Faculty physicians say they're burned-out, frustrated

Experts are particularly concerned because previous studies showed faculty were feeling stressed even before resident work-hour limits took effect.

By Myrle Croasdale — Posted March 13, 2006

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With limits on how many hours residents can work, faculty physicians are now the ones putting in central lines and fielding prescription queries, with the extra work coming at the expense of their academic and research responsibilities, according to recent studies.

John Mellinger, MD, co-author of a January Academic Medicine study examining the impact of resident duty hours on surgical faculty at five academic and four nonacademic general surgery residencies, found the majority of faculty members were working more, feeling more stressed, and spending less time teaching and conducting research since residents' work hours were limited to 80 a week.

"Faculty see the reasons they went into academic medicine being undermined," Dr. Mellinger said of their growing malaise.

Among faculty members surveyed:

  • 67% reported they had less time available to teach.
  • 73% were performing duties previously handled by residents.
  • 61% reported feeling more work-related stress.

Dr. Mellinger, who is the general surgery program director at the Medical College of Georgia in Augusta, has experienced this personally. He used to be able to find time during his hectic week to slow down while rounding with residents and spend more time teaching and talking through cases.

"The opportunity for that is much less now," Dr. Mellinger said. "Very frequently, my primary concern is who has been here how long and how quickly I can get you out the door."

With residents having to leave regardless of their patients' stability, he often stays to make sure care isn't compromised as one group of residents hands off patients to the next.

What he and his fellow researchers discovered is echoed by a recent study that surveyed clinical faculty in the surgical department at Washington University in St. Louis School of Medicine. In this study researchers found that more than half of the school's surgical faculty reported they were doing work previously done by residents. While the majority of physicians said they'd been able to preserve their clinical productivity, most felt their academic productivity had suffered.

Burnout existent before new rules

What concerns some researchers about the recent findings is that faculty physicians in all specialties already reported feeling pressure before the residents' duty-hour limits took hold in 2003.

Barbara Schindler, MD, vice dean of education and academic affairs at Drexel University College of Medicine in Philadelphia, took the pulse of more than 3,500 academic faculty during 2000 and 2001 from four medical schools across the country.

She discovered high levels of depression, anxiety and job dissatisfaction among these doctors.

"If I did the study today, it would be even worse," she said. "Very few hospitals are investing in physician extenders. They're expecting the attendings to pick up the slack."

She was particularly surprised by the rate of depression. Women are typically twice as likely to be depressed as men, but Dr. Schindler found almost equal rates of depression among male and female faculty. She also found younger faculty were more prone to depression than older doctors.

Some 77% of faculty said they didn't get enough sleep, and 20% had symptoms of clinical depression. While the researchers didn't have access to all the data from a similar but smaller study done in 1984, they believed the rate of depression had risen since then.

Faculty in 2000-01 said they spent 41% of their time treating patients, compared to 21% in 1984. They reported that the time spent supervising medical residents and doing research dropped from 21% in 1984 to 15% in 2000-01.

To cap it off, 45% of the physicians surveyed said they would not recommend medicine as a career to young people today, according to Dr. Schindler's study that ran in the January Academic Medicine.

Dr. Schindler said these results are indicative of widespread frustration among academic doctors.

"I've presented the data at two national meetings and at grand rounds, and I've never had so many people come up to me afterward," Dr. Schindler said. "I've had [faculty] come to me and cry, tears rolling down their face."

Long-term ramifications

Faculty burnout could have serious consequences for the medical profession, Dr. Schindler said. High turnover of junior faculty costs institutions in terms of recruitment and development costs. It also has a costly impact on faculty morale.

"Our current faculty are training the doctors of the future," she said. "It is urgent that we address these issues. [Students] won't be inspired to become academic faculty themselves and may be discouraged from staying in medicine."

This sense of urgency is shared by James Coverdill, PhD, a sociologist at the University of Georgia in Athens and lead author of the study done with Dr. Mellinger.

"I can't think of many other cases where hours and schedules have been changed so dramatically, especially among professionals," Dr. Coverdill said. "This is a huge change taking place, and I believe there have been some significant consequences for faculty in surgical programs."

The surgical faculty he surveyed expressed intense frustration at being distracted by trivial things that they felt shouldn't be their responsibility, he said.

Dr. Coverdill was struck by how discouraged faculty physicians were because they believe the professionalism and commitment to patient care that they cherished is being lost to the next generation due to the tyranny of the clock.

"I'm concerned," he said of faculty. "We need motivated people to be surgical educators."

Dr. Schindler said she hoped the recent studies would result in faculty development efforts to directly address the emotional toll faculty are paying amid the rising pressures of academic life.

Dr. Mellinger agreed that solutions need to be sought.

"As we move into an era where a variety of external forces increasingly change the landscape of how we train physicians, we clearly have to be mindful of unintended consequences," he said. "We can say, 'Woe is me. Health care is on the way down,' or we can see this as an opportunity to rethink how we do things and perhaps do them better."

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Surgical faculty feel hours crunch

Surgical faculty are spending more time with patients and less time teaching residents and doing research, according to a study of 233 faculty at five academic and four nonacademic general surgery residency programs. Here is what the study showed after duty hour restrictions were put into place:

The shift to the 80-hour work week has... Agreed or
strongly agreed
Decreased faculty expectations
and standards for residents
Improved faculty supervision
of residents
Decreased time available to
teach residents
Increased the overall time I am
on call
Increased the number of times I've
been called back to the hospital
Decreased the time I devote to
enhancing surgical skills
Increased my workload at the hospital 69%
Required that I perform duties
previously handled by residents
Increased the stress I feel from
my work
Decreased the satisfaction I derive from my academic position 55%

Source: "Duty-Hour Restrictions and the Work of Surgical Faculty: Results of a Multi-Institutional Study" Academic Medicine, January

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External links

"The Impact of the Changing Health Care Environment on the Health and Well-Being of Faculty at Four Medical Schools," abstract, Academic Medicine, January (link)

"Duty-hour restrictions and the work of surgical faculty: results of a multi-institutional study," abstract, Academic Medicine, January (link)

"Impact of resident duty-hour reform on faculty clinical productivity," abstract, Current Surgery, January/February (link)

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