How Readily Do Physicians Switch Careers?

Jane B. Sofair, MD

,
Stephanie Chiu, MPH

Stephanie Chiu is a biostatistician and research manager affiliated with the Atlantic Center for Research, Atlantic Health System.

Is the COVID-19 burnout enough to make some physicians step away from medicine?

What does physician burnout look like through the lens of someone starting over? Among a sample of 26 physicians, predominantly psychiatrists, only 50% were satisfied with their medical career, yet 96% chose to remain in clinical practice. With COVID-19 making a career in medicine more stressful than ever, understanding career decisions and burnout is essential for the future health of the profession.

More Than One Dream

“I have shed a tear or two for my life and career. At the same time, you have to keep moving forward. My dream has always been, and will always be, to be a singer. But now I have more than one dream.”

These are the soulful words of baritone Steven LaBrie, forced to make a 180-degree pivot from the opera world to that of software engineering when COVID-19 closed down the concert halls.1 You may be thinking, what does this have to do with psychiatry? Our answer would be nothing, yet everything.

Among psychiatrists, career fluctuation has been discussed since before the COVID-19 global health crisis. Yet, according to medical search engines and occupational databases, few in medicine are documented to have made a career pivot like Mr LaBrie. It is not uncommon to see doctors burning the candle at both ends. One example is Sir Charles Tupper, MD, the renowned 19th-century Canadian physician and first president of the Canadian Medical Association, who left his medical career to become the Canadian prime minister.2 However, large scale studies looking at doctors who have expanded their career or opted out of medicine are scarce.

Our interest stems in part from wishing to understand how physicians have navigated their professional paths, but a seed of curiosity was also planted several years ago during a workshop on professional burnout. During the workshop, the course director asked physician attendees to indicate if they had ever experienced burnout. As one might predict, only a few audience members raised their hands. Despite steadfast efforts to destigmatize burnout, most physicians struggle to admit that they feel disappointed or burned out with their work.

Witness a recent survey on burnout among 2084 psychiatrists conducted by Richard F. Summers, MD, and colleagues.3 Depression, female gender, and workplace stressors were identified as risk factors for burnout, but study respondents had been de-identified, suggesting residual burnout stigma. Some physicians also pride themselves on being particularly dedicated, for example a group of front line physicians in Texas who rejected the term burnout altogether. They felt that their self-acknowledged pandemic exhaustion—attributed to the fear of contracting the COVID-19 virus, and to the burden of personal protective equipment (PPE), or a lack thereof—was justified, and not deserving of a label. Regarding personal wellness initiatives, one physician commented, “it is absurd to believe that yoga will solve the problems of treating a cancer patient with a declined preauthorization for chemotherapy… These problems are not the result of some failing on the part of the individual clinician.”4

Two years ago, our team looked at burnout from a different angle—allowing for burnout, did this lead to career change? A convenience sample of 126 multispecialty physicians were anonymously and electronically surveyed as to whether they had expanded their career beyond the practice of medicine. This was a publicly available survey communicated through a variety of channels, including telephone outreaches, emails, and mailing lists. The hospital institutional review board granted exemption from formal committee review. All questions were designed to fit onto a single page for the respondents’ convenience. Inquiry was sequentially ordered by research interest, starting with career satisfaction then possible second career, followed by demographic information and the rating of potential workplace stressors. Our goal was to raise awareness on the importance of burnout among physicians and its potential impact on productivity as well as career decisions.

Due to the small sample size, our findings are briefly summarized and presented in Tables 1 and 2.

Here are some of the findings:

- Twenty-six out of the 126 anonymously surveyed physicians completed the survey. The majority were psychiatrists, and over 80% were in middle to late career. While 73% cited a higher calling as the reason for entering medicine, only 50% reported professional satisfaction within their career. All but 1 retained medicine and/or psychiatry as their sole career. Despite unmet career expectations, respondents remained as doctors.

- Electronic medical records and administrative overburdening were ranked as the most bothersome workplace stressors, followed by long work hours and fear of being sued. Board maintenance requirements and feeling professionally undervalued fell comparatively lower as career stressors.

- Respondents commented on professional happiness and career decisions. They expressed gratitude for the opportunity to express their opinions and wrote many comments, perhaps the most compelling aspect of the study.

- Only 2 respondents were unconditionally supportive of physicians expanding their career outside of medicine. The rest were supportive of a balanced lifestyle, but not necessarily leaving the practice of medicine.

Measures of career satisfaction among physicians have yielded comparable findings elsewhere. A prospective survey of South Dakota physicians showed that over 40% of both male and female respondents were not satisfied with their work-life balance, despite the majority stating they would enter medicine again if given the choice.4 A Mayo Clinic comparison of early, middle, and late career physicians in the United States showed highest percentage of career disappointment, as well as intent to leave medicine for middle career physicians (12.5%) and lower rates (5.2%) for those late in career.5

Within our sample, a sense of calling, the status of being a doctor, and financial security were judged protective, even with unmet career expectations. Moreover, respondents are inferred to have felt settled on multiple levels—professionally, financially, and perhaps being in closer proximity to retirement rather than a new start. 

The major limitation of our study is the regrettably low response rate. As such, we believe important questions remain. For instance, should burnout be conceptualized as episodic or chronic, and if episodic, what factors promote its resolution? It would be useful to further document burnout-related career decisions longitudinally from residency training through retirement, notably against the backdrop of the COVID-19 pandemic.

A final point is that the 40% estimate of burnout and depression among physicians has recently received pushback. One research group contests this statistic, suggesting that it may be inflated. Moreover, the group suggests that the persistent publicity over burnout has become self-defeating, resulting in many physicians, who happen to love what they do, including the long hours, to feel work-shamed.7

Dr Sofair practices psychiatry in northern New Jersey. She is affiliated with Morristown Medical Center, Atlantic Health System. Stephanie Chiu is a biostatistician and research manager affiliated with the Atlantic Center for Research, Atlantic Health System.

The authors would also like to acknowledge and thank Laura Logiudice, Esq; Yi Zhou, MLIS; Denise Sikora, AAS, MLT.

References

1. Woolfe Z. Two friends, two continents, very different pandemics. New York Times. January 13, 2021. Accessed May 11, 2021. https://www.nytimes.com/2021/01/13/arts/music/opera-singers-coronavirus-pandemic.html

2. Murray TJ. Serving two masters: the medical and political careers of Sir Charles Tupper. CMAJ. 2017;189(25):E866-E868.

3. Moran M. Burnout appears highly prevalent among psychiatrists, survey finds. Psychiatric News. August 18, 2020.

4. Berlin J. No escape: COVID-19 continues to exacerbate physician burnout. Tex Med. 2021;117(2):16-21.

5. Clemen NM, Blacker BC, Floen MJ, et al. Work-life balance in women physicians in South Dakota: results of a state-wide assessment survey. SD Med. 2018;71(12):550-558.

6. Dyrbye LN, Varkey P, Boone SL, et al. Physician satisfaction and burnout at different career stages. Mayo Clin Proc. 2013:88(12):1358-1367.

7. Sotile WM, Fallon R, Orlando J. Curbing burnout hysteria with self-compassion: a key to physician resilience. J Pediatr Orthop. 2020;40 Suppl 1:S8-S12.