Burnout has become a colossal issue in contemporary healthcare. I have been witness to a near complete turnover of nursing and paramedic staff in the ED; many departing for less exhausting assignments because they were simply done with the daily trouncing that we all take. In my own anecdotal experience, I have felt burnout off and on throughout most of my attending career. And studies indicate that when healthcare workers are burnt out, it has negative impacts not just provider quality of life but on hospital efficiency, patient care, and interpersonal/family relationships.
Each year, Medscape conducts a burnout survey of physicians across a variety of specialties. This year the results were interesting and somewhat predictable. 2021 was the first full year after wide COVID vaccination availability and lifting COVID induced lockdowns. Similar to the days after a major, destructive storm, 2021 was a year where we began to assess the damage to our lives and healthcare system caused by COVID and begin to start putting the pieces back together. What processes no longer work? What systems needed revising? What staff is left? And, what are the mental health consequences to those that remain?
So, with that as a background, here is my summary of the Medscape 2022 Report on Physician Burnout & Depression.
The most burned-out specialty
Well, I am proud to say, that it is my own: Emergency Medicine. Proud? Maybe that’s not the right word. 60% of physician respondents in emergency medicine reported being burned out. Think about it, if you work in the ED, over half the doctors you see are burned out. If you are a patient in the ED, there is a better than not chance that your doctor is burned out with medicine. Scary! What’s even more interesting, though, is that this was a large jump from previous years. In 2020 and 2021 emergency medicine burnout rate was around 45%.
Second to emergency medicine is critical care at 56%. These numbers (while alone are incriminating) certainly make sense since emergency medicine and critical care shouldered an enormous physical and emotional load caring for COVID patients and keeping the healthcare system afloat in the past three years.
What contributes to burnout?
Respondents to the survey indicated what are the factors that contribute most to burnout.
The top causes are:
Too many bureaucratic tasks
Lack of respect from administrators, employers, colleagues & staff
Too many hours at work
Lack of control over my life.
Insufficient compensation
Increasing computerization of practice
While inexcusable, this list makes sense.
The fundamental, foundational component to healthcare is the doctor-physician relationship and the ability of the physician to care for the patient. This bond is the motivating force for healthcare providers.
Unfortunately, as healthcare advances technologically and becomes more corporatized and regulated, there is an increasing list of things that begin to encroach on healthcare providers, invade the exam room and drive a wedge in the doctor-patient relationship. As a result, physician’s time, livelihood, and ability to care for patients have become subject to the direction of non-clinical administrators and regulators. Add to that, the new epicenter of healthcare has become the electronic health record. This nefarious partner has metastasized into the space between the doctor and patient and has successfully transformed physicians into glorified and overpaid data entry experts. The privacy of the doctor’s office that was once a sacred space in healthcare has become a crowded room of administrators, regulators, accountants, insurance companies – all illuminated by the cool, blue glow of computer screens.
Does this have an impact on my life?
It would be one thing if burnout only affected one’s performance at work. While still damaging to the delivery of healthcare, at least the problem would be compartmentalized. But the survey indicated that burnout has far reaching tentacles affecting multiple spheres of a physician’s life.
54% report that burnout has a strong impact on their life and 22% report that burnout has a moderate impact on their life. This means that the vast majority (76%) of respondents feel like issues at work negatively impact their lives in other spheres. Furthermore, 68% of respondents indicate that burnout has a negative impact on their relationships.
Depression among physicians:
The report indicates that 24% of respondents reported having clinical depression (i.e. depression that meets DSM criteria). An additional 64% report colloquial depression where feelings are significant and palpable but do not rise to the level of clinical depression.
The mental health of health care providers has gained increasing attention in recent years. This is certainly multifactorial, but several reasons are changing perceptions of mental health among providers and de-stigmatization of mental health among health care workers. We as doctors have a hard time taking off the healer’s coat and admitting that we sometimes need some healing ourselves.
Summary:
In total, the report paints a rather drab picture about the current state of healthcare. Many of the issues surrounding and causing burnout have been smoldering for a while, but COVID has certainly decreased work-life happiness.
So, what do we do? Honestly, I don’t know. As I have been working through my own issues of burnout, this has been a question that has been on the forefront of my mind. I have a number of books on a reading list and a number of thoughts that provide material for an upcoming blog post. But the first, and perhaps most important thing, is for all stakeholders (healthcare workers, families, administrators, regulators, etc.) to take an honest look at the present situation. We need to see the world the way it really is and not the way we wish it to be. Or borrowing from healthcare to complete the metaphor, to achieve healing, both the doctor and the patient need to make and accept the diagnosis.
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