Some clearly coincidental placement of our smaller feature articles this month, with a look at eight ways the Affordable Care Act may impact your practice (p. 78), followed by a look at physician burnout (p. 82). A poll published this month by just happens to rank “present and future impact of the ACA” as the second leading cause of burnout among its surveyed physicians. (The leading cause, “too many bureaucratic tasks,” seems unlikely to find much relief as ACA rolls out.)

The good news in the medscape survey is that ophthalmology ranked 22nd of 24 specialties for the percentage of doctors identifying themselves as burned out, defined as experiencing at least one symptom including loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment. The bad: That percentage was still better than 30 percent.

Researchers are quick to point out that no single stress-relief strategy or set of behaviors works for everyone, physician or otherwise. But the relatively new effort to study “physician resiliency” has gained momentum in recent years and is making some interesting connections between lifestyle choices and avoiding burnout.

A 2012 study of more than 7,000 members of the American College of Surgeons reported that “surgeons placing greater emphasis on finding meaning in work, focusing on what is important in life, maintaining a positive outlook, and embracing a philosophy that stresses work/life balance were less likely to be burned out.”1

A troubling finding in the study is the revelation that “although approximately 70 percent of surgeons reported having a primary-care provider, less than half had seen their provider in the last 12 months and more than 20 percent had not seen a primary care provider in the last four years.”

Surgeons who had seen their primary-care provider in the last 12 months “were more likely to be up to date with all age- and sex-appropriate health screening guidelines and ... had higher overall and physical quality of life scores.”

The study identified three specific measures associated with lower rates of burnout and improved quality of life among surgeons: 1) increasing weekly aerobic exercise and weight training to recommended levels; 2) annual visits to their primary-care provider; and 3) age-appropriate preventive testing.

In an interview with the Canadian Medical Association Journal, the lead author of the surgeon study referred to the “physician personality” that’s characterized by hard work, perfectionism and an exaggerated sense of responsibility to patients. “Part of what makes us good at what we do also puts us at risk,” he said.


1. Shanafelt TD, et al. Annals of Surgery 2012;255:625-632.