Emergency medicine physicians top list of most burned-out specialties

Photo: Dean Mitchell/Getty Images

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 – and this burnout is having an effect on these specialties, particularly emergency medicine.

A new American Medical Association survey found that 62% of emergency medicine physicians report feelings of burnout, ranking it as the top specialty affected by burnout.

Rounding out the top six most burned-out specialties are hospital medicine (59%); family medicine (58%); pediatrics (55%); obstetrics and gynecology (54%); and 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.

More than 13,000 responses from physicians and nonphysician providers across 30 states were received from more than 70 health systems that participated.

WHAT'S THE IMPACT?

At Dayton Children's Hospital in Ohio, 36% of pediatricians reported burnout, which is about 20 percentage points lower than the pediatric benchmark. Survey authors used the hospital's experience as a case study on how to address burnout.

Dr. Sean Antosh, a pediatric anesthesiologist and the chief medical wellness and engagement officer at Dayton Children's, said that when RSV and other respiratory ailments started popping up at the hospital during the late summer and early fall of 2022, the hospital implemented a "multi-tiered" approach.

"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," said Antosh. "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."

This meant making "sure that we were servicing every kid appropriately, but being cognizant of just the volume that was in the hospital as well," he 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, though that has now 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," 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.

Meanwhile, about 66% of pediatricians reported feeling valued at Dayton Children's Hospital, compared with the pediatric benchmark of 55%. One of the ways the hospital accomplished this was by tying values to awards.

"We asked for nominations from all staff for these awards based on their values," said Antosh. "Then the winners were chosen by their peers. 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," he said." It's those moments of feeling appreciated that brings the value."

THE LARGER TREND

Frenzied work conditions during the COVID-19 pandemic contributed to burnout among clinicians, but some of this hardship can be alleviated by letting healthcare professionals know they're valued and appreciated, and not going through their ordeal alone, according to findings published last November by JAMA Health Forum.

Analysts suggested that one means of addressing burnout and dissatisfaction would be to create a federal surveillance system that analyzed, in real time, levels of clinician and healthcare worker outcomes. 

Clinicians have faced new sources of stress since the beginning of the pandemic, including fear of the virus, inability to modulate workload, changes in childcare and eldercare responsibilities, requirements for care that is felt to be ethically untenable (such as rationing), and some degree of questioning their meaning and purpose in the profession, researchers found.

These stressors have led to clinician exhaustion and burnout, and a degree of turnover and exit from practices that are unsustainable.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com