Why Are There So Many Surveys?

Why am I feeling complete overwhelm and exhaustion? Why do I dread going to work in the morning? Has the career of my dreams turned into a nightmare? Could I be burned out? These are the questions that so many physicians are facing.

Burnout is defined as a long-term stress reaction marked by one of the following:

1) emotional exhaustion
2) depersonalization
3) lack of sense of personal accomplishment

It is a very real problem, but many medical professionals don’t know where to begin or how even to identify the signs of burnout.

As a physician burnout coach, I wanted to find a burnout survey to recommend to clients. A lot of doctors “need the data.” They want to see some test, in writing, that shows them they “qualify.”

But why are there so many surveys?

My first google search was a huge surprise. There were so many different scales and scores. Maslach Burnout Inventory (MBI), Oldenburg Burnout Inventory, Physician Work-Life Study’s Single Item, Copenhagen Burnout Inventory, Stanford Professional Fulfillment Index, Well-Being Index. The Annals of Internal Medicine has the ProQOL R-IV Professional Quality of Life Scale with Compassion Satisfaction and Fatigue Subscales – Revision IV. Mayo Clinic Physician Well-Being Index. AMA has a calculator and a module on burnout.

However, there’s a significant problem; not only is it confusing not to have a standardized tool, these surveys are almost all voluntary. Trust me, I am not going to bore you with a bunch of statistical information and put you all to sleep, but voluntary bias occurs when sample members are self-selected. This leads to the overrepresentation of individuals with strong opinions. Would it be better to force all physicians to take the surveys? I don’t think so. I know I have been forced to participate in many surveys and studies against my will and have not always put in the best effort. For example, when I was a resident, we were all forced to participate in a study one of our professors was trying to publish. We had no option. I may (or may not) have answered them incorrectly.

Maybe I am a little bit paranoid, but if it is truly anonymous, then why do I have to enter my NPI number at the beginning of the survey? If surveys start to become mandatory, and doctors feel their corporations will be able to see their responses, will people start to lie? Doctors are not comfortable with being weak, and many will not want their bosses to know their true feelings. Also, burnout is not static. Answers to survey questions are going to vary by the circumstances each physician is having that month, that week, that day. Did they just get back from a vacation and are in that short amount of blissful time before burnout creeps back in? Did the system just announce a pay-cut? Did they add another new mandatory screen of “box clicking” that must be done on every patient every day?

I often get the feeling that “they don’t listen anyway” and "nothing ever changes," so what is the point? Wouldn’t it be nice to take a survey and know what is going to be done with the results? Have a plan for improvement or a plan to implement changes that are needed?

Why are there so many different surveys? The Maslach Burnout Inventory (MBI) is the one that has been around the longest and most studied. However, it costs money to take and costs money for me to link to my website for others to take. Why are people making money off of creating and implementing these scales when physicians are struggling and dying? Is it truly necessary for every large organization to pay to create their own survey? The Mayo Clinic site even offers an easy calculator a healthcare system can use to estimate the cost of giving all their physicians the survey. Couldn’t that money be spent better for activities or tools to actually start managing the problem? I understand that in order for a program to continue to be financed, the C-suite is going to want to see improvement on some kind of data. But, let’s just accept that there are plenty of surveys out there and move on to the problem – physician burnout.