73: Burnout Is Going Down. That Might Be the Bad News.

Here's the number.

In twenty twenty-five, forty-one point nine percent of physicians reported at least one symptom of burnout, down from forty-three point two percent the year before and forty-eight point two percent the year before that.

Fourth consecutive annual decline.

That's the AMA's national data.

Tens of thousands of physicians, dozens of states, more than a hundred health systems.

It is not a small or sloppy data set.

And I'm not here to tell you the good news is fake.

But I am going to ask a question about it, and it's the question we'd ask about any study we read in Journal Club.

Who's in the denominator? Because that survey asks practicing physicians, people still in the building.

And if you want to know why a number like that goes down, there are two possible explanations, and they are very different from each other.

Explanation one, physicians are less burned out than they used to be.

Things got better.

The interventions worked.

Explanation two, the most burned out physicians left, and the people still answering the survey are the ones who stayed.

Same number.

Completely different world.

That second one has a name, survivorship bias.

And you already understand it because it's the same error as looking at the patients still coming to clinic and concluding the treatment is working great when the ones it failed stop showing up.

The pool didn't get healthier.

The pool got selected.

So which is it? Let's go find out because we actually have the data.

The AMA published research this year on when physicians stop practicing.

Not intent, not survey answers, actual attrition.

Physicians are now leaving clinical practice nine years earlier than they did in two thousand eight.

Nine years.