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Editorial – Monique George, MD

Monique George, MD* - Assistant Sec-Treasurer

Monique George, MD* – Assistant Sec-Treasurer

Secure Our Own Masks First

We strive to improve the care of our patients, in the clinic room, on the phone with specialists, with insurance companies and advocating in Sacramento and on the hill. We also need to improve how we take care of ourselves.

Burnout is afflicting many of us. It hurts individual physicians, families and healthcare as a whole. Many institutions recognize the impact of burnout; both the monetary cost and the human cost. An analysis from Atrius Health showed that replacing a physician who retired early or left to pursue other career opportunities can cost between $500,000 and $1 million due to recruitment, training and lost revenue.

Dr. Shanafelt, a hematologist and physician-burnout researcher at the Mayo Clinic, states burnt out physicians often experience:

  • Depersonalization, treating people as though they’re objects rather than human beings
  • Emotional exhaustion: losing enthusiasm for your work
  • Low personal accomplishment: feeling you’re ineffective in your work, whether or not that is an accurate perception

Fifty-one percent of physicians reported experiencing frequent or constant feelings of burnout in 2017, up from forty percent in 2013, according to Medscape’s annual survey. That means the majority of us have some symptoms of burnout or our colleagues are experiencing it. When we look by specialty, Family Medicine reported a high degree of burnout at fifty-five percent, only behind Emergency Medicine (fifty-nine percent) and Obstetrics and Gynecology (fifty-six percent) and equal with Internal Medicine and Infectious Disease.

How does medicine compare to other professions? In a U.S. News and World Report in 2016 physicians were fifteen times more likely to experience burnout than other professionals. Our work life balance has also worsened according to a Mayo Clinic Proceedings study. In 2011 forty-nine percent reported a satisfactory work-life balance and this declined to forty-one percent in 2014.

The U.S. Surgeon General, Dr Vivek Murthy is now focusing on chronic stress and isolation as prevalent problems and this includes the need to improve physician well-being. In a recent interview he noted; “At a time when physician burnout is high and the need for capable and compassionate physicians is growing, it is more urgent than ever that we invest in improving the emotional well-being of physicians.”

Returning to Dr. Shanafelt, he makes an interesting comment that many of us are using a survival mentality as our strategy for burnout. When he spoke at the AMA Annual Meeting in 2016 he noted this is common in residency; “I’ve just got to make it through; things will get better when I’m done with residency.” However, he notes that many of us continue with this approach, with one study he cites reporting that thirty seven percent of physicians look forward to retirement as an effective wellness strategy. “This is the same thing as the survival mentality, and what was notable was that it was equally common to report this strategy for those under the age of forty as those who were older. It’s not just those who were actually getting closer to retirement.”

So how are we improving our odds of survival? Some workplaces are acknowledging the problem and many now have wellness committees and efforts to reduce burnout. There is research that these efforts to reduce isolation and bring colleagues together can have a positive impact. However, the root of the problem may be more in how the practice of medicine has changed over time. The 2017 Medscape Lifestyle Report survey with 14,000 physician respondents, stated the top four causes for burnout as too many bureaucratic tasks, spending too many hours at work, feeling like just a cog in a wheel and increased computerization of practice. This isn’t just happening in your workplace. It is happening everywhere. So as an individual; quitting and getting another job may improve your conditions temporarily, but the trend suggests this wouldn’t be a sustainable survival strategy.

We’ll need to work together to tackle the root of the problem and break the trend. Cutting excessive workloads and bureaucratic tasks will not be easy to do. Talk with your fellow front line physicians, emphasizing the importance of the problems we face. If enough of us see reducing burnout and its root causes as a top priority, we can reverse an unsustainable trend.

Excessive workloads can suffocate. If we pass out from lack of air, what good are we to our patients, friends and family? We need to take care of ourselves. We need to secure our own masks first.