Viewpoints
Burnout Among Mohs Surgeons
By Todd V. Cartee, MD, FACMS
Physician burnout has become an increasingly well-recognized epidemic. A 2012 study shined a bright light on the magnitude of this issue, demonstrating not only widespread burnout among physicians (38%) but also a much greater incidence of burnout than among other U.S. workers (36% higher)1. This study brought much-needed national attention to physician burnout as the New York Times, Time Magazine, The Atlantic, and many others ran stories about this crisis. In the initial study, dermatologists fared relatively well, with the second lowest incidence of burnout among physicians. However, when the survey was repeated three years later, dermatologists experienced the highest increase in burnout of any specialty, jumping from 32% to 57%2. This set off alarm bells in our specialty and has generated a lot of research into the causes and potential solutions.
What’s going on in Dermatology? Dermatology continues to rank very high on work-life balance, traditionally considered a marker for job satisfaction. Compare our results to Neurosurgery, which has the lowest work-life balance but also relatively low burnout rates (much lower than ours).
Burnout in medicine is comprised of three major components: 1) the emotional exhaustion stemming from excessive workload and clerical burdens, 2) depersonalization or a sense of detachment from our patients, and 3) feelings of ineffectiveness and lack of accomplishment. At the recent Association of Professors of Dermatology annual meeting, an entire afternoon session was dedicated to burnout and its impact on dermatologists and trainees. Respondents highlighted a familiar refrain of burdensome regulation and requirements that erect barriers between the physician and patient. They bemoaned the negative impact of increasing government and insurance requirements on physicians (the all-too-familiar prior authorization plague!), the demands of electronic documentation, the newly devised administrative tasks that accompany the EMR, and ever-changing reimbursement schemes that are impossible to keep track of.
As reimbursement dwindles, there is an increasing need to see more and more patients in a finite period of time. This leads to brief, stilted encounters that are robbing us of the ability to connect to our patients. Perhaps it is this loss of control and connection that explains the difference between the dermatologist and the neurosurgeon. Certainly, the pressures and stress encountered are unparalleled yet, during a cerebral tumor resection, the neurosurgeon can concentrate completely on his/her craft for as long as is required for as long as is necessary to optimize the outcome. Extrinsic concerns can melt away and the patient is the sole focus. There is not the same constant pressure to wrap up one appointment and move as swiftly as possible to the next, to see 30, 40 or more patients in a day while not making one meaningful connection.
Mohs surgeons are unique subspecialists within dermatology. Ours is an outpatient specialty coping with the same pressures to see more and more patients and to spend less time with each of them. We suffer from the same loss of autonomy. But we are also surgeons who make a meaningful impact on our patients, curing their cancer, every encounter, every day. Certainly, we suffer from burnout to some degree but are we more like the general dermatologist or the neurosurgeon? Or perhaps our unique combination of stressors render us more susceptible than both?
To help answer this question, Penn State Dermatology is conducting a study on burnout, both its prevalence and, more importantly, how to combat it. Penn State has partnered with the Center for Resilience, a consulting firm that specializes in utilizing predictive analytics to not only assess burnout but also to provide professionals with practical tools to reduce stress and increase resilience. The study has two phases: an assessment phase to determine the prevalence and degree of burnout among Mohs surgeons, and then an intervention phase where resilience strategies are taught to participants.
Past ACMS president Dr. John Albertini spoke to the scope of the problem and the need for action: “Physician burnout has become a central focus for numerous stakeholders in the health care system from the AMA to academic institutions to large multi-specialty group practices.”
“The frenetic pace, need for constant multi-tasking, and unpredictable nature of the tumors and subsequent reconstruction predisposes Mohs surgeons to both physical and psychosocial stress and potentially to physician burnout,” he continued. “It is vital to our specialty to determine the prevalence and impact of burnout and all Mohs College members should assist this effort by participating in Dr. Lam's survey instrument.”
Dr. Charlene Lam, the principal investigator of the Mohs Surgeon Burnout Study, added the following:
“Compared to other specialties, dermatology has, fortunately, had lower rates of burnout. However, these previous studies have never specifically looked at Mohs surgeons. I suspect we may find some definitive differences given our daily routine. Furthermore, this study will take it a step further in looking at individual resilience which can be protective and help overcome the symptoms of burnout.”
“This information is the foundation for future interventions not only in the individual but in organizations that can improve our well-being,” she said.
You can ALL help advance these efforts by participating in this research project. Please use this link to assess your level of burnout.
References
- Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385.
- 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. Mayo Clin Proc. 2015;90(12):1600-1613.