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Relationship Between Burnout, Professional Behaviors, and Cost-Conscious Attitudes Among US Physicians

  • Liselotte N. DyrbyeEmail author
  • Colin P. West
  • Andrea Leep Hunderfund
  • Christine A. Sinsky
  • Mickey Trockel
  • Michael Tutty
  • Lindsey Carlasare
  • Daniel Satele
  • Tait Shanafelt
Original Research

Abstract

Background

Despite the importance of professionalism, little is known about how burnout relates to professionalism among practicing physicians.

Objective

To evaluate the relationship between burnout and professional behaviors and cost-conscious attitudes.

Design and Participants

Cross-sectional study in a national sample of physicians of whom a fourth received a sub-survey with items exploring professional behaviors and cost-conscious attitudes. Responders who were not in practice or in select specialties were excluded.

Measures

Maslach Burnout Inventory and items on professional behaviors and cost-conscious attitudes.

Key Results

Among those who received the sub-survey 1008/1224 (82.3%) responded, and 801 were eligible for inclusion. Up to one third of participants reported engaging in unprofessional behaviors related to administrative aspects of patient care in the last year, such as documenting something they did not do to close an encounter in the medical record (243/759, 32.0%). Fewer physicians reported other dishonest behavior (e.g., claiming unearned continuing medical education credit; 40/815, 4.9%). Most physicians endorsed cost-conscious attitudes with over 75% (618/821) agreeing physicians have a responsibility to try to control health-care costs and 62.9% (512/814) agreeing that cost to society is important in their care decisions regarding use of an intervention. On multivariable analysis adjusting for personal and professional characteristics, burnout was independently associated with reporting 1 or more unprofessional behaviors (OR 2.01, 95%CI 1.47–2.73, p < 0.0001) and having less favorable cost-conscious attitudes (difference on 6–24 scale − 0.90, 95%CI − 1.44 to − 0.35, p = 0.001).

Conclusions

Professional burnout is associated with self-reported unprofessional behaviors and less favorable cost-conscious attitudes among physicians.

Key Words

professional burnout physicians professionalism health care costs 

Abbreviations

EHRs

Electronic health records

AMA

American Medical Association

MBI

Maslach Burnout Inventory

Notes

Funding

Funding for this study was provided by the Mayo Clinic Department of Medicine Program on Physician Well-Being, the Stanford WellMD Center, and the American Medical Association. Funding sources had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

