Burnout Affects 40-60% of all Physicians
Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, June 27th, 2017
Physician burnout—emotional exhaustion, depersonalization—has reached epidemic proportions in the United States.
That is the assessment of a series of recent studies from the Mayo Clinic.
The first major study of physician burnout in 2011 pegged the rate of burnout at 45% of the physician population. Subsequent studies (and Professor Colin West, M.D., Ph.D. at the Mayo Clinic found 2,617 of them for his 2016 meta review and analysis) put the incidence of burnout at between 40-60% of all physicians.
The White Coat Doesn’t Come With a Cape
While doctors may have the aura of omnipotence, the fact is that at their core, they run on the same things as everyone else…emotional fuel. And when that dries up, they burnout like the rest of us.
John D. Kelly, IV, M.D. is director of sports shoulder and professor of clinical orthopedic surgery at the Perelman School of Medicine at the University of Pennsylvania. A passionate advocate of doctors caring for themselves, Dr. Kelly says we are greatly missing the mark when it comes to this issue.
“The physician is the most important element driving the healthcare machine,” Dr. Kelly told OTW. “Any attempt to revitalize healthcare without addressing the health of doctors is a wasted effort. With the latest data indicating that up to 60% of orthopedic surgeons are burnt out, this is a crisis—one that is not being recognized, much less addressed.”
The pressures are plentiful and time is more squeezed than ever. Dr. Kelly states, “Plummeting reimbursement, disconnection from patients due to electronic medical records, increased government and insurer intrusiveness…physicians are reaching the end of what we can handle.”
Disconnected From Yourself
Dr. Kelly notes, “Part of the antidote is truly being present with the patient and establishing a real rapport.”
But it is difficult to connect with others when you feel disconnected from yourself.
“Many of us are so depleted that we cannot even recover our equilibrium in our non-working hours. When that happens—and we find ourselves angry and cynical much of the time—it is time to try something new. “
Dr. Kelly walks the walk. “I have been meditating daily for about 10 years. There is ample literature indicating that mindfulness and setting aside calming time for oneself decreases stress, and helps alleviate depression and anxiety. I began all of this several years ago when I had an eye infection (with an organism typically only seen in an immunocompromised person), I was involved in a lawsuit, and my grandmother died. I was at rock bottom and I knew it was time to go in another direction. Mindfulness and dedication to self care may just have saved my life.”
“Residents often call me Father Kelly because I check up on them regularly and see how they themselves are faring. If necessary, I recommend a psychotherapist. These are hard conversations to have, but the fallout is worse—alcoholism, disintegrating families, and more.”
Screening for Burnout
“The medical field needs to have an official screening process for burnout. In the meantime, each program needs a physician advocate…someone who can take the issue to the administration and get their buy-in.”
“We have plenty of data showing that physician wellness is good business. For example, calm, satisfied doctors are less likely to make expensive medical errors. Happy doctors give better care and have fewer lawsuits.”
And they tend not to get fired, says Wayne Sotile, Ph.D., who has counseled thousands of physicians facing burnout.
Treating the Healer
Dr. Sotile is founder of the Center for Physician Resilience, an entity that provides intensive coaching for doctors and their families.
He laid out the situation for OTW: “One of the most serious—and documented—problems is the physician’s perceived loss of decision making power. There is also a loss of community relative to days gone by…staff used to be much more cohesive and engaged in more community-building activities.”
“Medical families now complain about a loss of connection; over 80% of medical spouses in an American Medical Association Alliance survey said they live in communities that minimize the special stresses that medical families encounter. People mistakenly think that doctors and their families have it all.”
The low hanging fruit in the burnout equation, says Dr. Sotile, is the obvious… electronic medical records, difficult or ineffective administrators, etc. “But let’s not forget: for every doctor who is burnt out there is one who is not. What is going on there?”
“Those who avoid burnout take an active role in their mental health. They rethink and reframe what their careers are about. These are the people who sit down and write out things such as: ‘What quality of work can I deliver given xyz?’ and ‘Would I apply for this job again?’ If the answer to that is ‘yes’ then they get back to focusing on what is right about their work.”
