Physician Burnout and Suicide
Physician burnout and suicide are real issues more and more doctors are facing. Physician burnout is basically emotional, physical, and mental exhaustion, the loss of desire to help patients, and doubting your work with patients is of any significance. Both burnout and suicide are on the rise and weren’t prominent issues until the 1990s. The American Association of Family Physicians (AAFP) just had a meeting on the 27th of June, 2017 to discuss the issue. Dr. Phil Roe stated, “Physician burnout is a huge issue around the country. It’s a real issue.” He says the job isn’t satisfying anymore due to a number of obstacles.
Physician suicide and burnout aren’t just affecting senior doctors, but also medical students and doctors throughout their careers. Statistics show 50% of medical students experience burnout, while 10% consider suicide. During residency 25%–75% of residents experience burnout, and this varies according to specialty. For senior doctors, it’s reported that, regardless of specialty, one in every three doctors experiences burnout, while some studies say up to 60% of physicians suffer from burnout. These are huge numbers that may significantly affect the quality of care. Whatever it is causing doctors to feel this way needs to be corrected.
We all suffer from burnout throughout our lives. We’ve had it during school, college, and probably work. It’s that feeling of being drained in every aspect, the feeling that you need a week or two off to recharge. Unfortunately for doctors, there isn’t much time to recharge, and being a physician is more demanding than most jobs, so, there’s more to be tired about and less time to recover from it. As previously stated, the three main symptoms of burnout are exhaustion, depersonalization, and the loss of feeling personal accomplishment. These are measured using a questionnaire called the Maslach Burnout Inventory, and the people who created it describe burnout as “an erosion of the soul caused by a deterioration of one’s values, dignity, spirit, and will.”
The opposite of physician burnout is physician engagement. Naturally, engagement is self-satisfaction and feeling like what you do as a doctor matters. These are the two ends of the spectrum and, naturally, the more a physician is engaged, the better they feel and work. There are countless factors that decide whether a physician is burned out or engaged. All the factors about to be discussed are additional stressors to the fact that a doctor has to keep working throughout his life to update his medical knowledge every day and maintain or even improve his clinical skills.
The first factor is the stress of medicine. Doctors wake up every day knowing lives depend on their decisions. What can be more stressful than knowing one simple mistake can cost someone their life? Then, of course, there’s dealing with sick people every day, some of whom are in very bad condition. If you’re not a doctor, you probably won’t understand the toll it takes. There’s a reason people are afraid of death, but doctors spend their days fighting it, sometimes winning and sometimes losing.
“What’s family time?” asks a doctor whose brain is full of symptoms and drug dosages. From the moment one enters medical school, their brain becomes crowded with so much information that, sometimes, non-medical data gets pushed out. I often joke with my friends that I started deleting childhood memories to make room for all the medical info. A few memories or appointments can be spared for the sake of saving someone’s life, but as doctors grow older and have families and other responsibilities, this becomes more difficult. Not finding time for your personal life and the ones you love is an added stress.
Additionally, there’s the fact that it all comes down to us. A patient’s medical team can’t move forward until their doctor does. Of course, their doctor is also the doctor of many other patients and, due to the increased workload and piles of paperwork, the doctor can be a little behind schedule. Realizing this adds more weight to the physician’s shoulders. Paperwork’s annoying uncle: malpractice can turn the job into a nightmare. Instead of seeing patients as people who need help, doctors may start viewing them as potential lawsuits, which causes one of the symptoms we talked about: depersonalization.
Another external factor is the political debate about medicine. Healthcare is a political hot topic, even more so these days. This wouldn’t be so bad if the people discussing it had the faintest idea what it’s like to be a doctor, but they don’t. It’s basically people who probably haven’t spent more than a couple of hours in a hospital their entire lives making decisions about people who practically live there. There’s also the financial complexity of all the health plans and insurance companies.
Most of these are external factors that have been imposed on physicians, making their lives tougher. One factor that is no one’s fault, however, is that the job becomes routine. After ten years of being a doctor, there isn’t much that can surprise you; you’ve probably seen it all and done it all. For some doctors, their main satisfaction is that the job is interesting and keeps the gears in their brains going at full speed, but once this happens, burnout is just around the corner.
Physician suicide may follow burnout or may happen earlier if a doctor suffered from depression. It’s hard to say for sure, as reporting isn’t as accurate as we’d like it to be, but it’s reported that about 300–400 doctors kill themselves each year. So, a doctor kills him/herself every day. This is a scary statistic. Medical professionals are constantly near the top of occupations with the highest suicide rates. If that didn’t convince you of the severity of the situation, you should know suicide is the second most common cause of death in medical students, the first being accidents. Medical students and residents suffer from higher rates of depression than the general population, as 15%–30% screen positive for it. Generally, doctors have at least the same rates of depression as the general population, as it affects about 12% of males and 19% of females. Let’s not forget suicide rates are often underestimated.
Doctors are less likely to die from cancer and heart disease because they know how to take care of themselves and how to prevent them, but this is a double-edged sword, as their knowledge of the human body results in higher suicide completion rates. Doctors who undergo suicide are mostly diagnosed as having depression, bipolar disease, alcoholism, or substance abuse, in that order.
Physician suicide isn’t just a major issue due to its high prevalence, but also because physicians don’t usually seek professional help. A survey of American surgeons showed one in sixteen surgeons contemplated suicide over the past twelve months and only 26% sought help. Most said they didn’t seek professional help because they were afraid it would affect their license to practice medicine. Physicians are often reluctant to admit to themselves or to others that they have a problem. This is even truer when it comes to psychiatric problems. The situation is also worsened by the lack of ability of fellow physicians to help a struggling one. Even when a patient seeks help from a psychiatrist, there are still obstacles such as worrying about their license. Some doctors even choose to treat themselves!
Burnout, depression, and suicide are affecting physicians everywhere. The stress from the job itself, constantly holding ourselves to the highest standards, and all the additional factors mentioned above take a lot of the fun out of practicing medicine. Physician suicide rates may be higher because reporting is increasing or because medicine is changing. During the AAFP’s meeting, it was stated all the documentation and external factors are putting barriers between doctors and their patients and are getting in the way of proper medical care. One doctor said, "At times, it sounds like physicians are being blamed for burnout. What physicians are saying is, 'Don't fix me; fix the system!' They are practicing in a dysfunctional system."
Changes need to be made. The dysfunctional system could be modified, doctors can be trained to cope with these stressors earlier, and, perhaps, follow-ups with physicians to make sure they’re okay can be performed. This is a real issue that not only impacts physicians, but also the patients they treat.
