It is a freezing day, and glistening ice covers the bare trees, reflecting the early morning light. You should be enjoying this view as you drive into work. Instead, you are sitting in the car and staring at the icy pond where the local crew team practices.<\/p>\n
![\"a](\"http:\/\/i0.wp.com\/post.medicalnewstoday.com\/wp-content\/uploads\/sites\/3\/2017\/07\/GettyImages-200555834-002_header-1024x575.jpg?w=1155&h=1528\")
<\/img><\/picture><\/span><\/p>\n To help support the mental well-being of you and your loved ones during this difficult time, visit our dedicated hub<\/a> to discover more research-backed information. <\/p>\n<\/div>\n<\/div>\n<\/div>\n <\/span><\/p>\n Over and over in your head, you may be thinking: If this sounds like you, don\u2019t ignore the signs \u2014 you may be experiencing physician burnout. Similar to any problem, recovery usually starts with recognition.<\/p>\n Physician burnout is not a psychiatric disorder \u2014 the World Health Organisation (WHO)<\/a> recognizes this as a syndrome. It is a measure of chronic distress associated with your job. <\/p>\n The three key components<\/a> are:<\/p>\n Medical school and clinical training are rigorous in ways that may be difficult for other professionals to comprehend. Looking after your health<\/a> can easily slip to the bottom of the priorities list in the face of the daily challenges of patient care and admin. <\/p>\n Medicine is known for a culture of self-reliance and independence, and unfortunately, it is common for physicians to feel that they cannot show any signs of weakness.<\/p>\n In an interview study<\/a> of 50 junior doctors about their work experiences, nearly half mentioned the unspoken rules they learned about expressing emotions and seeking help. One interviewee who treated doctors for stress said:<\/p>\n \u201cThere was a lot of stigma about people coming to seek help [\u2026] for a doctor in general to admit weakness, or if anybody, god forbid, even saw you there, people would talk.\u201d<\/p>\n Burnout is bad for physicians, as proven by increased alcohol<\/a> and drug misuse<\/a> rates<\/strong>, not to mention suicide<\/a>. Burnout is also bad for your patients<\/a> because it is associated with lower quality of care, lower patient satisfaction, higher physician turnover rates<\/strong>, and increased chances of medical errors.<\/strong><\/p>\n If you feel utterly exhausted and disconnected from your patients, perhaps even wondering if you still want to be a doctor, rest assured \u2014 you are not alone. Chances are your colleagues feel the same.<\/p>\n Find out how to spot the early signs of burnout and the symptoms you shouldn\u2019t ignore. We also offer you strategies to counter the destructive stress<\/a> that leads to burnout.<\/p>\n<\/div>\n Physicians at all stages of education and training are at risk for burnout. A 2013 review<\/a> found nine studies that show levels of burnout between 45\u201371% in medical students.<\/p>\n Burnout can also lead to depression<\/a>. A comprehensive 2016 review<\/a> looking at medical students from 47 countries found that 11.1% experienced depression during their studies. The prevalence of depression ranged between 7.4\u201324.2%, depending on how the research was conducted and how depression was measured. The study notes these figures were two to five times greater than the United States population of a similar age to medical students. <\/p>\n Sadly, a study has found that up to 15%<\/a> of medical students reported suicidal ideation at some point during their medical education.<\/p>\n On average, 28.8% of residents<\/a> report depression or symptoms of depression, with burnout symptoms affecting over 50%<\/a>, reflecting the high demands of residency and fellowship training.<\/strong><\/p>\n According to an article published in JAMA Internal Medicine<\/a><\/em>, 25% of family physicians self-reported signs of burnout, based on a single question asking about emotional exhaustion. The data showed a strong correlation between work-related factors \u2014 such as stress, chaotic working environment, or time spent on documentation \u2014 and burnout. <\/p>\n A 2019 online survey<\/a> of over 15,000 respondents used a different measure of burnout, which asked about the three elements: emotional exhaustion, depersonalization, and low personal accomplishment. Of these family physicians, 46% reported at least one burnout symptom. <\/p>\n Across all 29 medical specialties, the survey concludes that the overall rate of burnout in 2019 stood at 42%, which fell from 46% five years earlier. The annual survey\u2019s strength is that it uses the same definition of burnout year on year to allow comparisons.<\/p>\n The five specialties with the greatest percentages of burnout were: urology, neurology, nephrology, diabetes and endocrinology, and family medicine. <\/p>\n<\/div>\n <\/span><\/p>\n Three factors contribute directly to physician burnout. Below, we detail the leading causes and advise on how to counter them.<\/p>\n The practice of medicine in the U.S. today is mostly volume-driven. More patients per day and shorter visits have eroded the relationship between physician and patient. They can prevent physicians from providing the type of care they went to medical school to do.<\/p>\n Furthermore, unrealistic call schedules can impact a physician\u2019s quality of life by allowing the workday to continue at home.<\/p>\n With the advent of electronic medical records (EMRs) and smartphones, physicians are accessible 24 hours per day, meaning the workday potentially never ends.<\/p>\n While EMRs allow effective communication between the medical team and a patient\u2019s medical history at multiple locations, they can also be time-consuming and interfere with the precious few minutes that a patient and physician have together.<\/p>\n With the use of EMRs comes the added concern of patients having direct access to the physician through messaging via the EMR.<\/p>\n Rather than answering questions during office visits, patients also expect physicians to provide information outside of scheduled visits through these messaging systems.<\/p>\n Patient satisfaction scores are increasingly common in the U.S. medical system.<\/p>\n Physicians can easily be given a poor score for not giving a patient antibiotics<\/a> \u2014 even if not indicated, not providing a controlled substance at the patient\u2019s request, or for not ordering unnecessary laboratory tests.