“The data show that these physicians ‘join the parade’ of those trying to shape the unfolding changes that are afloat in medicine. And those who do not take an active role in that process, well, at least they thank those who do. It is not discussed very much, but there is an integrity and skill to being a good follower/team member. Not everyone wants to lead…but don’t be miserable and distrust those who do.”
“We have over 70 years of research on what drives resilience. At its core is the ability to broaden and deepen the relationships that matter in our lives—rather being miserable and complaining.”
“The first thing we know is that you have to actively look for what is right about your spouse, administrator, etc.”
“The second thing we know is that you must counter daily hassles with daily uplifts. Yes, this is tough…in large part because the more stressed out we get the more narcissistic we are.”
“Resilience is not for wimps,” stresses Dr. Sotile. “It takes courage and power to look in the mirror and commit to a process of change.”
“Starting with family, we can take hope and lessons from what we know it takes to make a busy marriage thrive. The data show that it is not a matter of lot of time, it is a matter of building a storehouse of positive emotions in the relationship—one interaction at a time. The University of Washington has 30 years of research on couples showing us that it’s possible to divorce-proof a relationship in 10 minutes a day.”
“In every interaction we are either depositing or withdrawing positives. It is a given that you will make big withdrawals (having to cancel a family vacation, etc.). The easy things that are proven to make a difference are to be kind, affirming, and forgiving. And it’s the same at work. The days are gone when you can run around with an aura of, ‘I’m a tough orthopedic surgeon; everyone is here to bolster my ego.’ This is an ill-informed way of managing relationships. You will need those people to cover you and tolerate you when you are having a bad day.”
The Latest Research
Dr. Sotile, also on the teaching faculty at the Tulane University department of orthopedics in New Orleans, says, “Our research indicates that the biggest predictor of a physician family being satisfied with ‘their’ orthopedic surgeon isn’t how much they work—it’s the mood they are in when they get home. And the mood at work is driven by the quality of relationships with people at work. Don’t let yourself have a ‘marital heart attack’…your emotions are contagious.”
“Data from 2012 show a 50% burnout rate among orthopedic surgeons; as of 2015 that number was up to 60%. It is getting worse across specialties but we don’t know why. What we do know is that it’s time to end the conspiracy of silence.”
“Recently, the National Academy of Medicine announced the Action Collaborative on Clinician Well-Being and Resilience. Their plan is to establish an evidence-based platform for physician well-being across multiple organizations. This forum will go a long way towards beginning to find solutions for these issues.”
“The field of positive psychology has vital lessons for physicians. This evidence-based information tells us that we must counter daily hassles with daily uplifts; specially, we need to have three uplifts for every hassle.”
“Human beings cope better when we are in a positive mood—and that mood is a by-product of choices we are making. We need to strive to see our families in unfamiliar ways. Frankly, many of us are so busy selectively perceiving the things that make us angry that we are omitting things that are uplifting.”
“If something you did made you feel a quiet sense of pride then you must make that louder in your head. You might stand in awe of your career, a la, ‘Wow. So few people in the history of the world have had the opportunity to do what I do!’
Wayne Sotile sometimes has to throw out a challenge to physicians, saying, “You say you are courageous and tough. Let’s see it. Your spouse and colleagues are aggravated with you. Here is a sobering fact: I know more doctors who have gotten fired in the past five years than in the preceding 30 years combined. Some have been fired from their own practices. The overwhelmingly reason is, ‘You just don’t fit into the culture we are committed to building.’”
Burnout is downright dangerous.
Dr. Sotile states, “According to research sponsored by the American Academy of Surgeons, a one point increase in burnout raises the rate of surgical error by 11%. The good news is that burnout can be reversed. If you put the same amount of dedication into revitalizing your personal and work relationships as you did into your training, then you will reverse this unhealthy—and untenable—tide.”