Large healthcare organisations are leaving physicians feeling overwhelmed, beaten up, and exhausted, with a recent report showing that in the US, 53% of physicians feel burned out by the job requirements, another 65% say work pressure has affected their relationships, while a number of doctors are leaving clinical medicine because of the pressures.
The Medscape US Physician Burnout & Depression Report: 2023 showed that topping the list for depression and burnout were emergency medicine staff (65%), followed by internal medicine (60%) and then paediatrics (59%). Bottom of the list were the least affected: public health and preventative medicine, at 37%.
What is it about being employed by large organisations that can be so negative? In another study, MEMO – Minimising Error, Maximising Outcomes – researchers at the University of Wisconsin surveyed more than 400 doctors to learn about how their working environments corresponded with medical errors.
More than half of them reported time pressures when conducting physical examinations. Nearly a third felt they needed at least 50% more time than was allotted for this patient care function, and nearly a quarter said they needed at least 50% more time for follow-up appointments.
Although one frustrated physician noted that “you have to be a sociopath to enjoy working in a large organisation” – lacking in feelings for others – “It’s a very small number of doctors who get in it for the wrong reasons and therefore care about their own benefit and not their patients”, said psychiatrist Wendy Dean, MD, CEO and co-founder of Moral Injury of Healthcare, a non-profit organisation addressing workforce distress in healthcare. “Those are the outliers.”
Most physicians do care about their patients – deeply, she said. They struggle under the weight of the healthcare system and yet must find ways to get through.
Today, thriving in an imperfect system requires honing new skills, asking for help when needed, and pushing for systemic and cultural change, reports Medscape.
“We’ve been assessing and trying to address burnout for half a century,” said Dean. “Despite all good intentions, and people dedicating their entire careers to solving the issue, we’ve barely made a dent.”
With the advent of new technological requirements on the job and more demands from increasingly larger healthcare organisations, the risk for burnout is higher than ever before.
“There’s a growing burden of regulatory-mandated and cumbersome administrative workload per patient,” said Dr Shomron Ben-Horin, co-founder of Evinature. “Often the computer/paperwork before and after a procedure is much longer than the procedure itself.”
Meeting health insurance requirements is increasingly cumbersome, too, and pre-authorisations and debates with payers over medical approval may put physicians frustratingly in the middle.
“This increases the psychological burden for physicians who may feel responsible for wrongdoing, no matter which option they deem better,” Ben-Horin says. “Add in physician accessibility around the clock via mobile phones, emails and apps, and you end up on call even if you’re not officially on duty.”
Why some doctors suffer more
Some physicians are more likely to suffer burnout than others, said Dr Jessi Gold, assistant professor in the department of psychiatry at Washington University in St Louis School of Medicine.
“The self-valuation concept comes into play here. If you make a mistake, do you blame yourself or see it as a growth opportunity? If it’s the former, you’re more likely to burn out.”
Ben-Horin added that the most patient-centric doctors are those who struggle most. “These are the doctors we’d all love to have as a patient,” he said. “But they are burdened by the extra tasks of the job, and they are the most stressed by the environment.”
So too are those physicians who never master compartmentalising their feelings and emotions. “We learn in training to compartmentalise our emotions,” said Dean. “You can’t allow yourself to get emotional while performing chest compressions on an 18-year-old kid. So you shut it all away; otherwise, you might lose the patient.”
This turn-off switch becomes automatic, but it also comes at a cost. “Doctors talk about how a life and death situation eventually becomes so common they have to put the emotions away, work on the patient and move on to the next,” said Dean.
“But the next patient needs you just as much. We must lock away our feelings and manage the situation.”
Gold said burying feelings, however, is a symptom of burnout. “We have to remove ourselves emotionally to protect ourselves. We can’t cry, but we can’t bury our feelings either.”
Instead, Gold suggested, a good medium may exist. “You may not be able to address them in the moment, but you should, sometime after.”
This is just a starting point on how to remain a dedicated, caring physician without burning out.
“The system is pretty broken, and to survive it first means wanting to survive it,” added Gold. “There’s a lot of focus on resiliency and lack thereof if a physician expresses burnout, but that’s a false notion. Doctors are a resilient bunch but even they get burned out.”
Change for the better must come from several places. One is asking for help, something that can be hard for a group conditioned to keeping a stiff upper lip. “Just because your peers might look healthy (emotionally) doesn’t mean they are,” she said. “We’ve normalised this culture of burying feelings, but that doesn’t mean it’s right.”
Ben-Horin also advocates diversifying your work. This might include engaging in research and academics, for instance. “This not only makes you a better broad-perspective doctor but allows you to psychologically switch gears on research days,” he said
The biggest place to make change, however, is within the healthcare system culture itself. The American Medical Association created various recommendations to address burnout at the resident and fellow level, a good starting point to carry through into staff work.
The steps include creating a well-being framework; gathering a team to support a well-being programme; developing the programme in a way to foster fun and connectivity among staff; fostering individual well-being that addresses emotional and physical well-being; and confronting burnout and creating a sustainable culture of well-being.
On a personal level, it's essential that physicians keep close tabs on themselves and peers. “Understand the signs and symptoms of burnout by taking stock of where you are emotionally,” advised Gold.
“Have a place and time at the end of a hard day to reflect or find a ritual that helps you and stay with it.”
You might also reach out to a therapist or a peer when you're struggling. Having honest conversations with peers can go a long way. “Find a confidant who allows you to be vulnerable,” she recommended. “Acknowledge that this is hard and that you might need help taking care of yourself. The system needs to change, but we can also learn to survive in the meantime. You don’t have to be a sociopath to make it.”
Medscape Burnout & Depression Report (Open access)
See more from MedicalBrief archives:
Peer comparison among doctors can backfire, increase burnout – UCLA study
Despite workplace improvements, US junior doctors have high depression risk
Doctors prone to moral distress when caring for cognitively-impaired elderly
Solutions to physician burnout — US National Academy of Medicine report
Rheumatologists top happiest doctors list