Is medicine turning into unhappy profession?

BACKGROUND: Stress is one of the most common problems; one manifestation of stress is burnout. Burnout and other stress-related illnesses among medical professionals are receiving increased attention and have been described in many branches of medical practice including dentists, nurses, etc., The purpose of this study was to measure the prevalence of stress and burnout in medical professionals in Rajasthan.
MATERIALS AND METHODS: The Maslach Burnout Inventory-Human Service Survey (MBI-HSS) and a demographic questionnaire of our own design were sent to 1,735 medical professional of various branches and different location throughout the state of Rajasthan. In response to that, 627 (36%) surveys were returned, of which 576 (92%) were found complete for analysis so later group constitute as sample for analysis. RESULT: 29.16% of medical professional showed high level of emotional exhaustion (EE), 20% showed high level of depersonalization (DP), and 17.9% showed low personal accomplishment (PA). Young professionals showed more sensitivity towards burnout (r = -0.122, P < 0.003). Females were more prone to burnout (40%) as compared to males (27%).
CONCLUSION: Burnout is an important problem in medical professionals in Rajasthan. Difference in approach to work and perceived environment at workplace, unrewarding career, unsupported behavior of peer group, balance between work and family needs appear to be important factors in burnout.

INTRODUCTION

Recently, an annual study on doctors and medical professionals in America has revealed that many professionals are unhappy with their own professional career. In this online study done by Medscape in year 2011-12, about 24,000 professionals from 25 different specialties were questioned regarding their professional life and out of the thousands of professionals only 54% said they would choose to pursue the same medical profession again if they would get a chance to choose. Noticeable thing is this that data was 69% in previous annual study in year 2010-11. A great fall of 15% clearly indicates, that now many people do not find this profession as satisfactory career.[1]

Furthermore; just 41% said they would opt for the same specialty again if they had a chance that means 59% would opt for something other. Similarly just 25% said they would choose to work in same practice setting as they are currently; surprisingly this figure was 50% in last study.[1]

By these data, we can understand simply that doctors are now losing interest in their profession. Causes might be so many and some might be deep also. Now question is why it is happening? Why doctors are unhappy? Richard Smith editor of British Medical Journal stated in his editorial that most oblivious cause of doctor's unhappiness is that they feel overworked and undersupported, and this phenomena is global.[2]

In India, burden of disease is quite large, there are wide disparities between different states as also rural and urban areas and healthcare is facing serious challenges due to inadequate infrastructure and lack of resources, doctor population ratio in India is 1:1,700.[3] Naturally the demand for overwork is really high. As doctors spend most of their time with patients dealing their sickness or sometime life-threatening conditions, which is quite stressful; if patient shows gratitude it seems rewarding, but when patient becomes more demanding situation turns more challenging.

Not only the demanding attitude of patient; but also other reasons like time urgency, regular need of developing new skills, malpractice of other doctors, work-home imbalance, low paid salaries, and rural postings where basic resources are not available create unavoidable pressure and finally takes the shape of burnout.

Burnout is an exhausted condition at emotional level where person gives up completely and feels no personal attachment towards his profession and this condition becomes more painful if other achievements are still low.

Burnout in medical professionals has drawn attention of many psychologists nowadays and it has become a serious issue.

Rajasthan, one of the most educationally backward states in the country makes condition more difficult for the doctors because before administrating treatment, they first need to provide health education and should convince the patient for continuing it properly. Therefore, it is such an area where burnout level among physicians could be high.

A study was conducted by author to access the level of burnout among medical professionals in Rajasthan. Six different variables were considered as age, gender, job type, job rank, field of specialty, and geographic location to see the effect on burnout.

MATERIALS AND METHODS

Research methodology and study design

The study was conducted with the help of Maslach Burnout Inventory-Human Service Survey (MBI-HSS) and a personal demographic questionnaire. Both the questionnaires were sent via post or email to 1,760 medical professionals with a covering letter of purpose of this study and a return addressed envelope. Participation was voluntary.

Instrument

MBI is a 22 item questionnaire developed by Maslach and Jackson.[4] It is a well-established and most widely used instrument to study burnout.[56]

MBI

MBI consists short statements related to feeling aspect of respondent about their job and can be answered on a Likert scale ranging from ‘0’ (never) to ‘6’ (every day). MBI evaluates three aspects of burnout: Emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) by independent subscales and total of the scores on three subscales in considered as high, moderate, or low according to given range.

Data collection

Total 1,735 survey questionnaires were sent to different medical professionals in Rajasthan including allopathy, homeopathy, dental, physiotherapy, and nursing field; out of which 627 survey returned back (response rate 36%) out of which 576 (91.8%) were found complete for analysis and considered as the sample for analysis.

Data according to variable:

Gender: In a total sample size of 576 professionals, 472 were male (82%) and 104 were female (18%)

Age: Whole sample was divided into three age groups; 30-45 years, 46-60 years, and 61 years and above

Job type: The entire sample was also categorized into three types of working profiles, that is, private practitioners (PP), full time academicians (FA), and academicians with private practice (AP). In our sample; 238 were private practitioners, 126 were full time academician, and 212 were mixed type (academicians with private practice)

Job rank: Two category of work profile (full time academician and academicians with private practice) were considered for cadre-wise division, out of which 54 were professors, 122 readers, and 162 lecturers. Retired professionals were considered as private practitioners only

Specialty: According to specialty or professional stream, 273 were allopathic doctors, 123 were from homeopathy, 95 were from dental stream, 28 were from physiotherapy, and 57 were from nursing staff

Geographic distribution: Geographically, 31 districts of the state were divided into four zones by an imaginary line. Divisions were made as: Eastern zone (Jaipur, Ajmer, Alwar, Bharatpur, Dausa, Karauli, Swaimadhopur, Tonk). Western Zone (Jaisalmer, Barmer, Jalore, Pali, Sirohi, Jodhpur), Northern Zone (Ganga Nagar, Hanumangarh, Bikaner, Churu, Jhunjhunu, Sikar, Nagaur), Southern Zone (Bhilwara, Bundi, Kota, Baran, Jhalawar, Banswara, Dungerpur, Udaipur, Rajasamand). From eastern zone there were 278 respondents, 53 from western zone, 132 from northern zone, and 108 from southern zone.

