Professional Satisfaction and the Career Plans of US Physicians

doi:10.1016/j.mayocp.2017.08.017

Mayo Clinic Proceedings

Volume 92, Issue 11, November 2017, Pages 1625-1635

https://doi.org/10.1016/j.mayocp.2017.08.017 Get rights and content

Abstract

Objective

To evaluate the relationship between burnout, satisfaction with electronic health records and work-life integration, and the career plans of US physicians.

Participants and Methods

Physicians across all specialties in the United States were surveyed between August 28, 2014, and October 6, 2014. Physicians provided information regarding the likelihood of reducing clinical hours in the next 12 months and the likelihood of leaving current practice within the next 24 months.

Results

Of 35,922 physicians contacted, 6880 (19.2%) returned surveys. Of the 6695 physicians in clinical practice at the time of the survey (97.3%), 1275 of the 6452 who responded (19.8%) reported it was likely or definite that they would reduce clinical work hours in the next 12 months, and 1726 of the 6496 who responded (26.6%) indicated it was likely or definite that they would leave their current practice in the next 2 years. Of the latter group, 126 (1.9% of the 6695 physicians in clinical practice at the time of the survey) indicated that they planned to leave practice altogether and pursue a different career. Burnout (odds ratio [OR], 1.81; 95% CI, 1.49-2.19; P<.001), dissatisfaction with work-life integration (OR, 1.65; 95% CI, 1.27-2.14; P<.001), and dissatisfaction with the electronic health record (OR, 1.44; 95% CI, 1.16-1.80; P=.001) were independent predictors of intent to reduce clinical work hours and leave current practice.

Conclusion

Nearly 1 in 5 US physicians intend to reduce clinical work hours in the next year, and roughly 1 in 50 intend to leave medicine altogether in the next 2 years to pursue a different career. If physicians follow through on these intentions, it could profoundly worsen the projected shortage of US physicians.

Section snippets

Participants and Methods

We conducted a survey of US physicians between August 28, 2014, and October 6, 2014. A description of the survey administration process, participation rates, and demographic characteristics of the overall survey has been reported previously.7, 12, 20 The physician sample for the survey was assembled using the American Medical Association Physician Masterfile, a nearly complete record of all US physicians independent of American Medical Association membership, which includes physicians of all

Results

The personal and professional characteristics of the 6695 physicians in active clinical practice at the time of the survey who were included in this analysis are summarized in Table 1. The median age was 56 years, two-thirds were men, more than half were in private practice, and the average hours worked per week was 52.2. We found minimal differences between early responders and late responders (a standard approach to evaluate for response bias) with respect to age, sex, or specialty.⁴

Discussion

Currently, information on the career plans of US physicians is limited. In this large national study across all specialty disciplines, roughly 1 in 5 physicians indicated that they would likely or definitely reduce their clinical work hours in the next 12 months. Similarly, roughly 1 in 4 physicians indicated that they would likely or definitely leave their current practice position in next 24 months. Although intent to leave is an imperfect predictor of actual behavior, multiple studies have

Conclusion

Nearly 1 in 5 US physicians responding to our survey intend to reduce clinical work hours in the next year and roughly 1 in 50 intend to leave medicine altogether in the next 2 years to pursue a different career. If physicians follow through on these intentions, they have the potential to profoundly worsen the projected shortage of US physicians. Burnout, dissatisfaction with EHR, and problems with work-life integration appear to be major factors influencing physician career plans. Concerted

References (42)

T.D. Shanafelt et al.
Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014
Mayo Clin Proc
(2015)
T.D. Shanafelt et al.
Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction
Mayo Clin Proc
(2016)
T.D. Shanafelt et al.
Potential impact of burnout on the US physician workforce [letter]
Mayo Clin Proc
(2016)
T.D. Shanafelt et al.
Longitudinal study evaluating the association between physician burnout and changes in professional work effort
Mayo Clin Proc
(2016)
T. Shanafelt et al.
Why do surgeons consider leaving practice [letter]?
J Am Coll Surg
(2011)
T.D. Shanafelt et al.
Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout
Mayo Clin Proc
(2017)
T. Dall et al.
The Complexities of Physician Supply and Demand: Projections from 2013 to 2025
(2015)
The Physician Workforce: Projections and Research into Current Issues Affecting Supply and Demand
(2008)
S.A. Shipman et al.
Exploring the workforce implications of a decade of medical school expansion: variations in medical school growth and changes in student characteristics and career plans
Acad Med
(2013)
M.W. Friedberg et al.
Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy
(2013)

S.K. Rao et al.

