title: Physician Burnout and the Calling to Care for the Dying: A National Survey.
abstract: BACKGROUND
  Physician burnout raises concerns over what sustains physicians' career motivations. We assess whether physicians in end-of-life specialties had higher rates of burnout and/or calling to care for the dying. We also examined whether the patient centeredness of the clinical environment was associated with burnout.
  
  
  METHODS
  In 2010 to 2011, we conducted a national survey of US physicians from multiple specialties. Primary outcomes were a validated single-item measure of burnout or sense of calling to end-of-life care. Primary predictors of burnout (or calling) included clinical specialty, frequency of encounters with dying patients, and patient centeredness of the clinical environments ("My clinical environment prioritizes the need of the patient over maximizing revenue").
  
  
  RESULTS
  Adjusted response rate among eligible respondents was 62% (1156 of 1878). Nearly a quarter of physicians (23%) experienced burnout, and rates were similar across all specialties. Half of the responding physicians (52%) agreed that they felt called to take care of patients who are dying. Burned-out physicians were more likely to report working in profit-centered clinical environments (multivariate odds ratio [OR] of 1.9; confidence interval [CI]: 1.3-2.8) or experiencing emotional exhaustion when caring for the dying (multivariate OR of 2.1; CI: 1.4-3.0). Physicians who identified their work as a calling were more likely to work in end-of-life specialties, to feel emotionally energized when caring for the dying, and to be religious.
  
  
  CONCLUSIONS
  Physicians from end-of-life specialties not only did not have increased rates of burnout but they were also more likely to report a sense of calling in caring for the dying.
authors.affiliation: 1 Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA.|2 The MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Yoon
authors.affiliation: 3 The University of Chicago Divinity School, Chicago, IL, USA.
authors.forename: Natalie B
authors.initials: NB
authors.lastname: Hunt
authors.affiliation: 4 Georgetown University School of Medicine, Washington, DC, USA.
authors.forename: Krishna C
authors.initials: KC
authors.lastname: Ravella
authors.affiliation: 1 Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Jun
authors.affiliation: 5 Trent Center for Bioethics, Humanities, and History of Medicine, Duke University, Durham, NC, USA.
authors.forename: Farr A
authors.initials: FA
authors.lastname: Curlin
mesh_terms: D000328:Adult; D000368:Aged; D002055:Burnout, Professional / Q000453:epidemiology*; D002321:Career Choice; D004777:Environment; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D010820:Physicians / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*
keywords: burnout; calling; hospice; palliative medicine; patient-centered care; religion