The acuity of our patients plays a role. For many of the patients under my care, it is inevitable that they will suffer a complication of their disease that I was not clever enough to prevent, or a complication of a drug that I prescribed, which is a heavy burden to bear for five clinics every week. Also, we are not fooling anyone. Patients recognize when we are burned out, and when they sense this, they are less likely to follow through on our advice.4
Data collected by the Agency for Healthcare Research and Quality indicates that burnout affects physicians, nurses and physician assistants in approximately equal numbers.5 In the first nationwide survey of physician burnout, conducted by Medscape in 2013, approximately 40% of physicians reported experiencing symptoms attributable to burnout, which they had defined as experiencing a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.6 By 2017, that number had increased to one out of every two physicians.7
Physicians respond to burnout by giving up and giving in. In one study, published in the Mayo Clinic Proceedings, physicians reporting one or more symptoms of burnout had a 43% greater likelihood of reducing their clinical responsibilities in the ensuing 24 months.8 Burnout has the potential to affect physicians both in and out of the workplace. Not surprisingly, burnout seems to impact adversely both healthcare and patient safety.9 Perhaps more surprisingly, physicians who complain of burnout also find it difficult to enjoy life outside of work.7
Physicians have the highest risk of suicide of any profession. This is an upsetting statistic that I was reluctant to put on the page, but it is that inclination to avoid difficult discussions that, frankly, got us into this mess in the first place. An inability to acknowledge our own faults and failings and, more importantly, that these faults and failings do not make us bad doctors, is how the cycle of burnout begins. Every year, 400 physicians take their own lives.10 It is a grim fact that every year, it takes three medical school classes to replace the physicians that we have lost to suicide.
There is proof that rheumatology is moving up in the world, but not in a good way. The 2017 Medscape Physician Lifestyle Survey contacted more than 14,000 physicians in more than 30 specialties.7 Interestingly, rheumatologists were the sixth most likely group to report experiencing burnout, topped only by specialists in emergency medicine, obstetrics and gynecology, family medicine, general internal medicine, and infectious disease. Just two years prior, rheumatology was toward the bottom of that list, with only allergy, ophthalmology, gastroenterology, pathology, psychiatry, and dermatology reporting greater levels of job satisfaction.