The impact of administrative burden on academic physicians: results of a hospital-wide physician survey

Acad Med

(2017)

C. Sinsky et al.

Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties

Ann Intern Med

(2016)

T.D. Shanafelt

Finding meaning, balance, and personal satisfaction in the practice of oncology

J Support Oncol

(2005)

T. Shanafelt et al.

Oncologist burnout: causes, consequences, and responses

J Clin Oncol

(2012)

T.D. Shanafelt et al.

Satisfaction with work-life balance and the career and retirement plans of US oncologists

J Clin Oncol

(2014)

T.D. Shanafelt et al.

Burnout and satisfaction with work-life balance among US physicians relative to the general US population

Arch Intern Med

(2012)

L.N. Dyrbye et al.

Work-home conflicts have a substantial impact on career decisions that affect the adequacy of the surgical workforce

Arch Surg

(2012)

L.N. Dyrbye et al.

Work/home conflict and burnout among academic internal medicine physicians [letter]

Arch Intern Med

(2011)

L.N. Dyrbye et al.

A survey of U.S. physicians and their partners regarding the impact of work-home conflict

J Gen Intern Med

(2014)

M. Hann et al.

Relationships between job satisfaction, intentions to leave family practice and actually leaving among family physicians in England

Eur J Public Health

(2011)

T.D. Shanafelt et al.

Parental satisfaction of U.S. physicians: associated factors and comparison with the general U.S. working population

BMC Med Educ

(2016)

Cited by (179)

