Physician burnout factors may differ by career stage

The epidemic of physician burnout has been well-documented, although many health systems are still struggling to foster a happier workforce. While gender-specific mechanisms for burnout have recently garnered attention, age-related differences have been less examined.

Edward Fry, MD, took a stab at identifying generational stressors among physicians in an April 12 presentation at the MedAxiom CV Transforum in Ponte Vedra Beach, Florida. He used Medscape’s 2018 National Physician Burnout and Depression Report to launch into his own take on which stressors are most impactful to early-, mid- and late-career physicians.

Interestingly, the report noted that mid-career physicians aged 45 to 54 had the highest rate of burnout at 50 percent. The prevalence dipped to 41 percent for those between 55 and 69, and was 44 percent for ages 35 to 44 and 35 percent for ages 28 through 34.

Fry believes many early-career providers haven’t had time to become burned out yet, while late-career doctors have their eyes on the finish line and are therefore less daunted by new changes to the ever-shifting healthcare landscape. Mid-career physicians have neither of those advantages, thus explaining why they have the highest levels of burnout.

Across the board, additional time spent working has contributed to higher rates of burnout in the current era, Fry said. He noted providers are working 20 percent more than they were 10 years ago and are spending about 30 hours per month doing traditional office work from home.  

“EHRs (electronic health records) have basically changed our industry to be 24/7 for everyone and that obviously creates great stresses and strains as well,” said Fry, the chair of cardiology and the cardiovascular service line at St. Vincent Medical Group in Indianapolis. “This in turns creates tremendous distraction from patient care, which is why a lot of us went into healthcare in the first place.”

Even though EHRs are something all physicians have to deal with, it impacts late-career physicians the most and early-career physicians the least. Here are some of Fry’s other speculations on the degrees to which specific factors of burnout affect physicians of different ages:

  • Work-life balance and opportunities for advancement and leadership cause the most anxiety among younger physicians.
  • Mid-career physicians are most worried about compensation because they’re at the age where they’re attempting to build nest eggs and may have children to put through college. They are also the most afraid of change and compliance/regulatory issues because they’ve had time to get used to a status quo but have a dozen or more years left to work in a potentially changing landscape.
  • Early-career doctors have the least fear of change and regulatory issues, while late-career physicians are between their middle-aged and youngest counterparts in that regard. Again, the finish line is nearest for them so the prospect of working just a little longer in a changed system isn’t as scary, Fry said.

In the Medscape poll, 43 percent of cardiologists reported being burned out—in the top half among the 29 specialties surveyed but still behind the leaders of critical care and neurology at 48 percent apiece. However, cardiologists ranked last in two categories: only 21 percent reported being happy at work and only 17 percent said they were likely to seek professional help for burnout, depression or both.

Fry said the unhappiness could stem from traditional burnout factors along with treating very sick patients in the acute setting, which adds more stress to the job.

He concluded his presentation by claiming engagement is the antidote to burnout, but it is becoming increasingly difficult for administrations to engage individual staff members as health systems consolidate and become larger and larger.

“As we get bigger that divide grows and grows and that is very concerning because at a time when we really need the engagement of the clinical contingent to help the administration and vice versa, the priorities are being separated on what we’re measured on and what we’re capable of working to do,” he said.