The night shift insomnia that leaves me with about 4 hrs sleep a day has given me the chance to catch up with a bit of reading so here’s a paper for you.
This got a very amount of Twitter attention when it came out as it was a bit of a headline grabber:
Shanafelt, Tait D, Sonja Boone, Litjen Tan, Lotte N Dyrbye, Wayne Sotile, Daniel Satele, Colin P West, Jeff Sloan, and Michael R Oreskovich. “Burnout and Satisfaction with Work-Life Balance Among US Physicians Relative to the General US Population..” Archives of Internal Medicine (August 19, 2012): 1–9. doi:10.1001/archinternmed.2012.3199. PMID 22911330
First a quick run through of the study and then some thoughts
METHODS
- this was a massive survey of the AMA register of doctors compared with the general population. It was done effectively by mass emailing
- the survey used the “gold standard” of burnout: the Maslach Burnout Inventory
- the only problem here is that it’s a bit of a cumbersome tool so they let the docs fill in the whole survey whereas Joe Bloggs only filled in what the authors state are the predictive bits of the survey. They say that doing this has been studied before and is kosher but there you go…
RESULTS
- only a 26% (7000/27000) response rate in the docs. A response rate of somewhere closer to 70% is considered important as it’s giving a much more representative of the people you’re surveying. If you think about it could be only the pissed off, grumpy docs answering the survey. Or maybe even the opposite and only the calm and cool docs with lots of free time filled it out
- bottom line was that a lot of docs feel overworked and burnt out. And this is higher than the general population
- the people with the highest symptoms of burn out were the EM docs. By a clear country mile it seemed. We were much better than the surgeons in terms of work-life balance but despite this we were still burnt out.
THOUGHTS
I think this is vitally important stuff.
Emergency Medicine is like a puppy – it’s for life not just for Christmas but it seems increasingly both from my own anecdotal experience and now represented in study form in various settings that we’re going to have real difficulty keeping docs in the specialty.
In the US there are comparatively huge numbers of trained Emergency Physicians compared with the UK/Irish model. These guys work shift patterns often for their entire career. They are well paid and work reasonable hours (I was quoted that 30 hrs a week was an average for an EP in the US – can anyone corroborate this?) Despite their resonable work life balance these guys are really burnt out.
Now the UK/Irish model is a service delivered by trainees and non-board certified EPs, (the “sickest looked after by the thickest” as some have joked) these guys are paid less and work more hours than fully trained EPs, of whom we have vanishingly few. Just imagine how much more burn out might apply to those docs who deliver hands on emergency care day in, day out (or night in, night out)…
As I enter my ninth year since graduation from med school with no clear end in sight to my training (largely my own fault I’ll admit) the importance of work-life balance and the threat of burn out becomes more and more apparent. Workforce planning is one of the biggest problems (along with overcrowding) that EM has to face in this part of the world, but if we are to address it in any way we must address sustainability and burn out.
update:
Graham Walker did a survey for EM News on burnout that’s worth a read
http://mobile.journals.lww.com/em-news/_layouts/oaks.journals.mobile/articleviewer.aspx?year=2013&issue=03000&article=00008
A very relavent post Andy. Something I have been contemplating myself in recent times, particularly as I flirt with Intensive Care Medicine, which has a better structure, better work-life balance and perhaps more formal support and organised training.
Yeah ICM, is a bit more attractice though the on call can be pretty onerous surely?
Thanks for your post. I personally have found EM to be the best field I’ve worked in when it comes to work-life balance. In our shop we do 4 10-hr shifts a week on average, with a fairly split between day/evening/nights. Stress is high, but people don’t go into critical care med for a cushy day job 🙂
My ICU colleagues at registrar level are working up to 14hr days, up to 7 in a row, which I think is even more conducive to burnout.
Sorry you couldn’t make it to SMACC2013!
Mel @doc_indy
I think 4 10 hr shifts a week is a reasonable work level in a well functioning dept. Though some depts are pretty chaotic and unsupported and the stress level can be even higher
Nicely written thoughtful commentary Andy! As I think back many years ago to when I was working in the ED – as enticing as being off multiple days in a row was (and being “totally off” during that time!) – I think the shift work (particularly alternating between daytime, evening and night time hours) took a real toll on one’s body that was ok during one’s “youth” (it was most of us did during training) – but which becomes more difficult as a longtime profession …. BURNOUT is a real problem. Best prophylactic measure is to have an enjoyable “other life” – but EM is clearly a tremendously high intensity profession – so not surprising the high rates of “burnout” cited in the article.
It takes a toll not just physically but emotionally and socially as, yet again, you have to ring and say you can’t make the reunion or family gathering as you’re working
Important topic,
We did a survey of Irish ED docs 2 years ago (which will hopefully see the published light of day) and found alot of people were/felt they were getting burnout. we admittedly did nto use a validated tool like above as the survey was looking at a broiad number of things.
I find shiftwork and nights tougher in my 30’s now than i did a few years back. Having children at home adds another dimension. On the positive side there are days in the week and mornings/afternoons off that you can have with them that others do not get.
yeah I had that survey in mind when I wrote this – look forward to seeing the results (and any potential changes that might come from it!)
I’d be lost without my sneaky days of during the week. I like the nights and weekends, it’s just the number of them I struggle with.
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Andy, I worked for 20+ years in the USA as a FACEP and 10 years in Australia as a FACEM consultant. In America, a 30-35 hour week is standard. Except in large academic centers, EP’s see all the patients. They work like residents do in the UK/Eire and Australia, but are able to see about twice as many patients (that is because of a combination of expertise and a system that is incentivised to facilitate productivity) They have developed novel ways to attack the burnout problem. Evening shifts, when the volume is highest can be as short as 6 hours. Night shifts are paid at a higher rate. Our group recruited 2 guys who wanted to work only nights … which unloaded the rest of us, who hated nights. It was a good solution. And after age 60, no more night shifts. But the real key to avoiding burnout in my opinion, is having a low stress and rewarding work environment. The most stressful part of our job is not the patient care … that’s fun …. but enduring adversarial contact with other consulting staff and with the dysfunctional components of the system itself. It’s not difficult to have a lifelong career in EM if you find a place to work that has already solved some of these problems, or has the leadership willing to tackle them.
Hi deniz. Thanks for the great comments. Totally agree. I find working in Ireland fairly frustrating with the lack of interest in resourcing emergency care. I work part time (24 hrs a week) and that really helps me not onmlky survive but really enjoy my work. I think I’d happily work more if the system wasnt so oppressive
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