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    Why are ob/gyns burning out?

     

    Data show that burnout in our specialty is increasing, and not surprisingly is associated with a decline in satisfaction with work-life balance.7,8 Unfortunately, the outlook for burnout among ob/gyn trainees is no better. Two different surveys of residency programs from around the country found that 50%–89% of residents had burnout and that it was significantly associated with career choice dissatisfaction and depression.9,10

    Why is burnout increasing, particularly in our specialty? One important factor relates to the recent changes in healthcare delivery in the United States. More than 900 readers responded to the first annual Labor Force survey in the January 2016 issue of Contemporary OB/GYN. Sixty-two percent reported that they were less optimistic about their future. They attributed this mostly to healthcare reform, inadequate reimbursement, insufficient time with patients, and electronic medical records. The majority of responders said that both their workload and stress levels had increased in the past year. More time spent on administrative tasks, ineffective or burdensome technology, and increased patient volume were cited as the principal causes of increased work stress.

    Notably, only 32% of the respondents reported being satisfied with their job situation, whereas 37% reported being somewhat dissatisfied, and 20% reported being very dissatisfied. Not surprisingly, 40% of respondents reported that they are considering a job change in the next 12 months, and another 20% had transitioned to part-time, both groups driven primarily by a desire to achieve a better work-life balance.11

    Notably for the ob/gyn workforce, female gender and younger age are consistently cited as risk factors for physician burnout. A recent study of more than 7000 US physicians assessed work-home conflict in dual-career relationships and found that female physicians were 60% more likely than male physicians to report signs or symptoms of burnout.12 Female ob/gyns tend to take more time away from clinical practice to care for their families than do their male partners.13 One study found that up to 23% of female ob/gyns younger than age 40 had reduced their work hours or had taken extended periods of time off compared to just 5% of their male counterparts.14

    The changing demographics of ob/gyn residencies, with women making up more than 80% of graduating classes each year, make these issues particularly relevant to our profession.

    Why is it important that we as a specialty address burnout? The consequences of burnout extend beyond the individual physician, affecting patient care and eroding our profession. Burned-out physicians have higher rates of mental illness, substance abuse, and suicide. Unfortunately, studies show that physicians are not likely to ask for assistance with either depression or substance abuse problems, possibly because of fear of professional exposure.15-17 Additionally, burned-out physicians are less likely to comply with age- and sex-appropriate healthcare screening guidelines for themselves, to employ personal wellness promotion strategies, or to adhere to Centers for Disease Control and Prevention recommendations for aerobic exercise.18

     

    Ilana Cass, MD
    Dr. Cass is an Assistant Professor of Obstetrics and Gynecology, UCLA/Cedars-Sinai Medical Center, Los Angeles, Calif.
    Linda R Duska, MD, MPH
    Dr Duska is Professor, Obstetrics and Gynecology, Division of Gynecologic Oncology, Fellowship Director, Gynecologic Oncology, and ...

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    • Anonymous
      I think the tragedy of those 400 suicides is more a personal tragedy and less a bad return on investment!
    • Good article addressing most important issue facing the future of this specialty. The solution does not lie in yet more seminars to teach coping skills or research to document the obvious. We are tired of "coping". The only solution to the epidemic involves recognition by physician leadership that this is the tipping point and it is way past time physicians said "enough" and took back control of US Healthcare. The revolt against ABMS should be only the beginning. Physicians can learn to bind together or perish, plain and simple...
    • Anonymous
      Could not agree with the prior post. However, I would also point out that in addition to the myriad "burn out" factors that have been commented on and studied, the authors of this timely editorial did not devote enough commentary and analysis, is the issue of terrorism perpetuated on our specialty by the legal profession. This sad state of affairs is facilitated by unscrupulous colleagues that bend consensus, establish false parameters and bend the curve reality to suit a narrative that does not promote better outcomes. Rather, it has hastened the trends that were discussed in the article. Fortunately, our specialty has evolved to the point of recognizing the insanity of trying to be everything to all people. At the same time, we need to train our residents and impart on our younger colleagues the wisdom of our experience. Unless the aforementioned destructive trend ends with rational solutions, burn-out will produce a scarcity of providers. At that point, it may be too late.

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