Recognizing drivers and assessing well-being

Physician burnout is defined as a chronic state of stress characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment¹. Physicians are considered among some of the most resilient people in the world because they are accustomed to making sacrifices, working long hours, and putting others before themselves. Even so, they are not immune from burnout.

What’s causing such resilient individuals to experience burnout?

There is no simple answer. The causes are complex and evolving. Some cite the loss of physician autonomy, others an erosion of previously accepted values, or the shift from patient-first to regulations-first care. The reasons vary from one physician to another but research indicates some common contributors to burnout.

1. Demanding workloads: Dermatologists handle a high volume of patients, especially in busy clinical practices. The demand for dermatological services can be high, leading to long hours and a constant flow of patients.

2. Administrative burdens: The administrative tasks associated with medical practice, including documentation, insurance paperwork, and EHR requirements, can be time-consuming and frustrating, diverting time away from patient care. Dermatologists often feel dissatisfied when they spend less meaningful time with their patients and more time on administrative burdens.

3. Loss of autonomy: Some dermatologists have limited autonomy in making clinical decisions due to insurance regulations, organization policies, or treatment guidelines. Many of these problems are interrelated — excessive administrative burdens and regulatory requirements can make dermatologists feel a loss of autonomy.

4. Emotional strain: Dermatology patients often have psychological and emotional needs related to their skin conditions which may be severe and visually distressing. Sometimes, dermatologists must deliver bad news. Even the most dedicated caregiver can sometimes feel drained by the emotional needs of patients.

5. Long hours: Many dermatologists work long hours and may have to be on-call, especially in hospital settings or private practices with extended hours. Due to increased clinical documentation requirements, many dermatologists put in “pajama time” remote work to finish documentation they could not complete during regular work hours. This encroachment on personal time can contribute to burnout.

6. Complex or intractable cases: With more than 3,000 skin disorders in the U.S. alone, dermatologists encounter complex cases, including rare skin diseases and challenging diagnostic dilemmas. Managing these cases requires extensive time and expertise. Dermatologists regularly delve into research, consult colleagues, and attend conferences to stay updated.

7. Poor work-life balance: Achieving good work-life balance can be challenging for dermatologists, particularly when they are faced with demanding work schedules, on-call duties, and pressure to keep up with the latest research and treatments.

8. Patient expectations: Patients may have high and sometimes unrealistic expectations for outcomes from dermatological treatments and procedures. If these expectations are not met, dermatologists may feel they have let their patient down, or the patient may not appreciate the improvements that were gained.

9. Interpersonal differences: Like any workplace, a dermatology practice can be the scene of interpersonal tensions between colleagues, staff, or patients. Ongoing tensions can reduce well-being and satisfaction quickly.

10. Business pressures: Managing the business and financial aspects of a medical practice, including billing, insurance reimbursements, and overhead costs, can be stressful for dermatologists, particularly those in private practice. Rapidly changing ownership and reimbursement models have also had a large impact on dermatology.

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Wellness assessment

The following are evidence-based tools that are used to assess physician distress and work-life balance.

Maslach Burnout Inventory-Human Services Survey (MBI-HSS) for Medical Personnel: The Maslach Burnout Inventory (MBI) is recognized as the leading research instrument to assess burnout on three different scales: Emotional Exhaustion (or Exhaustion), Depersonalization (or Cynicism), and reduced Personal Accomplishment (or reduced Professional Efficacy).

Well-Being Index: The Well-Being Index was developed by the Mayo Clinic. This tool anonymously measures well-being in less than a minute, predicts risk of distress over six dimensions, provides resources, delivers comprehensive reports to leaders, and tracks individual and organization progress over time.

To mitigate physician burnout in dermatology, it’s essential for health care organizations to prioritize physician well-being and implement strategies such as workload management, support networks, and stress-reduction programs. Additionally, addressing administrative burdens and promoting good work-life balance can help reduce the risk of burnout, increase physician satisfaction, and substantially increase well-being.

1 Clin Dermatol. 2020 May-Jun;38(3):328-335. doi: 10.1016/j.clindermatol.2020.02.010. Epub 2020 Feb 19.

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