When you’re in to see the doctor, you have your own set of issues.
Perhaps you’ve sprained your ankle, your child has a lingering cold, or you’re in for routine prenatal care. Or, your visit is for something far more critical — chest pain, recovering from a stroke, or cancer treatment.
Regardless of why you’re there, you generally want your physician solely focused on you. That is his or her job, after all. To treat you. And you want to leave healed, or on the road to being well again.
But what happens when it is the physician who needs to be looked after?
An alarming number of physicians across the country — more than half of all doctors, in fact — are reporting burnout, according to a study just released by Mayo Clinic. Burnout is commonly defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. Burnout not only impacts a physician’s ability to care for himself, his families and his patients, it has also led to the highest suicide rate of any profession.
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The latest survey of nearly 36,000 U.S. doctors reveals that about 54 percent said they’ve experienced at least one symptom of burnout in 2014, compared to about 46 percent of doctors in 2011. That means physicians are about twice as likely to experience burnout as the average U.S. worker.
Cited the most was high emotional exhaustion. About 35 percent felt depersonalized or saw less value in their work, while about 16 percent felt a low level of personal accomplishment.
Physicians are about twice as likely to experience burnout as the average U.S. worker.
Burnout rates varied between specialties, with rates topping 60 percent among doctors in emergency medicine, family medicine, urology, rehabilitation and radiology.
A Medscape survey earlier this year showed similar results. The highest rates were found among critical care specialists (53 percent), emergency medicine (52 percent), and family physicians, internists, and general surgeons (50 percent).
There may be several reasons for the rising numbers.
“Too often, burnout is blamed on the person (victim) suffering from it — they aren’t ‘tough enough to hack it’ or they’re ‘weak.’ In reality, burnout is a downward spiral in response to a work environment where doctors have been trained to ignore themselves and their needs repeatedly over the years,” said Dr. Jill Kruse, a physician with Avera Health in Brookings, South Dakota.
Kruse is also the medical director for the newly implemented Avera LIGHT Program, which addresses physician burnout. She spoke about their physician wellness program in November at the Catholic Health Association Conference, a gathering of more than 1,200 Catholic health care sponsors, systems, facilities, and related organizations and services. Avera is one of only a small handful of providers working to quickly address the issue.
“Burnout is such a prevalent thing going on in medicine, it would really be remiss to not do something about it,” Kruse said. “When we looked at Avera’s mission statement, it talks about caring for people and communities, and giving quality health care based on Christian values. We thought: If we’re taking care of ‘people and communities,’ not ‘patients,’ then why can’t we take care of our own people?”
And the burnout culture starts early on, according to Kruse. She points out that the ACGME (accreditation body for residency programs) explicitly states that residents must demonstrate a “responsiveness to patient needs that supersedes self-interest.”
It is this self-sacrifice that doctors are trained to do from the start, that can turn into unhealthy boundaries in which physicians don’t know how to say “no” to anything; work when they are sick; work when they are exhausted; work when they should be with their family; essentially, work until they collapse — then get up and work some more.
Personal Insight
It was her own experience with burnout that led Kruse to research the topic and realize that there were few resources available, or that the condition even had a name. Near her due date with her second child, and working as a rural South Dakota physician, Kruse said there was never a chance to rest. She blamed her mental and physical exhaustion on the pregnancy, but constantly being at work or on call also took its toll.
Everyone around a physician can see the burnout, but oftentimes the professional is the last to understand.
Seeking a solution, she came across Dr. Dike Drummond, an expert in the treatment and prevention of burnout in physicians and other health care leaders. A Mayo-trained family practice doctor, Drummond is also the CEO of TheHappyMD.com.
“When your energy levels are low and you’re burned out, you go into survival mode and your focus is on one thing. That’s getting through to your last patient and back home again as soon as possible. You’re completely disconnected from the reason you went into medicine in the first place,” Drummond told LifeZette.
Recognizing burnout is difficult for a doctor. Everyone around a physician can see it, but oftentimes that professional is the last to understand what’s happening.
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There are three distinct symptoms physicians, their colleagues and families should watch for, according to Drummond: physical and emotional exhaustion; depersonalization or a callous attitude toward their patients; and a reduced sense of personal accomplishment.
Complicating things is the fact that doctors are required to list if they’ve sought help for mental health issues when they renew their medical license each year.
“They don’t ask the diabetics if they’ve had a low blood sugar reaction, or doctors who’ve had heart attacks when their last stress test was. It is strictly for mental health that they ask, ’Have you sought mental health care within the last year?’ So a lot of doctors will forgo any help because they’re afraid what checking ‘yes’ in that box will entail. Will it prevent them from practicing? Will it ruin their livelihood? When you have someone at the end of their rope and they can’t get help, a lot of times the solution they see is suicide.”
All of this is why Avera’s LIGHT Program is working so well. LIGHT doesn’t involve counseling or mental health care. It is more along the lines of what Drummond does — executive coaching — giving life skills and stress coping skills in a non-medical way. She hopes the increased attention makes it easier for physicians to ask for help.
“Burnout isn’t a failure of the physician. It is a failure of the system to take care of the physician,” Kruse told LifeZette.
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