, MS; Jeff Sloan, PhD; and Colin P. West, MD, PhD
Mayo Clinic Proceedings, December 2015
Conclusion
Burnout and satisfaction with WLB (work-life balance) among US physicians are getting worse. American medicine appears to be at a tipping point with more than half of US physicians experiencing professional burnout. Given the extensive evidence that burnout among physicians has effects on quality of care, patient satisfaction, turnover, and patient safety, these findings have important implications for society at large. There is an urgent need for systematic application of evidence-based interventions addressing the drivers of burnout among physicians. These interventions must address contributing factors in the practice environment rather than focusing exclusively on helping physicians care for themselves and training them to be more resilient.
http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/pdf
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Prevalence of Depression and Depressive Symptoms Among Resident Physicians:
A Systematic Review and Meta-analysis
By Douglas A. Mata, MD, MPH; Marco A. Ramos, MPhil, MSEd; Narinder Bansal, PhD; Rida Khan, BS; Constance Guille, MD, MS; Emanuele Di Angelantonio, MD, PhD; Srijan Sen, MD, PhD
JAMA, December 8, 2015
Conclusions and Relevance
In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.
http://jama.jamanetwork.com/article.aspx?articleid=2474424
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Effects of Health Care Payment Models on Physician Practice in the United States
By Mark W. Friedberg, Peggy G. Chen, Chapin White, Olivia Jung, Laura Raaen, Samuel Hirshman, Emily Hoch, Clare Stevens, Paul B. Ginsburg, Lawrence P. Casalino, Michael Tutty, Carol Vargo, Lisa Lipinski
RAND Corporation, March 19, 2015
The project reported here, sponsored by the American Medical Association (AMA), aimed to describe the effects that alternative health care payment models (i.e., models other than fee-for-service payment) have on physicians and physician practices in the United States. These payment models included capitation, episode-based and bundled payment, shared savings, pay for performance, and retainer-based practice. Accountable care organizations and medical homes, which are two recently expanding practice and organization models that feature combinations of these alternative payment models, were also included.
Within our sample, alternative payment models had not substantially changed how physicians delivered face-to-face patient care. However, the overall quantity and intensity of physician work had increased because of growing patient volume expectations and ongoing pressure for physicians to practice at the “top of license” (e.g., by delegating less intense patient encounters to allied health professionals), which was described as a potential contributor to burnout because lower-intensity patients could be an important source of respite for busy physicians.
Increased Stress and Time Pressure
New nonclinical work for physicians was almost universally disliked, especially when there was no clear link to better patient care. For example, frustration was common when physicians believed they were being asked to spend more time on documentation solely to get credit for care they had provided already. Overall, increased stress on physicians might directly harm the quality of patient care and might also serve as a marker that physicians are concerned about the quality of care they are able to provide.
http://www.rand.org/content/dam/rand/pubs/research_reports/RR800/RR869/RAND_RR869.pdf
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Comment:
By Don McCanne, M.D.
Since enactment of the Affordable Care Act (ACA), physician burnout and dissatisfaction with work-life balance have increased and now are experienced by over half of US physicians. The prevalence of depression or depressive symptoms amongst physicians in training is 29 percent and increasing. Health care payment models, which have increased under ACA, are contributing to physician burnout.
Do we really need to say it? ACA was the wrong model for reform.
We need to switch to a well designed single payer national health program which will then free us up to reform the health care delivery system so that we have contented health care professionals dedicated to providing optimal patient care. It would work for everyone.
