Physician burnout and suicide were epidemics before the current pandemic.
“Nationwide, our doctors are jumping from rooftops, overdosing in call rooms and hanging themselves in hospital chapels. It’s medicine’s dirty secret.”
This unnerving account by Pamela Wible, MD during her 2015 TEDMED talk sent chills down my spine. Dr. Wible described the death of one physician by bullying, hazing and sleep deprivation – a “torture technique” – adding that each year, more than one million Americans lose their doctor due to suicide. Her cell phone has become an unofficial suicide hotline. The founder of Ideal Medical Care, Dr. Wible is also featured in the groundbreaking documentary, Do No Harm, which has been virtually screened every Sunday in May at 8pm EST. “Suicide is an occupational hazard of our profession.”
Physician burnout was an epidemic BEFORE the Covid-19 pandemic. According to a 2018 study, 400 physicians die by suicide each year – double that of the general population. In addition, doctors have the highest suicide rate of any profession in the U.S including combat veterans. From an economic standpoint, studies estimate that physician burnout is costing the health care system approximately $4.6 billion per year. So, how do we stop this dreadful reality? Read on (HINT: it’s NOT through resilience and wellness trainings).
Burnout Isn’t Just Stress
Many doctors view medicine as a calling, entering the field with immense altruism paired with a passion for science and healing the sick. The erosion of these intrinsic motivators leads to burnout which psychologist Christina Maslach defines as a syndrome of emotional and physical exhaustion, depersonalization and diminished personal accomplishment.
“The stress of long hours, no sleep, poor eating, inadequate protection, the fear of contaminating loved ones, the fear of dying and seeing patients die no matter what you do, the disrespect by hospital administrators and the fear of being fired, all remain the reality for those who are in the thick of things,” denounced Lynette Charity, MD, an anesthesiologist who speaks nationwide about physician burnout.
Studies also show that burnout is associated with negative clinical outcomes: decreased quality of patient care; increased number of medical errors; and higher rates of addiction, depression and suicide among physicians.
Dr. Lynette Charity, an anesthesiologist and physician advocate, speaks nationwide about burnout … [+]
Lynette Charity, MD
Burnout has nothing to do with weakness, laziness or incompetence. “The prevailing attitude,” report Pamela Hartzband, MD and Jerome Groopman, MD in a recent NEJM article, “was that burnout is a physician problem and those who can’t adapt need to get with the program or leave.” Turns out that structural and systemic issues are heavy culprits. Despite lip service to “patient-centered care,” many physicians believe the current healthcare system is propelled by money and metrics, according to Hartzband and Groopman. Doctors are well-meaning and willing to work long hours, and hospital executives know this and exploit it, as Danielle Ofri, MD aptly asserts in The Business of Health Care Depends on Exploiting Doctors and Nurses.
Why the Covid-19 Pandemic Will Worsen Doctor Burnout
Medical workers in protective clothing move the body of a deceased patient to a refrigerated … [+]
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The medical field is at a crisis. This pandemic has exposed many cracks in the U.S. healthcare system. From inadequate testing and personal protective equipment (PPE) to overcrowded emergency departments, frontline health staff are putting their lives at risk to care for highly infectious patients debilitated by Covid-19. And yet medical professionals are responding to this crisis with unprecedented selflessness, resilience and compassion.
“For many physicians, Covid-19 may be the proverbial straw that breaks the camel’s back as they isolate themselves physically from their family and friends while encountering a surge of sickness and death,” said Nisha Mehta, MD, radiologist, physician advocate and keynote speaker.
Here are a few real-world examples. About a month into the pandemic, at the end of a difficult shift, an infectious disease physician with 20 years of experience, texted me the following: “Just admitted a 28yo pregnant woman in 2nd trimester w COVID. About to get intubated. I hate these days.” Two weeks later, this same physician texted: “I just started sobbing. I mean, bawling. But in the bathroom so my 6yo wouldn’t see.”
A doctor checks on a Covid-19-infected patient connected to a ventilator.
Tangible Solutions Moving Forward
Some hospitals have created the position, Chief Wellness Officer. Others have offered resilience and meditation workshops, social hours and tips for maximizing productivity. But, according to Hartzman and Groopman, none of these “solutions” address the underlying problem: a profound lack of alignment between caregivers’ values and the reconfigured health care system. Here are some strategies that may actually curtail the wave of physician burnout and suicide:
1. Reduce administrative burden – This includes prior authorizations, disability paperwork and the electronic medical record (EMR) which has simply become a burdensome billing tool. “Let the bean counters and the C-Suite collect the data and enter it into the EMRs,” suggested Dr. Charity, adding: “Provide scribes for the doctors.”
2. Flexibility over schedules – A 2017 study showed that physician input in scheduling was one of the few systems solutions that reduced burnout as it allowed for individual practice styles and patient interactions.
3. Mental health support – Because burnout can lead to depression, anxiety, PTSD and secondary trauma, appropriate and timely mental health treatment is critical and can include counseling and medications. In NY state, text NYFRONTLINE to 741741 to access 24/7 emotional support services.
Access to timely mental health support is critical in reducing burnout.
4. Reduce gender bias – The National Academy of Medicine reported that burnout may be 20-60% higher among female vs male physicians. Over 70% of women doctors experienced gender discrimination; they are consistently paid less than their male counterparts, less likely to be referred by their professional titles and less likely to be promoted. Female physicians also spend 8.5 additional hours per week on childcare and other domestic duties, while men reported spending an extra 40 minutes on domestic work.
6. Diversify Doctor Voices – We need more women and women of color to be in decision-making positions. Minority voices are not being heard, and they are being disproportionately harmed.
7. Speak Out – If you’re a physician who’s going through a hard time, I promise you you’re not alone. Please talk to somebody. And if you see a colleague suffering, please get her/him help. You may just be saving a life. Call National Suicide Prevention Lifeline 1-800-273-TALK (8255).
In addition to the above recommendations, a group of New York doctors (myself included) created a petition to advocate for physician protection and compensation which is being sent to legislators. It can be signed by non-healthcare workers.
Dr. Nisha Mehta, a physician advocate: “So many physicians contact me with fears, frustrations and … [+]
Ian McSpadden Photography
Medicine is a calling for many. But is it really worth dying for? I don’t think so. Doctors are people, too. And that’s not being trite. In order to stem the tide of physician burnout and suicide, we all have a role to play. If we want our doctors to be whole and full of joy, we must reaffirm their humanity and their value in society. Medical culture and health care systems must change – but this will only happen when they’re forced to change. Physicians must first acknowledge and heal their own pain and suffering – for their sake and that of their patients and communities.