Medicine has become increasingly stressful for all levels of health care providers. Every year, nearly 400 physicians commit suicide, and in a study published in the Journal of Academic Medicine, researchers found that almost 10 percent of final year medical students and first-year residents (called interns) reported having suicidal thoughts. Previous studies from the National Institutes of Health found that physicians were twice as likely to kill themselves as non-physicians. The statistics are staggering— suicide accounts for 26% of deaths in physicians ages 25-39 as compared to 11% of deaths in individuals of the same age in the general population. More must be done to both recognize and prevent physician depression — this all starts with working to avoid burnout.
Burnout in medicine, defined as “physician burnout,” is quite common. A study in the Mayo Clinic Proceedings found that burnout rates continue to rise and most physicians are very unsatisfied with their own work-life balance.
Warning signs of burnout
As burnout becomes more prevalent, we have been able to identify some early warning signs. Awareness of these signs may lead to early intervention and prevention of more serious burnout resulting in physicians leaving medicine entirely.
Warning signs include:
- emotional exhaustion
- depersonalization and trouble connecting with patients
- reduced accomplishment/confidence in skills
Causes of burnout
In order to make a difference in the lives of physicians and their families — and prevent burnout — a great deal of effort has gone into trying to determine the causes of burnout in hopes of making more of an impact early on and avoiding burnout before it occurs. To make this happen, we will need the support of lawmakers, regulators and medical societies.
Too many clerical tasks. Doctors now have to perform more administrative duties, and metrics are now putting increasingly daunting non-clinical tasks before physicians. Most doctors go to medical school to care for patients. Patient care provides fulfillment — paperwork does not. Physicians are now scribes, coders and schedulers in addition to healers. Many doctors are left to wonder why they went to medical school — it certainly was not for a data entry job.
Too little time to effectively work with patients. As physicians, most of us went to medical school because we loved science and we cared for patients. Patients provide challenges, opportunities for relationships and a way in which we can improve the world.
Declining salaries. Medicine takes commitment, time and money for education. Many physicians have taken on a great deal of debt and have made numerous personal sacrifices to train for years to provide top-notch care to the patients that they treat. As health care reform moves forward, physicians are caught in the middle. Salaries decline, workload and non-clinical demands increase. Without meaningful tort reform, frivolous malpractice claims continue to propagate. All of these factors work to diminish physician satisfaction and contribute to burnout.
Longer work hours. With declining reimbursement, physicians are being asked to do more with less time. Documentation requirements and electronic medical records (EMR) have resulted in more time spent at home completing paperwork. All of this takes away from private time with family and significantly impacts happiness and life-work balance.
Consequences of burnout
Poor patient care. When physicians are emotionally and physically depleted as commonly seen in burnout, patient care may suffer. Distraction, lack of attention to detail and poor decision-making can be more common. To provide the best care, physicians must engage with their patients and develop a personal connection. If physicians have burnout, often there is no time or energy left for cultivating these important relationships.
Depression/suicide. A staggeringly high number of doctors, when polled, have clinical signs of depression and many have contemplated suicide. Sadly, every year in the United States, over 400 physicians commit suicide. Depression can adversely affect family life and can impact a doctor’s ability to perform in the clinical setting. Sleep disturbances and fatigue are common.
Early retirement/MD shortages. For many, the prospect of practicing medicine is no longer tenable. Many physicians are looking for other business opportunities and are leaving medicine entirely. As the pool of insured patients grows, a physician shortage looms. If we continue to lose practicing, experienced physicians due to burnout and early retirement from medicine, this shortage will only become more significant. Patient access to skilled physicians is a critical part of patient engagement and improving outcomes. If more physicians leave medicine, the workload will only grow for those who remain.
What we can do about burnout?
Burnout is a real issue in medicine today. We must make efforts to address this problem before more doctors are lost. Here are a few things that I believe will help ward off burnout:
Schedule regular time off/extended vacations (two weeks). While it is not the typical American way to take a vacation, I think that extended time away from clinical responsibilities may be essential to avoid burnout. By “unplugging” from the office and clinical demands for more than a week at a time, health care professionals can recharge and return to clinical practice more refreshed and ready for the challenges of patient care.
Schedule regular exercise. It is a fact that regular exercise is associated with lower rates of depression and other chronic disease. In general, when we exercise, we can turn our thoughts away from work and outside stressors and focus on the moment. Exercise also promotes an ideal body weight and overall improved health status.
Healthy diet. Along with exercise, healthy eating can help physicians avoid burnout. When we eat good healthy well-balanced meals, we can maintain an ideal body weight. Avoiding sugars and alcohol can certainly help prevent depression and other burnout related complications.
Supportive spouse. Having a life partner or spouse who can listen and support the stressed physician is crucial. A supportive partner can serve as a sounding board and can offer suggestions and facilitate interventions when necessary. Also, the supportive spouse can also help identify early warning signs for burnout and suggest early intervention.
What does the future hold?
Burnout is more common than many physicians think. No health care provider is immune. It is essential for physicians, as well as their co-workers and families, to understand the signs and symptoms associated with burnout and intervene early. Burnout can have severe consequences including depression, and in severe cases — physician suicide. These are completely avoidable if we begin to better understand what the root causes of burnout are. By understanding the etiology of burnout, we may be able to design a better working environment for today’s physicians. If we do not make these changes, I fear that many physicians will leave the practice of medicine within the next five years.
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