Early in the pandemic, physician experiences were largely influenced by geography, specialty and personal COVID-19 experiences. But a year into the pandemic, the environment was different because physicians were facing staffing shortages, anti-science aggression, incivility and new dimensions of moral distress. All of this may have had an impact on professional fulfillment, which can contribute to a burnout rate that rose dramatically to 63% in 2021.
Professional fulfillment refers to a sense of satisfaction and enjoyment that comes from work. Meanwhile, physician burnout is defined as a state of emotional, physical and mental exhaustion caused by excessive and prolonged stress. When individuals experience professional fulfillment, they are more likely to feel engaged and motivated, which serves as a buffer against burnout.
In contrast, when individuals do not find their work fulfilling or meaningful, they may become disengaged, which can lead to burnout over time. Burnout can also negatively impact professional fulfillment by creating a cycle of exhaustion, cynicism and reduced productivity, contributing to decreased satisfaction and fulfillment in work.
Between Dec. 9, 2021, and Jan. 24, 2022, nearly 2,500 U.S. physicians responded to a survey by researchers from the Stanford University School of Medicine, AMA, the Mayo Clinic and the University of Colorado School of Medicine. The researchers found that professional fulfillment scores fell, dropping from 40% in 2020 to 22.4% in 2021.
Published in Mayo Clinic Proceedings, the study, “Changes in Burnout and Satisfaction With Work-Life Integration in Physicians Over the First 2 Years of the COVID-19 Pandemic,” also found that—consistent with those trends in professional fulfillment—only 57.1% of physicians indicated they would choose to become a doctor again, with 42.9% indicating they are unsure or would not again choose medicine. This trend dropped from 2020, when 72.2% of physicians said they would choose medicine again. This is also a decrease from 68.5% in 2017, 67% in 2014, and 70.2% in 2011.
“At the organization level, a number of randomized and controlled trials as well as systematic reviews and meta-analyses have reported that organizational interventions both work and are critical to creating an organizational culture and practice environment that cultivates professional fulfillment,” says the study.
With professional fulfillment at an all-time low, here are ways to make a difference and improve joy and meaning in work to reduce physician burnout.
- Resilient health systems support and protect the individuals within. For example, to address the systemic drivers of physician burnout and support the full spectrum of professional fulfillment and well-being, the physician who helps lead well-being efforts at The Permanente Medical Group, has learned the importance of using physician feedback to drive meaningful changes, having critical conversations and tracking progress. And doing all of that is impossible without meaningful leadership participation at all levels.
- Ochsner performs an Organizational Biopsy™ which includes a burnout assessment as well as an expanded set of questions across key domains of organizational culture, practice efficiency and individual self-care. This allows leaders to identify drivers of professional fulfillment and assess issues such as intent to reduce work hours or leave the organization at granular department and service-line levels. With the help of the AMA, this has led to annual measurement of the burnout levels of physicians and other staff with the ability to benchmark Ochsner against other systems.
- At the onset of the pandemic, patient medical advice request inbox messages increased by 57% and that volume has become the “new normal” for physicians. The added work not only cuts into physicians’ time—each message results in an additional 2.32 minutes of EHR active-use time—but it also contributes to physician burnout. Some organizations are finding solutions to ease that in-basket burden for physicians and restore joy in medicine. And for Atrius Health, they were able to cut the inbox volume by 25% for primary care physicians who previously received about 100 messages daily.
- Improving practice efficiency with interventions such as advanced models of team-based care with in-room support can help reduce burnout. At the same time, interventions to improve organizational culture—including connections with colleagues and improved local leadership—can improve professional fulfillment and reduce burnout.
- At The Permanente Medical Group—a recipient of the Joy in Medicine™ Health System Recognition Program—the aim of helping physicians and other health professionals achieve joy and meaning in medicine is increasingly critical, especially amid the strains of the COVID-19 pandemic. That’s why it is part of their “total performance strategy,” which also includes the interconnected components of operational excellence and exceptional care experience.
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
Editor’s note: This story was first published with the headline, “In pandemic’s wake, over 40% of doctors regret career choice.” At the request of the study’s authors, the headline was changed to avoid confusion given that respondents were not asked explicitly about career regret, but rather were queried on whether they “would choose to become a physician again.”
In addition, the story wrongly reported that 57.5% of physicians would choose to become a physician again. The correct figure, as published in the study, is 57.1%. The AMA regrets the errors.