Have you lost some of your enthusiasm for work? Do you find yourself becoming more cynical? At the end of the day, do you wonder if you have really accomplished anything? If you answered "yes" to any of these questions, some studies suggest that you are at significant risk of burnout. In fact, it may have already happened.

In a recent study, "Burnout and Satisfaction With Work-Life Balance Among U.S. Physicians Relative to the General U.S. Population," investigators found that more than 45% of physicians in the United States are at risk for burnout (Arch. Intern. Med. 2012 Aug. 20 [doi:10.1001/archinternmed.2012.3199]). People with MD or DO degrees are at higher risk than are high school graduates. On the other hand, graduates with bachelor’s degrees, master’s degrees, or doctorates in disciplines other than medicine are less likely to burn out than are those with high school diplomas.

This is bad news not only for physicians but for their patients as well, because other studies have suggested that physician burnout erodes professionalism, negatively influences the quality of care, and increases the risk of medical errors.

The study authors also found that those physicians in what they labeled the "frontline" medical disciplines are most vulnerable; emergency physicians experience the greatest level of stress (about 65%), with general medicine and family medicine scoring slightly less. If you are a general pediatrician, the good news is that we are at the bottom of the list, along with dermatologists and the preventive medicine folks. Conversely, these same three specialties are at the top of the list when the respondents were asked if they were content with their life-work balance; almost 60% of us admitted that we were.

Why are pediatricians at less risk of burnout? The authors emphasized that the groups at most risk are frontline specialties. Well, excuse me, but I don’t think one can get much closer to the battlefield than pediatrics. We’re in the trenches as much as anyone, and our trenches are often littered with dirty diapers.

I think the answer to this discrepancy with their interpretation can be summed up in one word: children. Most pediatricians do what they do because they like children. We grew up liking children. Not everyone shares the intensity with which we enjoy being around children, but you have to be a world-class curmudgeon not to feel even a little pang of goodness when you see a cute child smile. Pediatricians don’t have to be coached into feeling sympathy for their patients.

Furthermore, children are resilient. Most of their illnesses are self-limited. So, even if we don’t provide the cure, they get better anyway. Children often outgrow things, and we seldom have to be the bearer of bad news.

However, despite the fact that working with children helps protect us from burnout, why are more than a third of us still at risk? The study authors proposed some reasons.

First on their list is excessive workload. I disagree. If we consider the number of patients we see in a day as a measure of workload, it appears to me that most pediatricians are seeing fewer patients now than they were a few decades ago. If I am enjoying what I am doing, I can easily tolerate days when I’m having too much of a good thing.

Also on the list of contributors is loss of autonomy. When you talk with people (not just physicians) who have spent some of their career self-employed, most will tell you that it was a time when they never worked harder nor felt more fulfilled. Group practice certainly has its advantages, particularly when it comes to offering more-humane call schedules. However, as group practices have spread, autonomy has evaporated.

Not surprisingly, the struggle for balance that most people face when they try to integrate their personal and professional lives appears on the researchers’ list. Words such as discipline and compartmentalization come to mind, but they are just words. The reality of weaving the professional and personal is far more challenging.

Finally, the authors mentioned "inefficiency due to excessive administrative burdens." For me, this phrase translates into "electronic medical records." If anything drives me to the brink of burnout, it is spending an additional 6-7 minutes per patient using an EMR. This means that on a modestly busy day, I am spending as much as 120 minutes doing something that provides me no sense of personal accomplishment. And to make matters worse, it has robbed me of 2 hours with the most potent burnout deterrent I know: children.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at pdnews@elsevier.com.

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