Assessment of Adverse Childhood Experiences, Adverse Professional Experiences, Depression, and Burnout in US Physicians
2023, Mayo Clinic Proceedings
To assess associations of adverse childhood experiences (ACEs) and adverse occupational experiences (AOEs) with depression and burnout in US physicians.
We performed a secondary analysis of data from a representative sample survey of US physicians conducted between November 20, 2020, and March 23, 2021, and from a probability-based sample of other US workers. The ACEs, AOEs, burnout, and depression were assessed using previously published measures.
Analyses included data from 1125 of the 3671 physicians (30.6%) who received a mailed survey and 6235 of 90,000 physicians (6.9%) who received an electronic survey. The proportion of physicians age 29-65 who had lived with a family member with substance misuse during childhood (673 of 5039[13.4%]) was marginally lower (P <.001) than that of workers in other professions (448 of 2505 [17.9%]). The proportion of physicians age 29-65 who experienced childhood emotional abuse (823 of 5038 [16.3%]) was similar to that of workers in other professions (406 of 2508 [16.2%]). The average physician depression T-score was 49.60 (raw score ± SD, 6.48±3.15), similar to the normed US average. The AOEs were associated with mild to severe depression, including making a recent significant medical error (odds ratio [OR], 1.64; 95% CI, 1.33 to 2.02, P<.001), being named in a malpractice suit (OR, 1.30; 95% CI, 1.07 to 1.59, P=.008), and experiencing one or more coronavirus disease 2019–related AOEs (OR, 1.76; 95% CI, 1.56 to 1.99, P<.001). Having one or more ACEs was associated with mild to severe depression (OR, 1.58; 95% CI, 1.38 to 1.79, P<.001). The ACEs, coronavirus disease 2019–related AOEs, and medical errors were also associated with burnout.
Assessing ACEs and AOEs and implementing selective primary prevention interventions may improve population health efforts to mitigate depression and burnout in physicians.
A pre-post study of stressors and burnout affecting breast radiologists before and during the COVID-19 pandemic
2023, European Journal of Radiology Open
To compare burnout and stressors of breast radiologists prior to and during the COVID-19 pandemic.
Members of the Society of Breast Imaging were emailed an IRB-approved survey in January 2021 during the COVID–19 pandemic. Survey included questions from the Maslach Burnout Inventory and specific stressors including work pace, work-life balance, care of dependents, and financial strain. Data were compared to previous surveys prior to the pandemic.
The response rate was 25% (261/1061) for those who opened the email. Of the respondents, 74% (194/261) were female, 82% (214/261) were white, 73% (191/261) were full time, 71% (185/261) were fellowship trained, 41% (106/261) had more than 20 years of experience, and 30% (79/261) were in academic practice.
Respondents in 2021 reported frequent levels of depersonalization (2.2) and emotional exhaustion (3.4) while reporting frequent levels of personal accomplishment (5.3), a protective factor. These values were nearly identical before the pandemic in 2020: (2.2, 3.5, 5.3, respectively, p = .9). Respondents rated practicing faster than they would like as the highest stressor; however, 5 of the 6 stressors improved after the pandemic onset (p < .05). Conversely, participants perceived these stresses had gotten slightly worse since the pandemic (p < .01). Almost 50% of respondents reported they were considering leaving their practice; the most common reason was work/life balance.
Burnout in breast radiologists remains frequent but unchanged during the COVID-19 pandemic. While participants perceived that some stressors were worse during the pandemic, there was slight improvement in most stressors between the pre-pandemic and pandemic cohorts.
Career Plans of US Physicians After the First 2 Years of the COVID-19 Pandemic
2023, Mayo Clinic Proceedings
To assess the career plans of US physicians at the end of 2021 relative to 2011 and 2014.
Physicians in the United States were surveyed from December 9, 2021, to January 24, 2022, using methods similar to prior studies in 2011 and 2014. Responding physicians in active practice (n=1884) were included in the analysis. At all time-points, physicians indicated the likelihood they would (1) reduce clinical work hours in the next 12 months and (2) leave their current practice within 24 months.
In 2021, 542 of 1344 (40.3%) indicated that it was “likely” or “definite” they would reduce clinical work hours in the next 12 months compared with 1120 of 6950 (16.1%) and 1275 of 6452 (19.8%) in 2011 and 2014. In 2021, 466 of 1817 (25.6%) indicated it was “likely” or “definite” they would leave their current practice in the next 24 months compared with 1284 of 6975 (18.4%) and 1726 of 6496 (26.6%) in 2011 and 2014. On multivariable analysis pooling responders from 2011, 2014, and 2021, physicians who responded in 2021 had higher odds of reporting intent to reduce clinical work hours compared with those who responded in 2014 (OR, 3.12; 95% CI, 2.73 to 3.57), whereas those responding in 2011 had lower odds relative to 2014 (OR, 0.81; 95% CI, 0.74 to 0.89).
Roughly two of every five US physicians intend to reduce their clinical work hours in the next year, more than double previous rates. These findings have potentially profound implications for the adequacy of a US physician workforce already facing substantial shortages.
At-Risk Work Hours Among U.S. Physicians and Other U.S. Workers
2023, American Journal of Preventive Medicine
Systematic reviews by the WHO have shown an increased risk of morbidity and mortality related to ischemic heart disease and stroke among individuals working an average of ≥55 hours/week.
A cross-sectional survey of U.S. physicians and a probability-based sample of the general U.S. working population (n=2,508) was conducted between November 20, 2020, and February 16, 2021 (data analyzed in 2022). Among 3,617 physicians who received a mailed survey, 1,162 (31.7%) responded; among 90,000 physicians who received an electronic survey, 6,348 (7.1%) responded. Mean weekly work hours were assessed.
The mean reported weekly work hours for physicians and U.S. workers in other fields were 50.8 hours and 40.7 hours, respectively (p<0.001). Less than 10% of U.S. workers in other fields (9.2%) reported working ≥55 hours/week compared with 40.7% of physicians. Although work hours decreased among physicians working less than full time, the decrease in work hours was smaller than the reported reduction in professional work effort. Specifically, for physicians who worked between half-time and full-time (i.e., full-time equivalent=50%–99%), work hours decreased by approximately 14% for each 20% reduction in full-time equivalent. On multivariable analysis of physicians and workers in other fields adjusting for age, gender, relationship status, and level of education, individuals with a professional/doctorate degree other than an MD/DO (OR=3.74; 95% CI=2.28, 6.09) and physicians (OR=8.62; 95% CI=6.44, 11.80) were more likely to work ≥55 hours/week.
A substantial proportion of physicians have work hours previously shown to be associated with adverse personal health outcomes.
Clinician Well-Being Assessment and Interventions in Joint Commission–Accredited Hospitals and Federally Qualified Health Centers
2023, Joint Commission Journal on Quality and Patient Safety
Clinician burnout is a longstanding national problem threatening clinician health, patient outcomes, and the health care system. The aim of this study is to determine the proportion of hospitals and Federally Qualified Health Centers (FQHCs) that are measuring and taking system actions to promote clinician well-being.
This cross-sectional study used an electronic questionnaire from April 21 to June 27, 2022, to assess the current state of organizational efforts to assess and address clinician well-being among a national sample of 1,982 Joint Commission–accredited hospitals and 256 accredited FQHCs. Outcomes of interest included the proportion of hospitals and FQHCs that assessed the prevalence of clinician burnout, established a chief wellness officer position, established a wellness committee, made clinician well-being an organizational performance metric, and implemented other activities/interventions that target clinician burnout.
A total of 481 (21.5%) organizations responded to the survey (hospital n = 396 [20.0%], FQHC n = 85 [33.2%]). Response rates did not differ by organization size, type, teaching status or urban vs. rural location. Approximately one third (34.0%) of the organizations in the sample conducted an organizational well-being assessment among clinicians at least once in the past three years. Although nearly half of responding organizations reported implementing some kind of intervention to address clinician burnout, only 28.7% of organizations had adopted a comprehensive approach to address clinician well-being/burnout. Only 10.1% of hospitals and 5.4% of FQHCs reported having an established senior leadership position responsible for assessing and promoting clinician well-being at the organization level, and less than half (29.3% FQHCs, 37.6% hospitals) of organizations reported having an established wellness committee. Among 500+ bed hospitals, 61.2% had surveyed, 75.6% had established a well-being committee, 78.0% had implemented interventions to promote clinician well-being, and 26.8% had established a chief wellness officer.
Although half of Joint Commission–accredited hospitals and FQHCs reported taking steps to improve clinician well-being, a minority are measuring clinician well-being, and few are taking a comprehensive approach or established a chief wellness officer position to advance clinician well-being as an organizational priority. Organizational clinician well-being improvement efforts are unlikely to be successful without measurement and leadership in place to drive change.
Vascular Surgery Training Positions and Applicant 10-Year Trends with Consideration for Further Expansion
2023, Annals of Vascular Surgery
There is a significant shortage of vascular surgeons in the United States and projections for these practicing surgical specialists continue to worsen. Annual appraisal of our workforce recruitment and growth is imperative.
Retrospective data were analyzed using the National Resident Matching Program from 2012–2022 applicant appointment years (specialty code for vascular surgery 450). Simple linear trend analysis was performed for the number of positions available and the number of applicants, stratified by fellowship or residency.
Over the 10-year study period, the total vascular surgery trainee positions expanded from 161 to 202. Integrated residency positions increased (41 positions in 2012 vs. 84 in 2022) while available fellowship positions remained stagnant (120 in 2012 vs. 118 in 2022). Total applicants rose as well, from 213 to 311. In 2022, unmatched applicants have increased for both paradigms (25 fellowship and 84 residency applicants) and 100% of programs filled. On average, the number of residency positions offered increased by 4 each year (P < 0.0001) and the number of fellowship positions increased by 0.5 each year (P = 0.1617). The number of integrated residency applicants increased by approximately 9 per year (P = 0.001), while the number of fellowships applicants increased by approximately 1.5 per year (P = 0.121).
Applicants for both vascular tracks have increased since 2012 indicating successful recruitment; however, all 2022 programs filled, leaving many applicants unmatched. Residency positions have continued to expand while fellowship positions have not. With the demonstrated surge among applicants, the disproportionate lack of increasing training positions, and the existing shortage of vascular surgeons, there is an urgency to meet the increasing demand. A concerted effort should be made toward adding additional residency and fellowship positions where feasible.

