Burnout in doctors and stressed physicians hurt patients

The following op-ed was published on July 18th, 2010 in USA Today.

A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted.

Burnout affects more than half of doctors, according to researchers at the University of Rochester School of Medicine. Beyond mere job dissatisfaction, these doctors are emotionally exhausted to the point where they lose focus. They tend to be more depressed — perhaps one reason why doctors have a higher suicide rate than the general population.

While burnout can happen in any profession, the performance of stressed-out doctors can hurt someone else: patients.

Studies show these doctors exhibit less empathy, which erodes the doctor-patient relationship. More ominous is how physician burnout can lead to medical mistakes. A Mayo Clinic study released last month found that burnout in surgeons correlated to a higher rate of major medical errors. That corroborated last year’s finding in The Journal of the American Medical Association of a similar effect among internal medicine doctors.

Overwhelmed

I see plenty of reasons why doctors are ending up this way. With the explosion of new treatment options and an expanding number of patient care guidelines, our responsibilities are increasing. It’s estimated that it would take 18 hours a day to provide all the recommended preventive and chronic care services to my patients. And that’s not counting the 20 telephone calls I return and 30 test results I review daily, which, as The New England Journal of Medicine reported in April, is typical of what other doctors like me face.

When the burden gets to be too much, doctors are simply walking away from the job. Recently, researchers from the American College of Physicians and the American Board of Internal Medicine found that one in six primary care doctors had left their field mid-career. More than 20% cited long hours and administrative hassles as reasons.

Finding answers

Physician training must begin to address burnout. Earlier this year, psychiatrists noted that 4% of entering medical residents were diagnosed with depression, a rate comparable to the public. But that percentage ballooned to 25% after a single year.

As Colin West, associate program director of the Mayo Clinic’s internal medicine training program, told The New York Times last October, “There has been a tendency in medicine to minimize our distress because our focus is supposed to be on the patient … but the distress in medical training right now is epidemic.”

Organizations that regulate resident physicians have sought to limit hospital work hours to mitigate fatigue. But dealing with stress and depression is just as important. Early identification and management can prevent at-risk doctors from continuing on a path toward burnout.

Practicing physicians should also be given the tools to ward off burnout. A pilot study at the University of Rochester’s School of Medicine last year found that teaching meditation and relaxation techniques resulted in less emotional exhaustion, and gains in patient empathy.

Stressed doctors who quit will be of no help to the more than 30 million newly insured patients in the coming years. Although health care reform has allocated resources to shore up primary care and train more providers to meet the new demand, little has been proposed to recognize and treat burned out physicians. These doctors, and their patients, deserve better.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • Patrick

    I agree, doctors tend to put other’s first, often at our own detriment. In Texas, we have some CME on the topic of preventing burnout, depression, and maintaining balance: http://www.texmed.org/Template.aspx?id=2169

  • http://blog.abhayamedia.com AbhayaMedia Health

    Most people in the profession of handling people have stress related problems. Nevertheless, doctors have to bear the highest burden as they are ethically and morally responsible for their patients and patient’s family. it is not easy to handle the pressures of being a doctor.

  • bev M.D.

    I believe a huge source of burnout is our failed medical ‘system’ which creates bureaucratic chaos in offices, hospitals and patients’ minds and leads to a mentality (and reality) of constantly putting out fires. Physicians’ medical societies need to recognize what is going on and devote some of their energies to resolving these issues, which may be ultimately more important to our profession than how much $$ we can make. Contrary to what docs think, we CAN work with administrators and the government, if it is done in a thoughtful and science-based, rather than reactionary, manner.

  • http://drgrumpyinthehouse.blogspot.com/ Dr. Grumpy

    It’s hard to avoid it, especially in solo practice. I try to balance my work with things I enjoy doing, (family, writing) to keep my sanity.

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