A national survey of physicians finds the prevalence of burnout at an “alarming” level, says a study out Monday.

While the medical profession prepares for treating millions of patients who will be newly insured under the health care law, the Mayo Clinic (Rochester, Minn.) reports nearly 1 in 2 (45.8%) of the nation’s doctors already suffer a symptom of burnout.

“The rates are higher than expected,” says lead author and physician Tait Shanafelt. “We expected maybe 1 out of 3. Before health care reform takes hold, it’s a concern that those docs are already operating at the margins.”

Being asked to see more patients and not getting enough time with them create an atmosphere of “being on a hamster wheel,” says physician Jeff Cain, president-elect of the American Academy of Family Physicians, which is not associated with the study. “We know when enough time is spent with patients that outcomes improve and costs are down.”

Differences varied by specialty: Emergency medicine, general internal medicine, neurology and family medicine reported the highest rates. The authors note other studies show burnout can decrease the quality of care, lead to increased risk for errors and push doctors into early retirement, as well as cause problems in their personal lives.

“There have been other studies done on doctor burnout, but we assumed it was the surgical specialties who would be at primary risk,” says Shanafelt. “Instead we found out it’s the physicians on the front line of care who are at the greatest risk.”

Also highlighted in the report: Physicians were more likely to complain of burnout than other U.S. workers. When asked about emotional exhaustion, 37.9% of physicians reported signs, compared with 27.8% reported by other workers surveyed.

Participants completed a 22-item Maslach Burnout Inventory questionnaire, considered the gold standard for measuring burnout. The issues examined were emotional exhaustion, depersonalization (treating patients as objects rather than human beings) and low sense of personal accomplishment. Of 27,276 physicians asked to participate, 7,288 (26.7%) responded. They had to report only one symptom to be included among those reporting burnout.

The burnout rate is nearly twice as high as in an earlier report by physician Mark Linzer, director of the Hennepin Healthcare System in Minneapolis. He is not associated with the Mayo study. He found 26.5% of doctors complain of burnout.

The doctors in the Linzer survey typically reported more than one symptom, but, if left untended, the doctors surveyed in the Mayo study could reach that point, too, he says.

“Control is the biggest predictor of burnout across the board,” Linzer says.

Among control issues that add to stress:

• How many patients you see.

• How much time you have with them.

• How many different types of patients you might see in a short period.

• When you might have to release someone from the hospital.

He adds team-oriented approaches could help ease the pressure: “It used to be all about the clinician caring for the patient. Now it needs to be the clinician, nurse, care coordinator and others. When you start expanding the numbers of types of people who are caring for a patient, that helps a doctor and patient a lot.”

Bottom line, says Linzer, “The Affordable Care Act is going to put more pressure on the front lines. This new study could be an important wake-up call the country needs to hear to build health care teams to meet the need.”

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By Janice Lloyd, USA TODAY