The events of recent years have catapulted mental health awareness into the spotlight. With long hours and intense workplace pressures, physicians unfortunately are not immune to burnout and depression.
According to the WHO, “Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” It is characterized by exhaustion, negative feelings about one’s job, and reduced professional efficiency.
More than 40% of all physicians and 50% of female physicians reported feeling burned out, according to a 2019 Medscape report. Fast-forward 2 years, and a raging COVID-19 pandemic has plagued physicians with increased stress and unsafe working conditions, driving burnout rates to an all-time high, according to Medscape’s 2021 report. When asked about burnout severity, more than 70% of physicians considered burnout to be serious enough to have a moderate effect on their lives, with 10% considering it severe enough to weigh leaving medicine altogether.
What are the leading causes of physician burnout and what factors are preventing physicians from seeking help? And for those who want help but don’t know where to start, what are the mental health tools and resources available to physicians?
Causes of burnout
According to the 2021 Medscape National Physician Burnout and Suicide Report, the leading causes of burnout among doctors are too many bureaucratic tasks, long work hours, and lack of respect from employers and colleagues.
Interacting with patients and making a tangible difference in their lives is often the most rewarding part of practicing medicine. However, paperwork and administrative tasks are increasingly becoming a burden on doctors and reducing the time they have to devote to their patients. A decade ago, most doctors only clocked in 1-4 hours of paperwork a week, with a minority spending 5-9 hours. In a 2019 report, 74% of physicians reported spending more than 10 hours a week on paperwork-related tasks, with 36% devoting more than 20 hours to completing these tasks.
Impact on patient care
With pervasive feelings of burnout in the medical community, what are the repercussions on patient care? When asked about the impact feelings of depression and burnout had on their patient interactions, more than half of physicians reported negative consequences, according to the 2021 Medscape report. A third of physicians reported feeling easily exasperated with their patients, with 15% acknowledging making medical errors they would not normally make.
Root of mental health stigma
Physician burnout is leading to disastrous consequences for doctors and patients alike. So, what is stopping physicians from seeking help?
Many physicians are afraid that they will be perceived as weak or unfit to practice medicine by their colleagues and employers. This stigma is deeply ingrained in the medical community and begins early in medical training. For example, only a third of medical trainees who reported experiencing feelings of burnout sought help. This same reluctance to seek help among doctors also applies to feelings of depression, substance abuse disorders, or suicidal thoughts.
Apart from the stigma associated with seeking help, physicians are often reluctant to admit feelings of burnout or depression due to worries about license renewals. Between 1996 and 2006, questions about substance and mental illness on state medical license renewal applications have almost doubled, allowing state medical boards to discriminate against doctors who admit and seek mental health help. In 2018, the Federation of State Medical Boards (FSMB) published recommendations to limit questions related to mental health to only what is necessary and relevant. However, a recent article published in the Journal of American Medical Association found that as of July 2020, the FSMB guidance was only adopted fully by the state of North Carolina and five states were found to be non-adherent to any of the recommendations. While there have been positive strides taken to limit medical license application questions concerning mental health, we still have a long way to go in ending the stigma associated with seeking help.
Mental health resources
Interventions aimed at reducing physician burnout can be classified as organization-directed or physician directed. Physician-directed resources increase physician resilience by promoting activities such as mindfulness, improving coping and communication skills, and enhancing competency. However, these approaches generally fall short because burnout often originates from system-level factors. Interventions to prevent burnout are likely to be effective when a combination of physician-directed and organization-directed approaches are utilized. Some examples of organization-directed changes include adjusting work schedules to reduce workloads, improving teamwork, and including physicians in the day to day decision making.
When organization-driven changes are not possible, here are a few physician-directed ways to limit burnout.
Find a support group. Having a close-knit community of colleagues and mentors to confide in, especially when stress levels are high, can help you cope with feelings of burnout and depression. Not suffering in silence allows you to share your experiences with trusted peers who may have had similar experiences.
Incorporate exercise into your routine. Spending 30 minutes each day exercising can have a positive impact on your health, improving mood and sleep habits. Nearly 50% of physicians reported that they use exercise as a coping mechanism when feeling burned out.
Join a task force. Joining committees at the workplace allows you to take an active role in influencing the policies that directly affect you.
Take a class. Continuing education allows you to remain current and focused. For physician well-being activities that offer continuing medical education credits, click here.
Ultimately, physicians are suffering from feelings of burnout at alarming rates and individual as well as organizational changes are desperately needed to combat this epidemic.