View all citing articles on Scopus

: T.D.S. is currently affiliated with Department of Medicine, Division of Hematology, WellMD Center, Stanford University, Stanford, CA.

: For editorial comment, see page 1608; for related article, see page 1688

: Funding for this study was provided by the Mayo Clinic Department of Medicine Program on Physician Well-being.

View full text

Original articleProfessional Satisfaction and the Career Plans of US Physicians

Abstract

Objective

Participants and Methods

Results

Conclusion

Section snippets

Participants and Methods

Results

Discussion

Conclusion

Mayo Clin Proc

Mayo Clin Proc

Mayo Clin Proc

Mayo Clin Proc

J Am Coll Surg

Mayo Clin Proc

The Complexities of Physician Supply and Demand: Projections from 2013 to 2025

The Physician Workforce: Projections and Research into Current Issues Affecting Supply and Demand

Exploring the workforce implications of a decade of medical school expansion: variations in medical school growth and changes in student characteristics and career plans

Acad Med

Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy

The impact of administrative burden on academic physicians: results of a hospital-wide physician survey

Acad Med

Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties

Ann Intern Med

Finding meaning, balance, and personal satisfaction in the practice of oncology

J Support Oncol

Oncologist burnout: causes, consequences, and responses

J Clin Oncol

Satisfaction with work-life balance and the career and retirement plans of US oncologists

J Clin Oncol

Burnout and satisfaction with work-life balance among US physicians relative to the general US population

Arch Intern Med

Work-home conflicts have a substantial impact on career decisions that affect the adequacy of the surgical workforce

Arch Surg

Work/home conflict and burnout among academic internal medicine physicians [letter]

Arch Intern Med

A survey of U.S. physicians and their partners regarding the impact of work-home conflict

J Gen Intern Med

Relationships between job satisfaction, intentions to leave family practice and actually leaving among family physicians in England

Eur J Public Health

Parental satisfaction of U.S. physicians: associated factors and comparison with the general U.S. working population

BMC Med Educ

Original article
Professional Satisfaction and the Career Plans of US Physicians