References

  1. 1.
    Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12:573-6.CrossRefGoogle Scholar
  2. 2.
    Wynia MK, Papadakis MA, Sullivan WM, Hafferty FW. More than a list of values and desired behaviors: a foundational understanding of medical professionalism. Acad Med. 2014;89:712-4.CrossRefGoogle Scholar
  3. 3.
    American Board of Internal Medicine, American College of Physicians-American Society of Internal Medicine, European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med 2002;136:243-6.CrossRefGoogle Scholar
  4. 4.
    West CP, Shanafelt TD. The influence of personal and environment factors on professionalism in medical education. BMC Med Educ 2007 30;7:29 https://www.ncbi.nlm.nih.gov/pubmed/17760986
  5. 5.
    Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016;165:753-60.CrossRefGoogle Scholar
  6. 6.
    Shanafelt T, Dyrbye LN, Sinsky C, et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc. 2016;91:836-48.CrossRefGoogle Scholar
  7. 7.
    Shanafelt T, Bradley K, Wipf J, Back A. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358-67.CrossRefGoogle Scholar
  8. 8.
    Shanafelt TD, West C, Zhao X, et al. Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med. 2005;20:559-64.CrossRefGoogle Scholar
  9. 9.
    Thomas MR, Dyrbye LN, Huntington JL, et al. How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Intern Med. 2007;22:177-83.CrossRefGoogle Scholar
  10. 10.
    Dyrbye LN, Massie FS, Jr., Eacker A, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010;304:1173-80.Google Scholar
  11. 11.
    Dyrbye LN, West CP, Satele D, Boone S, Sloan J, Shanafelt TD. A national study of medical students’ attitudes toward self-prescribing and responsibility to report impaired colleagues. Acad Med 2015;90:485-93.CrossRefGoogle Scholar
  12. 12.
    Passalacqua SA, Segrin C. The effect of resident physician stress, burnout, and empathy on patient-centered communication during the long-call shift. Health Commun. 2012;27:449-56.CrossRefGoogle Scholar
  13. 13.
    Melville A. Job satisfaction in general practice: implications for prescribing. Soc Sci Med. 1980;14A:495-9.Google Scholar
  14. 14.
    Grol R, Mokkink H, Smits A, et al. Work satisfaction of general practitioners and the quality of patient care. Fam Pract. 1985;2:128-35.CrossRefGoogle Scholar
  15. 15.
    Reid RJ, Coleman K, Johnson EA, et al. The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health affairs (Project Hope) 2010;29:835-43.CrossRefGoogle Scholar
  16. 16.
    Shanafelt T, West CP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011-2017. Mayo Clin Proc In press (ePub available).Google Scholar
  17. 17.
    (AAPOR): Aafpor. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. 2011.Google Scholar
  18. 18.
    Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto: Consulting Psychologists Press; 1996.Google Scholar
  19. 19.
    Rafferty JP, Lemkau JP, Purdy RR, Rudisill JR. Validity of the Maslach Burnout Inventory for family practice physicians. J Clin Psychol 1986;42:488-92.CrossRefGoogle Scholar
  20. 20.
    Lee RT, Ashforth BE. A meta-analytic examination of the correlates of the three dimensions of job burnout. J Appl Psychol 1996;81:123-33.CrossRefGoogle Scholar
  21. 21.
    Leiter M, Durup J. The discriminant validity of burnout and depression: a confirmatory factor analytic study. Anxiety Stress Copin 1994;7:357-73.CrossRefGoogle Scholar
  22. 22.
    Maslach C. Maslach Burnout Inventory Manual. Palo Alto: Consulting Psychologists Press; 1986.Google Scholar
  23. 23.
    Thomas NK. Resident burnout. JAMA 2004;292:2880-9.CrossRefGoogle Scholar
  24. 24.
    Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Annals of Internal Medicine 2002;136:358-67.CrossRefGoogle Scholar
  25. 25.
    Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Academic Medicine : journal of the Association of American Medical Colleges 2006;81:82-5.CrossRefGoogle Scholar
  26. 26.
  27. 27.
    American Medical Association. AMA Code of Medical Ethics. Opinion 9.031. Reporting Impaired, Incompetent, or Unethical Colleagues. Accessed at https://www.ama-assn.org/delivering-care/ethics/reporting-incompetent-or-unethical-behaviors-colleagues. accessed 6 Nov 2019
  28. 28.
    Sulmasy LS, Bledsoe TA, for the ACP Ethics P, Committee HR. American College of Physicians Ethics Manual: Seventh Edition ACP Ethics Manual. Annals of Internal Medicine 2019;170:S1-S32.CrossRefGoogle Scholar
  29. 29.
    Tilburt JC, Wynia MK, Sheeler RD, et al. Views of US physicians about controlling health care costs. JAMA 2013;310:380-8.CrossRefGoogle Scholar
  30. 30.
    Ryskina KL, Halpern SD, Minyanou NS, Goold SD, Tilburt JC. The role of training environment care intensity in US physician cost consciousness. Mayo Clinic Proceedings 2015;90:313-20.CrossRefGoogle Scholar
  31. 31.
    Antiel RM, Curlin FA, James KM, Tilburt JC. Physicians’ beliefs and U.S. health care reform—a national survey. N Eng J Med 2009;361:e23.CrossRefGoogle Scholar
  32. 32.
    Goold SD, Hofer T, Zimmerman M, Hayward RA. Measuring physician attitudes toward cost, uncertainty, malpractice, and utilization review. J Gen Intern Med 1994;9:544-9.CrossRefGoogle Scholar
  33. 33.
    Hurst SA, Slowther AM, Forde R, et al. Prevalence and determinants of physician bedside rationing: data from Europe. J Gen Intern Med 2006;21:1138-43.CrossRefGoogle Scholar
  34. 34.
    Kirchhoff AC, Hart G, Campbell EG. Rural and urban primary care physician professional beliefs and quality improvement behaviors. The Journal of Rural Health : official journal of the American Rural Health Association and the National Rural Health Care Association 2014;30:235-43.CrossRefGoogle Scholar
  35. 35.
    Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014.[Erratum appears in Mayo Clin Proc. 2016 Feb;91(2):276]. Mayo Clin Proc 2015;90:1600-13.CrossRefGoogle Scholar
  36. 36.
    National Alliance for Physician Competence. Guide to good medical practice-USA. 2008: available at http://www.ama-assn.org/ama1/pub/upload/mm/377/ggmp-usa.pdf, accessed 2/27/2014.
  37. 37.
    Gunderman R. For the young doctor about to burnout out. The Atlantic 2014.Google Scholar
  38. 38.
    Shanafelt T, Goh J, Sinsky C. 2017 The business case for investing in physician well-being. JAMA Intern Med;177:1826-32.CrossRefGoogle Scholar
  39. 39.
    Johnson TP, Wislar JS. Response rates and nonresponse errors in surveys. JAMA 2012;307:1805-6.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Liselotte N. Dyrbye
    • 1
    Email author
  • Colin P. West
    • 1
  • Andrea Leep Hunderfund
    • 1
  • Christine A. Sinsky
    • 2
  • Mickey Trockel
    • 3
  • Michael Tutty
    • 2
  • Lindsey Carlasare
    • 2
  • Daniel Satele
    • 4
  • Tait Shanafelt
    • 3
  1. 1.Mayo ClinicRochesterUSA
  2. 2.American Medical AssociationChicagoUSA
  3. 3.Stanford School of MedicineStanfordUSA
  4. 4.Department of Health Sciences ResearchMayo ClinicRochesterUSA

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