<\/p>\n Medical organizations also expect physicians to navigate situations where patients are drug-seeking, noncompliant, or even threatening.<\/p>\n Dr. Lotte N. Dyrbye, associate chair of staff satisfaction, faculty development, and diversity in the Department of Medicine at the Mayo Clinic, told Medical News Today<\/em>, \u201cbetween 2011 and 2014, the prevalence of burnout increased in U.S. physicians, even though work hours did not.\u201d<\/p>\n She went on to say, however, \u201cDuring this period, the prevalence of burnout among other U.S. workers did not increase. The drivers of burnout for physicians are factors within the practice environment.\u201d<\/p>\n<\/div>\n <\/span><\/p>\n The Maslach Burnout Inventory<\/a> takes into account three factors for physician burnout:<\/p>\n In addition to the organizational and cultural factors<\/a> that increase the risk of burnout, there are individual character traits and behaviors<\/a> associated with it:<\/p>\n Some of these factors reflect traits that enable young people to take up medicine in the first place, such as a high degree of personal responsibility and hard work ethic. A recent review<\/a> shows that organizational factors, such as work demands, the work environment, and work-life balance, are paramount in understanding and solving the problem. <\/p>\n Recognizing the signs and symptoms early on makes it easier to look for effective ways of preventing full-blown burnout.<\/p>\n<\/div>\n A systematic review and meta-analysis in The Lancet<\/a><\/em> by Prof. Colin P West from the Division of General Internal Medicine and Division of Biomedical Statistics and Informatics at the Mayo Clinic and colleagues analyzed the outcomes of burnout intervention strategies.<\/p>\n The authors show that both individual-focused and organizational or structural interventions were associated with a significant burnout reduction.<\/p>\n Self-care<\/a> means having a personalized strategy to look after yourself. It also means reflecting on the fact that life requires attention in multiple facets, including family, career, community, spirituality, and the inner self.<\/p>\n There are many strategies that promote self-care, including having hobbies, making time for family and friends, focusing on a healthy lifestyle with exercise and adequate sleep, and practicing mindfulness.<\/strong><\/p>\n In an article in The New England Journal of Medicine<\/a><\/em>, Dr. Adam B. Hill shared his take on self-care and recovery.<\/p>\n A palliative care physician and associate program director for pediatric residency training at the Indiana University School of Medicine in Indianapolis, Dr. Hill is no stranger to this topic.<\/p>\n As a former recovering alcoholic who has suffered suicidal tendencies, he uses \u201ccounseling, meditation and mindfulness exercises, exercise, deep breathing, support groups, and hot showers\u201d in his self-care. He has also rearranged his own hierarchy of needs. \u201cI learned that I must take care of myself before I can care for anyone else,\u201d he wrote.<\/p>\n Dr. Murphy, a physician who has recovered from burnout, highlights in his book<\/a> that \u201cyou can\u2019t be all things to all people.\u201d Recognizing this starts with learning to say no and creating appropriate boundaries concerning your scheduling, patient volume, work week, and size of your patient panel.<\/p>\n Furthermore, it is important to clearly define your work-time and your off-time to your colleagues, employers, patients, and most importantly, yourself.<\/strong><\/p>\n Likewise, there are several researched methods<\/a> for improving the work environment for physicians.<\/p>\n Adding a \u201cfloat pool\u201d to cover for life events, allowing physicians some control over their schedule, decreasing patient panel sizes, adjusting staff ratios, and lengthening visits, can all reduce stress levels.<\/p>\n Flexible and part-time physicians tend to be more satisfied with their careers and are less likely to leave their positions.<\/p>\n Including physician well-being and satisfaction as a quality metric can help shed light on burnout levels in an organization and show which intervention strategies are most impactful.<\/p>\n Research<\/a> also shows positive effects if administrators allocate time for practicing clinicians to incorporate teamwork, mindfulness, sharing of workload through Patient-Centered Medical Home models, and coaching for challenging experiences.<\/strong><\/p>\n Finally, adding charting slots throughout the day or increasing the length of visits to allow for charting time could decrease the burden associated with EMRs.<\/p>\n If organizations cannot address physician burnout at all three levels, it is clear that the U.S. healthcare system is steering headlong into a crisis.<\/p>\n <\/strong><\/p>\n Interventions are needed to address factors within the practice environment that contribute to burnout, rather than focusing primarily on individual strategies. That being said, all physicians have a responsibility for self-care.\u201d \u2013 Dr. Lotte N. Dyrbye<\/p>\n<\/blockquote>\n She concludes, \u201cRegularly assessing one\u2019s level of well-being and taking intentional steps to maintain and improve one\u2019s well-being is essential.\u201d<\/p>\n Looking after your health and well-being, as well as finding a working environment that allows you to enjoy your work as a physician, are key to helping you avoid burnout.<\/p>\n For more practical tips, check out local American College of Physicians chapters, such as the New Mexico<\/a> chapter and Stanford Medicine<\/a>. Both offer resources to help with burnout, stress, and physician wellness.<\/p>\n<\/div>\n
<\/br>\u201cI can\u2019t do this anymore.\u201d
<\/br>\u201cMy patients just ramble on and on.\u201d
<\/br>\u201cThere is just not enough time, and my colleagues are so lazy.\u201d
<\/br>\u201cWhat\u2019s the point, I\u2019m not a good doctor.\u201d<\/p>\n\n
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1. Time<\/h3>\n
2. Administration<\/h3>\n
3. Patients<\/h3>\n
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1. Strategies at the individual level or self-care<\/h3>\n
2. Burnout at the work level<\/h3>\n
3. Administrative or institutional level strategies<\/h3>\n