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    Why are ob/gyns burning out?


    Dr Cass is Vice Chair and Clinical Professor, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California. She is also a member of the Contemporary OB/GYN editorial board.

    Dr Duska is Professor, Obstetrics and Gynecology, Division of Gynecologic Oncology, Fellowship Director, Gynecologic Oncology, and Associate Dean for Clinical Research, University of Virginia School of Medicine, Charlottesville.


    A career in obstetrics and gynecology is both enormously gratifying and demanding. The combination of long and unpredictable hours, high-stakes decision-making, and associated liability issues can take a toll on ob/gyns. With the current uncertainty about how healthcare reform will modify reimbursement and healthcare delivery, ob/gyns often feel overwhelmed and are at high risk of burnout. Burnout is a critical issue for us to acknowledge and address, because we are at risk of losing providers and perhaps even our ability to continue to provide women with excellent care.

    We hear a lot about burnout: on social media, on popular websites, and in the popular press. But what exactly is it and how can it be objectively assessed? Burnout is a triad defined by any of the following 3 elements: lack of enthusiasm for work, skepticism and distrust, and low sense of personal accomplishment. Objectively, burnout can be measured by the Maslach Burnout Inventory, a valid and reliable tool that assesses 3 domains: emotional exhaustion, depersonalization, and low personal accomplishment. The syndrome of burnout is present if at least 1 of these elements is significantly abnormal.1

    It has been estimated that half of all medical students, residents, and attending physicians experience burnout, and that healthcare providers suffer more burnout than other American workers.2,3 Unfortunately, ob/gyns are at particularly high risk. One large study of more than 12,000 physicians compared career satisfaction among specialties, and ranked obstetrics and gynecology 30th out of 31 specialties in terms of career satisfaction leading to significant professional distress.4 Two large studies—a 2014 survey of 369 members of the Society of Gynecologic Oncologists (SGO) and a 2008 survey of 7900 members of the American College of Surgeons (ACS)—established the high prevalence of burnout in gynecologic oncologists and surgeons, affecting 32%–40% of responders, respectively.5,6


    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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