Each year, nearly 400 physicians commit suicide and a study published in the Journal of Academic Medicine, reported that nearly 10% of final year medical students and first year residents (interns) expressed they were having suicidal thoughts.
Previous studies from the National Institutes of Health showed that physicians were twice as likely to kill themselves compared to 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 (Physician burnout) is quite common. A study in the Mayo Clinic Proceedings found that burnout rates continue to rise and most physicians are highly 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 could 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
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 preventing burnout before it occurs. However, to effectively accomplish this, we would 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 where 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 healthcare reform moves forward, physicians are caught in the middle. Salaries decline, workload and non-clinical demands increase and 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 EMRs 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.
Patient care can easily suffer when physicians are emotionally and physically depleted. Distraction, lack of attention to detail, and poor decision-making can become more common. In order to provide the best care, physicians must engage with their patients and develop a personal connection. But, if physicians experience burnout, often there is no time or energy left for cultivating these important relationships.
A staggeringly high number of physicians, 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.
• 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, 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 (2 weeks).
While it is not the typical American way to take vacation, I think that extended time away from clinical responsibilities could be key. By “unplugging” from the office and clinical demands for more than a week at a time, healthcare professionals would be able to recharge and return to clinical practice more refreshed 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 are able to turn our thoughts away from work and outside stressors and focus on the moment. Exercise also promotes a more ideal body weight and overall improved health status.
• Healthy diet.
Along with exercise, healthy eating can help physicians avoid burnout. When we eat healthy, well-balanced meals, we are able to maintain a more ideal body weight. Avoiding sugars and alcohol can certainly help avoid the depression and other burnout related complications.
• Supportive spouse.
Having a life partner or spouse who is able to listen and support the stressed physician is very important. A supportive partner can serve as a sounding board and can offer suggestions and facilitate interventions when necessary. The supportive spouse can also help identify early warning signs for burnout and prompt early intervention.
What does the future hold?
Burnout is more common that many physicians think – no healthcare provider is immune.
It is essential for physicians as well as their coworkers and families to understand the signs and symptoms associated with burnout, as it can have severe consequences including depression, and in severe cases, physician suicide. 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.