All is not well in academic medicine in the U.S. In fact, a lot seems to be unwell.
In a survey of academic physicians, 32.6% of the respondents stated their intention to leave their institutions within two years, as described by a recent publication in JAMA Network Open. And when you want to leave the medical school or academic health system that you are working at, chances are it’s not because you’re so happy that you can’t stand it. The survey found that many physicians were the opposite of happy with 37.9% meeting the criteria for burnout and only 39.3% feeling professional fulfillment. Clearly, this is not feel good news about those who are responsible for the wellness of so many patients around the country. What then are U.S. medical schools, hospitals, health systems and their leadership doing about this apparent wellness crisis? Are most of them sounding the alarm, substantially changing their practices and making physician wellness a top priority? Well, not exactly.
The results of this survey shouldn’t be t00 surprising given how many studies have already shown alarming levels of physician dissatisfaction and burnout. It’s not as if studies have found nothing but happiness, rainbows and unicorns with the changes in the U.S. healthcare system that have occurred since the 1980s. For example, last year, Oliver Whang wrote for the New York Times an article entitled, “Physician Burnout Has Reached Distressing Levels, New Research Finds,” describing a study that had found exactly what the headline indicated. The year prior to that in 2021, I reported for Forbes on a study that revealed how doctors were facing various obstacles in getting proper assistance to deal with burnout. The Covid-19 pandemic most likely worsened this physician burnout problem. But if you want to blame it solely on the pandemic and somehow expect the problem to magically go away at some point, you’d be wrong. Wrong as an operating room gong. This problem has existed and been growing long before 2020, as I covered for Forbes back in 2018. Things are kind of well beyond the let’s-gather-evidence-to-see-if-this-is-a-big-issue phase.
This latest piece of survey evidence focused on doctors from various academic medical institutions, you know the places that are supposed to be generating key insights and information about wellness, patient care and training physicians. A research team from different academic medical institutions (Jennifer A. Ligibel, MD, Nicolette Goularte, PhD, Jennifer I. Berliner, MD, Steven B. Bird, MD, Chantal M. L. R. Brazeau, MD, Susannah G. Rowe, MD, MPH, Miriam T. Stewart, MD and Mickey T. Trockel, MD, PhD) had sent the survey originally to 37,511 attending-level medical specialists based at 15 academic medical institutions that were part of the Healthcare Professional Well-Being Academic Consortium. The survey included questions comprising the Professional Fulfillment Index (PFI), which can assess levels of burnout and professional fulfillment. From October 2019 through July 2021, a total of 18, 719 academic physicians provided responses to the survey. So this was not an insignificant sample size.
What was also not insignificant were the survey findings. Having over a third of academic physicians suffering from burnout and over two-thirds not having professional fulfillment should be quite disturbing to the thousands of patients that they see every day. Imagine boarding an airplane knowing that there is a fairly high probability that the pilot flying your plane is feeling burnt out—not exactly the most comforting of thoughts given that your life may be in that pilot’s hands. Well, the same should be true regarding your doctor who may have your life and many other parts of you in his or her hands. Plus, academic physicians are supposed to be leading the way in developing new insights about and approaches to patient care. How feasible is this if the physicians don’t feel cared for themselves?
With so many academic physicians suffering from burnout and lack of professional fulfillment, guess what could happen to such physicians? If you said, “Make like a tree and get out of here,” you wouldn’t be wrong. Every one-point increase in burnout was associated with greater intention to leave their positions. The same was true for each one-point decrease in professional fulfillment. Now, not all physicians with the intention to leave will necessarily end up doing so. There can be a big gap between wanting to do something and being able to do something. Nevertheless, knowing that the physician who is taking care of you may not really want to be there is not exactly the most comforting of thoughts.
What then was associated with less intention to leave? How about things like perceived gratitude, alignment between personal values and the organization’s values, supportive leadership behaviors and organizational support regarding Covid-19. Yep, surprise, surprise, what the organization was and was not doing for each physician seemed to make a significant difference.
So, again, are the leaders of U.S. medical schools, hospitals and health systems sounding the alarm about this apparent physician wellness crisis? Are they taking responsibility and asserting that they will do what it takes to change the situation Captain America style? Or are they doing what so many leaders seemed to do before the Covid-19 pandemic threw everything into a tizzy in 2020: wait for a disaster to happen before really trying to do something about it?
