Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.

Regarding anesthesiologist burnout: What if I told you 50% of physician anesthesiology trainees suffer burnout, and those trainees average $220,000 in educational debt by the age of 32? 

The term “burnout” was coined in the 1970s by American psychologist Herbert Freudenberger, who used the term to describe the consequences of severe stress and high ideals in helping professions such as doctors and nurses, who sacrifice themselves for others.

The symptoms of physician burnout are recognized as: 

  • Exhaustion
  • Emotional detachment, i.e. feeling alone in the world
  • Self-doubt
  • Feeling helpless, trapped, and defeated
  • Increasingly cynical and negative outlook
  • Decreased satisfaction and sense of accomplishment

Our specialty’s premiere journal Anesthesiology recently published a study by Dr. H. Sun titled, “Repeated Cross-sectional Surveys of Burnout, Distress, and Depression among Anesthesiology Residents and First-year Graduates.” The study reported that “Based on survey data from 2013 to 2016, the prevalence of burnout, distress, and depression in anesthesiology residents and first-year graduates was 51%, 32%, and 12%, respectively. More hours worked and student debt were associated with a higher risk of distress and depression, but not burnout. Perceived institutional and social support and work-life balance were associated with a lower risk of burnout, distress, and depression.”

I completed two residencies in the 1980s at Stanford University Hospital, the first in internal medicine and the second in anesthesiology. The internal medicine residency required 100-hour weeks of service. I worked 30-hour shifts in the hospital every third night on most rotations, without a day off afterwards. The anesthesia residency was 80 hours per week with in-hospital night call.

Were residents burned out in the 1980s? I believe they were, but no one was publishing data on burnout then. Fellow residents I knew committed suicide, became addicted to fentanyl and overdosed, or dropped out of their residencies. We had a battlefield mentality—everyone was stressed, but we marched onward with the goal of finishing our training and entering the early career years. The plot of a popular 1970s medical novel, The House of God by Samuel Shem, involved a cohort of Boston medical interns who had burnout symptoms, and began to cynically dislike their patients and their own lives. In the end these young doctors dropped out of their internal medicine residencies to join cushier specialties such as radiology, dermatology, pathology, ophthalmology, and (gasp) anesthesiology. 

Now we learn that anesthesiology residents have a 50% incidence of burnout. In the Sun study the mean physician age was 32 years, the mean number of hours worked per week was 61, the mean number of night calls/night shifts per month was 5, and 37% of the doctors were females. Females were more likely than males to suffer from burnout (54% vs. 49%, P = 0.002). Seventy-eight percent of the respondents reported having student loan debt, with a median amount of $220,000. 

In 1980 I graduated from the University of Chicago School of Medicine with $23,000 in student debt. In 1984 the average debt for students who graduated from a private medical school was $27,000. Per Consumer Price Index data, $1 in 1980 equaled $3.11 in 2019. Adjusting for inflation, the average student debt from 1984 calculates to $83,970 in 2019 dollars, or roughly 40% of what today’s students are borrowing.  

Among medical specialties studied, anesthesiology has a higher rate of burnout (approximately 48%) than the all-physician average (46%).  Anesthesiology ranks seventh on the list of burnout by specialty, with emergency medicine, internal medicine, neurology, and family medicine having the four highest rates.  

Medical school application rates remain high. In 2019 there were 849,678 applications to U.S. medical schools, and 21,622 students matriculated. The average student applied to 16 schools. It’s terrific that bright students are still interested in becoming physicians. Are they driving themselves toward the twin brick walls of physician burnout and six-figure educational debt? Yes, many of them are.  

The current political healthcare debate includes the prospect of Medicare for All. How would Medicare for All affect anesthesiology? Medicare pays anesthesiologists approximately 20% of what commercial insurance pays anesthesiologists. If Medicare for All ever becomes a reality, those young anesthesiologists who already own $220,000 in student debt will see their income plummet. Paying off their debt will take significantly longer, adding stress to an already stressed young physician’s life. 

If you’re a patient reading this, you might wonder how all this might affect you. Consider this: we all want our doctors to be emotionally and physically healthy. We all want our caretakers to be content, well-reimbursed, non-burned out professionals rather than stressed-out MDs in chronic debt. 

What can be done about physician burnout? Per the Sun article, “Perceived institutional and social support and work-life balance were associated with a lower risk of burnout, distress, and depression,” and “those who believed they maintained an appropriate balance between personal and professional lives and who were satisfied with the level, accessibility, and acceptability of workplace resources were much less likely to suffer from burnout, distress, and depression.” Stanford Medical Center recently hired Tait Shanafelt MD as their first Chief Wellness Officer, in an effort to provide programs with a supportive medical center environment for Stanford physicians. 

I still recommend a career path toward medical school for motivated and qualified students, with these reservations: 

1. It’s important that your medical school and your residency training program have intact resources to support psychologically stressed/burned out/depressed enrollees; and 

2. You need to carefully examine your projected economic stress, i.e. the debt you will incur in your medical training vis-à-vis your expected income in the medical specialty you hope to enter.   

Anticipate psychological stress and debt in your medical training. You’ll need to be well informed and supported in your journey to become a physician in 21st Century America.


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