Burnout in Family Physician Maternity Care Providers?

We appreciate Goldstein and colleagues’ comprehensive, thoughtful article summarizing strategies to support family physician maternity care providers and we share their aim to reverse the trend of fewer family physicians providing maternity care.1 However, we were surprised that the authors identified burnout as a possible reason for leaving maternity care practice, and disappointed that they did not use a more precise definition of burnout.2

The authors defined burnout as “being at high risk for leaving maternity care practice.” Perhaps a more widely-accepted definition of burnout could have been used, such as “a psychological syndrome in response to chronic interpersonal stressors on the job... three key dimensions of this response are an overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment.”3 For many contemporary physicians, causes of burnout may not be the burden of traditional “doctoring” work, such as caring for pregnant women, delivering babies, and providing newborn care, but more modern practice demands, such as documentation, asynchronous communication, and productivity pressure.

It is certainly possible that burnout contributes to physicians’ decisions to leave maternity care practice. However, if we are to reverse the attrition of family physicians from the maternity care workforce, it is important that we identify and define the real causes. In our community, many family physicians have recently stopped providing inpatient maternity care. When questioned about why, the most common reason given was not burnout, but rather the competing demands of personal life. This theme is supported by literature, which indicates that family physicians stop practicing obstetrics primarily because of logistical considerations, including the demands of on-call time, family needs, and concerns about maintaining competence.4 More research is needed to better understand the motives of family physicians who stop delivering maternity care, and more importantly, to identify system changes that can make maternity more care feasible for contemporary family physicians.

Labeling “being at high risk for leaving maternity care practice” as burnout implies that practicing maternity care contributes to burnout, but evidence suggests the contrary. Recently, Weidner and colleagues published a secondary analysis of the 2016 National Family Medicine Graduate Survey, which asked family physicians 3 years after residency graduation about self-reported burnout. Their evidence suggests that providing maternity care is protective against burnout (OR=0.64; 95% CI, 0.47-0.88; P=.0058), at least for new physicians.5

Perhaps we should propose that family doctors provide maternity care as an antidote to burnout. Although maternity care is real work, we who deliver this care find that it brings us real joy. Contrary to the burnout definition above, it promotes a sense of connection with patients and families, professional effectiveness, and accomplishment. By delivering maternity care, we stay connected with our rich history and identity as family physicians, while simultaneously providing a service our communities desperately need.

In any event, we should be careful about our definitions, and seek to better understand how we can reverse the loss of maternity care from family medicine practice.