In the relentless pursuit of excellence and the preservation of well-being, medical professionals stand at the forefront of modern health care. Yet behind the white coats and stethoscopes is an epidemic that requires urgent—and ongoing—attention: physician burnout.
But as the demands of the medical field continue to intensify, physicians practicing in some specialties find themselves grappling with the harrowing consequences of excessive stress, long hours and emotional exhaustion, according to an exclusive survey from the AMA.
More than 13,000 responses from physicians and nonphysician providers across 30 states were received from more than 70 health systems who participated in the AMA’s Organizational Biopsy® (PDF). The AMA benchmarking report—which is exclusive data to the AMA that is not published anywhere else—reflects 2022 trends in six key performance indicators: job satisfaction, job stress, burnout, intent to leave an organization, feeling valued by an organization and total hours spent per week on work-related activities (known as “time spend”).
The purpose of the aggregated data is to provide a national summary of organizational well-being and to serve as a comparison for other health care organizations. The results may be limited by the health systems that chose to participate.
For the most stressful medical job in 2022, the highest percentages of burnout occurred among six physician specialties. They are:
- Emergency medicine: 62%.
- Hospital medicine: 59%.
- Family medicine: 58%.
- Pediatrics: 55%.
- Obstetrics and gynecology: 54%.
- Internal medicine: 52%.
Meanwhile, just 52% of pediatrician respondents reported feeling valued by their organization. The other top five specialties all fell below 50% on that metric. Only 40% of ob-gyns said they felt valued by their organization.
At Dayton Children’s Hospital, 36% of pediatricians reported burnout, which is about 20 percentage points lower than the pediatric benchmark. Here is how this Ohio hospital has reduced burnout and improved job satisfaction among pediatricians who face different stressors and challenges now that the COVID-19 federal public health emergency has ended.
“Dayton Children’s has done an amazing job of supporting the physicians throughout COVID and return to normalcy,” said Sean Antosh, MD, a pediatric anesthesiologist and the chief medical wellness and engagement officer at Dayton Children’s Hospital in Ohio. “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.”
For example, “last summer is when we started seeing RSV popping up and then through the fall, which is very atypical,” said Dr. Antosh. “Usually those are winter things, so the hospital was very proactive in the beginning trying to figure out a surge response and making sure that our emergency rooms, our urgent cares and even our general pediatricians were not overloaded and how they could best utilize all those resources.”
“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. 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,” he said. “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.”
It also meant making “sure that we were servicing every kid appropriately, but being cognizant of just the volume that was in the hospital as well,” Dr. Antosh said. “The hospital is really good at listening to physicians and so there were conversations with not only the divisional leaders, but those on the front lines to find out what they need.”
Since the COVID-19 emergency has ended, pediatricians are facing new stressors. For example, a lot of children at Dayton are on Medicaid and during the pandemic the reverification processes were suspended. But now that has ended.
But “a lot of families don’t realize that they have to reverify their Medicaid and so those support services are hitting our families and then that gets put on the physician to follow up and make sure that they are able to go through that process,” Dr. Antosh said. To help, “the hospitals worked on that as well to get those families back on Medicaid and make sure they realize that they do have to reverify to make sure our kids are being seen and able to be seen,” which takes it off the pediatrician’s plate.
When it comes to EHR burdens, half of Dayton Children’s Hospital pediatricians reported between zero and two hours spent in the EHR outside of work hours. By comparison, just 29% of pediatricians in the AMA benchmark survey spent so little time in the EHR outside of work hours.
“I work very closely with our chief medical information officer and our clinical informatics team to make sure that the stuff we’ve done in our EHR makes sense. And if it doesn’t make sense, how we can improve it and make it better for our providers,” Dr. Antosh said. “We’re constantly working on initiatives that improve that.”
In fact, “in the next month we’re rolling out some inbox messaging changes that will decrease the burden, and we also looked at regulatory compliance issues and having dual verification on outpatient prescriptions,” he said. “It’s those things that we’re constantly trying to improve and find what the stressors are to make small changes that lead to more time to do other things."
One resource that has helped tremendously is the AMA STEPS Forward® toolkit “Getting Rid of Stupid Stuff,” which has been used “to start conversations, especially with our senior leadership team, to show that things are proven, and we are able to move forward,” Dr. Antosh said.
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.
About 66% of pediatricians reported feeling valued at Dayton Children’s Hospital, compared with the pediatric benchmark of 55%.
“How do you make people feel that they’re valued? ... What we got down to was recognition and appreciation for what everyone does,” Dr. Antosh said. Working with the marketing team, “we have different recognition abilities. One is peer to peer, which is an internal recognition software program that we use that you can send kudos very easily.”
“The other thing we started two years ago was tying our values to awards. … We asked for nominations from all staff for these awards based on their values. Then the winners were chosen by their peers,” he said. “Honestly, the recommendations and nominations we got were amazing and we were able to send those out to each individual and their immediate supervising chief to give them that little bit more recognition.”
“We’ve also started recognitions at our monthly meetings of call outs of great things people have done. It’s those moments of feeling appreciated that brings the value,” Dr. Antosh said. “Last year, when I sent out just the nominations to every person who was nominated, I got more emails back saying that it uplifted them and that they had never heard some of these things from the people who work with them side by side every day.”
Beyond that, Dayton Children’s Hospital is also using the AMA Joy in Medicine™ Health System Recognition Program “as our road map to keep moving forward with well-being,” Dr. Antosh said. “We plan to submit for recognition next year, but the road map really helps guide the next steps in a logical direction.”
Additionally, Dayton Children’s Hospital has created “commensality” groups, which are gatherings that help to increase the sense of connection and collegiality among physicians while building comradery and meaning in work. Groups meet monthly for breakfast or lunch, depending on their schedules.
“We piloted last year, and we had about 40 physicians partake in it. Everyone who participated really did value the time they got to spend with colleagues who they may have not met before,” Dr. Antosh said, adding that the groups “discussed why they’re in medicine and how they got to where they are now and what they use to destress.”
“The AMA has been amazing,” Dr. Antosh said, enabling Dayton Children’s Hospital to customize it’s well-being survey to uncover factors unique to its practice environment.
By surveying with the Organizational Biopsy, Dr. Antosh and his colleagues discovered that “the typical divisions that seem to be the most burnt out in our organization were the opposite of what we thought.”
Rather, there were a few “subspecialties within pediatrics that we under recognized that they had more stressors.”
“In the next year we’re working with those four divisions to reduce their stressors, but it’s one of those things that if we didn’t measure, we wouldn’t have known. So, that’s very important,” he said. “Then, following the information and the data that those surveys derive and talking to the people to figure out what it is that’s really causing the burnout issues.”