Specialties reveal their differences in rates of burnout and career choice regret


Neurologists and urologists have the highest rate of burnout among specialists, with almost two thirds of  trainees reporting symptoms, according to a US study.

Researchers from the Mayo Clinic sought to explore the factors associated with career regret and burnout in a group of 3588 specialist trainees from 49 medical schools, who were surveyed during the fourth year of medical school and during their second year of graduate training residency.

Almost half (45%) of the doctors – representing 20 physician and surgical specialties  – reported the symptoms of burnout, defined as a syndrome driven by work-related stressors such as emotional exhaustion, depersonalisation and a low sense of personal accomplishment. Burnout was associated with higher frequency of medical errors, problematic alcohol use and suicidal ideation, according Dr Lisolette Dyrbye and her co-authors of the study in JAMA.

Source: JAMA September 2018, Vol 320 number 11

Their study assessed doctors using two questions from the Maslach Burnout Inventory;”I feel burnt out from my work” and “I’ve become more callous toward people since I started this job.”

The top three specialities with the highest prevalence of burnout were urology (63.8%) neurology (61.6%) and ophthamology (55.8%).

Specialties with the lowest rates of burnout were dermatology (29.6%), pathology (34.7%) and radiology (35.4%)

Burnout was more common in women than men (risk difference 7.2%) and in those who had reported higher levels of anxiety, and lower levels of empathy when they were in medical school.

The prevalence of burnout symptoms among residents was similar to that of practicing physicians, and much higher than the 28% average across US workers in other industries, the authors noted.

Higher rates of burnout in females than their male counterparts suggested difficulties with work-life balance and work-home conflicts, sexism, stereotype threat and discrimination, they added.

The specialties with a high prevalence of burnout in residents were mirrored among practicing physicians, suggesting characteristics of the job itself played a role.

“Alternatively, the high prevalence of burnout symptoms among supervising physicians in these specialties may be adversely affecting the learning environment, or these supervising physicians may model burnout to resident physicians, placing the resident physicians who are in training in these specialties at greater risk,” the authors suggested.

Symptoms of burnout were also associated with career choice regret, with 14% of resident physicians reporting they would not choose to become a physician again and 7% indicating they would not choose the same specialty. The highest rates of career choice regret were reported by pathologists (relative risk 2.6 compared to general internal medicine), anaesthesiology (RR1.7) and radiology (RR1.6). The lowest rates of career choice regret were reported by specialists in plastic surgery (RR0.35), family medicine (RR 0.69) and O&G (RR 0.78).

However a linked editorial said the vague definitions for burnout and wide heterogeneity in the design of studies into the condition meant it was impossible to draw firm conclusions about its prevalence and effects.

‘The term burnout has taken on meaning far beyond what is understood about it as an actual diagnosis or even a syndrome,” wrote Dr Thomas Schwenk and Dr Katherine Gold.

“Simply accepting the oft-quoted statement that “half of all physicians are burned out” is inappropriate, they said.

“Physicians reporting burnout are receiving recommendations for treatments before there is any real understanding of the diagnosis. The profession has violated the very way it has taught, and been taught, to approach the care of patients. The profession can and should do better.”

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