There is a disease sweeping the nation that has significant consequences for every person living in this country, even if they never contract it directly. And despite its lethality, there is precious little being done about it. It’s called physician burnout, and it affects all of us.
Doctors, on average, spend at least eight years in college, followed by years of postgraduate training during which time they work 80 hours a week. They graduate with a mountain of debt, face the constant fear of malpractice litigation, and are burdened by incessant demands to see more patients in less time with more administrative paperwork. On top of which, there’s compassion fatigue – helping the sick, the injured and the dying is rewarding no doubt, but often emotionally draining. All of this leads to physician burnout.
More than any other profession, doctors face burnout, and the rates have been increasing. A recent study by researchers at the Mayo Clinic found that the number of physicians suffering from burnout is 54%, up from 45% in 2011. And physicians are more than twice as likely to commit suicide than non-physicians; every year, 400 doctors in this country take their own lives.
Why should you care? Because the emotional health of doctors has a direct effect on the broader public. There are a plethora of stories of physicians who describe the chilling consequences of their depression. One surgeon wrote in a recent blog, “my depression…was exacerbated by work. I clearly wasn’t performing to the best of my abilities, and my patient complications and complaints were increasing. A patient died from a post-operative bleed. Would I have managed it better if I wasn’t suffering myself? (When I spoke to the patient’s wife, as he lay dying 20 feet away, she asked me if I was OK.)” Burnout causes a lack of clarity in thinking leading to medical mistakes. “Given the extensive evidence that burnout among physicians has effects on quality of care, patient satisfaction, turnover, and patient safety, these findings have important implications for society at large,” researchers from Mayo Clinic told Forbes.
But it’s not just that doctors who are burned out are more likely to make errors – they’re also more prone to biases noted a recent report. And, it’s clear that bias clouds judgment and causes physicians to treat certain patients differently than others. “Physicians who are burned out, stressed and generally frustrated over near-term crises or long-term concerns are more likely to react negatively to patients,” said a recent study.
Beyond medical errors and poor patient interactions, physician wellbeing also affects access to care. A recent Physicians’ Foundation survey found that 44% of physicians were planning on reducing patient access by either cutting back on patient load, working part time, closing their practice to new patients or retiring. Physicians are getting tired of the “turnstyle” medicine they are being forced to practice – seeing more patients in less time – rather than building the relationships that inspired them to enter the profession. Increasingly, however, the physician-patient relationship is being supplanted by the economic demands of a medical machine. While some have tried to fight back with efforts to unionize, others simply retire or find alternate careers. Such erosion of the profession, especially when coupled with an expected doctor shortage over the coming decades due to fewer trainees, has the potential to seriously impede access to care.
As physicians, we have the humbling privilege of caring for the sick, the weak and the injured. We spend years perfecting our skills in diagnosis and treatment so much so that the idea that we may be suffering ourselves is difficult to accept. We can no longer afford to ignore the fact that burnout affects not only ourselves and our families, but our patients as well.
This is not an issue physicians can address alone. Indeed, a concerted effort is required across all stakeholders. Hospitals must work to foster environments where the economic demands of a viable enterprise are balanced against the need for a happy and healthy physician workforce. Policy makers must consider the ramifications of increasing administrative burdens and reducing reimbursements which only serve to fuel physician fatigue. As a society, we need to ensure we look after the professionals we entrust with our health. When over half of all physicians are burned out and the trend is continuing to rise, there is a silent healthcare epidemic in this country that needs to be addressed. How long can we continue to ignore what is becoming a “critical condition”?
Anees Chagpar is a Yale associate professor of surgery and Director of The Breast Center — Smilow Cancer Hospital at Yale-New Haven.
While current practice is dismaying
Think of all the people they ‘infect’ with their dissatisfaction – their colleagues, families and patients.
Almost every time I consult with a MD I get their sad stories about how difficult their jobs have now become – churning of patients, the attach of EHR, the cost of their education and debt. You would think that they were the only ones affected by this whole new speed-up, techno world. And suicide is the choice of some in handling it? Hmmm.
I don’t mean to downplay the stresses physicians face only to say that practically the whole medical world is facing the same thing. They are not alone.
Nurses who spend eight plus hours at bedsides with large patient loads, demands for charting, ordering, patient services et al. And, the paternalistic ‘doctor knows best’ attitude only adds further stress. For years their response to these stresses was to leave and find something more satisfying.
And the cost of your education? Check to see what a nurse practitioner or doctor of nursing practice has to pay for his/hers.
With the large number of nurses and physicians practicing today, it is hard to understand why a concerted effort to change the broken system is not underway. It only took one or two Moms to start MADD or two college students to start a electronics revolution.
The background rate of burnout in physicians has been 30% over 40 years of prevalence studies … AND the recent increase is very troubling. 54% in the latest study of US physicians and the conditions in the British NHS are probably worse judging by the strikes and suicide numbers coming out recently.
In my work with hundreds of burned out physicians we have found four major categories of stress that cause burnout.
It is also important to know there are over 117 ways to prevent burnout if we combine personal resilience tools and organizational responses.
And we have been fortunate enough to have a number of corporate clients who have worked closely with our burnout prevention tools to the point where we have a best practice strategy for a system-wide, proactive burnout prevention program.
Hope this helps you and your people
Dike Drummond MD
CEO and Founder
You hop quickly to poor pay and administrative burdens as the sources of the problem. However, one can point to other probable culprits.
Sleep: The key to emotional health and long term well being. The science is clear, but the medical community ignores it for its own. 80 hour weeks for residents–and most face demands to bend rules and work more–breaks future physicians down slowly but surely and lowers the quality of care. Established physicians prop up these archaic practices by justifying it with macho stories from their harrowing 100+ hour week residencies, as if the inhumane treatment they faced is proven worthwhile if incoming physicians relive harsh hours. And surgeons in particular seem to carry on with limited sleep as a long-term life style. This tradition of sleep deprivation is something that the medical community could end on its own through self regulation.
There is more to emotional pressures on physicians than lack of sleep, of course. For one, the science of medicine expands exponentially, while the capacity of one human’s brain does not. This leads to increasing gaps between best medical practice and the insights that any doctor can offer their patient in their individual practice, and thus the emotional stress from vague awareness that gaps in their knowledge impact patient lives. Are there answers to this? Team-based care is perhaps one means, and it would be interesting to know whether physicians working in collaborative teams maintain stronger emotional health. Can new IT tools reduce some of these knowledge gaps? Given the stress faced by physicians, and I bow to them and what they do for society, it’s worth rolling out artificial intelligence and testing whether it can aid physicians at least some.
“Increasingly, however, the physician-patient relationship is being supplanted by the economic demands of a medical machine.”
Why aren’t physicians part of the “medical machine”? 2015 survey of compensation shows specialties earn average of just under $300k and PCPs just under $200k.
Do you separate “burnout” of specialties and PCPs, or hospital docs as opposed to private practice?