Statistical analysis

Scores of EE, DP, and PA were analyzed by developing algorithms. Correlation coefficient was used to evaluate relationship between demographic information and three burnout scales.

Analysis of variance (ANOVA) test and Mann-Whitney U (two sample) test were conducted to test the hypotheses of difference between male and female groups. Kruskal-Wallis (K-W) one way ANOVA (k sample) test was used to test the hypotheses of difference in different age groups, job types, job rank, and specialty. Descriptive statistics were generated to describe participant demographic summary. For data analysis SPSS Version 19 was used. SPSS is a computer program designed to perform a wide range of statistical procedures for analysis of gathered research data.

RESULTS

Table 1 gives the distribution of data of whole population (576 professionals) for various demographic variables.

Table 1

Demographic representation of the entire population in the following variables

Burnout score for the entire sample is given in Table 2:

Table 2

Burnout scores for the entire sample

Distribution of respondents in general with regards to the three elements of the burnout; 29.2% professionals scored high in first burnout element EE, 20.1% scored high in DP, and only 18% showed evidence of feeling of low PA

There was a significant difference in the burnout amongst female and male, that is, females were seen to be highly burnout as compare to males [Figure 1]

Figure 1

Burnout in different age groups and gender

A two-tailed Pearson's correlation test was used to check the correlation between age and three elements of burnout and we found that age showed significant inverse correlation with EE and DP, that is, the younger age group (≤45) were seen to have more burnout as compared to other age groups [Figure 1]

Difference in the job type showed that academicians into private practice were highly depersonalized as compared to the other groups [Figure 2]

Figure 2

Burnout in different job type and rank

The impact of job on burnout showed that lecturers showed higher number of respondents coming into high EE and high DP category than those belonging to higher ranks (reader and professor) [Figure 2]

Among all the five specialties, dentists were most prone to burnout and physiotherapists were the least prone [Figure 3]

Figure 3

Burnout in different specialties and geographic zones

There was no statistically significant difference seen in burnout scores amongst respondents belonging to different zones (using K-W test).

DISCUSSION

This was the first epidemiological study to be conducted among healthcare professionals in the state of Rajasthan in which, both male and female professionals, belonging to various age groups, regions, specialties, job type, and ranks were included. Out of a total of 576 participants, we found that 29% professionals showed high level of EE, 20% showed high level of DP, and 17% showed low level of PA, in general.

Discussing the various demographic variables in details, we found that the prevalence of burnout was maximum in the younger age group, that is, 37.6% professionals showed high EE in younger age group as compared to 22.3% in middle-aged, and 25.8% in older group. These results were similar to the results obtained by Maslach and Jackson[7] and Cordes and Dougherty,[8] where it was seen that more experienced professionals showed lower level of EE and DP by virtue of more experience and stability which rendered them less prone to burnout.

Contrary results were obtained by Lin et al.,[9] where they found that older, married nurses with more personal responsibilities and in a more senior position experienced higher levels of emotional exhaustion. Randall[10] found that there was a significant negative correlation between age and both EE and DP.

Females reported higher level of burnout as compared to males in all three subscales. These differences may reflect due to role difference, as women are more emotionally oriented, more sociable, and more sensitive than men, who are supposed to be more rational, tough, and emotionally insensitive. In terms of gender and role, women are in care giving roles and eventually this double caring life leaves women more susceptible to becoming emotionally exhausted.[11]

Reviewing the impact of rank on burnout, we found that lecturers showed more level of burnout on all three scales in comparison to readers and professors. Mearns and Cain,[12] showed that older or more experienced people, who obviously were at a higher rank, by virtue of their maturity, were able to cope with stressful conditions better as compared to younger physicians. Another reason suggested was: Since professors are more likely to have more wage, status, recognition, and better working conditions than other academicians; they seem to have lower burnout.[13]

Academicians having private practice were seen to be higher on DP score (27.14%) as compared to full time academicians (23.43%) and private practitioners (12.18%).

Marion Vogt in 2008[14] observed that a key factor influencing the risk of job burnout is working time. Academicians having their own private practice have longer working schedules as they have to balance both their institutions and their practice. Whereas private practitioners and full time academicians tend to have a specified working time, thus they tend to have more time for themselves.

This study also confirmed the hypothesis that levels of burnout do not differ per region. This finding was similar to many studies like those by Te Brake et al.,[15] and Campbell et al.[16]

Among all the five specialties, it was the dentists who showed maximum scores of EE. Freese[17] observed that dentistry is certainly one of the most stressful of all occupations. The work is difficult and is conducted in an uncomfortable position at chairside, as a result dentists experience occupational musculoskeletal problems in general and carpal tunnel syndrome in particular.

CONCLUSION

Burnout has had and continues to have a strong impact on our healthcare system. The future of health care around the world continues to be burdened by burnout. The intent of this research study has been to call attention to the problem facing physicians today regarding the symptoms of burnout in their lives and also to extend a call to action so that possible effective and preventative measures can be taken in an attempt to reduce the high levels of burnout in the physician population. Change cannot happen instantly.