Burnout rife among American doctors
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While attending the funeral of a fellow doctor, Pamela Wible realised she had lost an unusual number of colleagues through suicide. “While I was sitting there, I realised that I know a lot of people lost to suicide and all of them were medical doctors,” she recalls. Long shifts, sleep and food deprivation are just a few factors to blame for what she describes as a violation of human rights.
“I was suicidal in 2004 and I felt that I was the only starched white coat who was experiencing this,” she says. “Once I recovered completely, I decided to be a real doctor and not a factory worker.”
Studies suggest that at least 50 per cent of US doctors are experiencing professional burnout, a syndrome characterised by exhaustion, cynicism, and reduced effectiveness. It was recognised by the World Health Organization in May as an occupational phenomenon “resulting from chronic workplace stress that has not been successfully managed”.
Tait Shanafelt is chief wellness officer at Stanford Medicine. His primary responsibility is to tackle burnout among doctors — a problem that affects care and patient safety at hospitals across the country.” He says the problem was traditionally considered to be a matter for human resources departments, “focused on trying to improve healthy behaviours in employees . . . to reduce insurance costs and expenditures”.
But such interventions only add to the problem, he says. “When you offer these solutions, it sends a message that the problem is with the individual and not with the system.”
According to a study published in Annals of Internal Medicine, a medical journal, the US healthcare industry loses an estimated $4.6m every year as a result of doctor burnout. “It’s only the tip of the iceberg,” says Christine Sinsky, one of the authors of the study.
She and her colleagues decided to attach a cost to burnout to attract the attention of decision makers. “Burnout has primarily been studied through the lens of wellness,” says Joel Goh, an assistant professor at the National University of Singapore. But this study, he says, puts the issues of burnout in terms that healthcare managers can understand.
The report estimated that the annual economic cost associated with the problem was approximately $7,600 per employed doctor each year. But as it only takes into account the loss in clinical hours and doctor turnover, the estimate is conservative. It does not account for the risks of malpractice and the higher likelihood of medical errors.
Another study conducted by Sinsky found that 2 per cent of US doctors were likely to leave medicine altogether for another career.
Over the past few years, efforts have been made to increase the number of medical schools in the US to ensure that there is no shortage of doctors. “When you think about how much we’ve invested to create, roughly, 10 to 12 new medical schools in the last decade, at hundreds of millions of dollars per school, just to increase the pipeline of physicians being trained, we also need to think at the far end of the physicians who are leaving medicine because of burnout,” says Sinsky.
Though doctor burnout is well-recognised, most of the efforts to reduce it have tended to “blame” the individual and not the environment they work in. In 2017, a group of healthcare chief executives said burnout was a public health crisis, urging their fellow CEOs to unite against the problem.
According to Tait, 80 per cent of the challenge faced by doctors is down to the organisation where they work, and only 20 per cent could be attributed to personal resilience.
Wellbeing experts say that until healthcare companies recognise that the condition is a reflection of a dysfunctional workplace, rather than a reflection of weakness on the part of the individual, the rates of burnout are not likely to reduce.
One of the major factors for doctors is the electronic record system. It takes a physician 15 clicks to order a flu shot for a patient, says Tait. And instead of addressing this problem, healthcare companies end up offering physicians mindfulness sessions and healthy food options in the cafeteria, which only frustrates them further.
Productivity expectations have increased, says Tait, while doctors have less time with patients, and the presence of computers in the examination room distract from human interaction. The fact that doctors work in “organisations which have a motivation of financial revenue generation, rather than always providing the best care, has led to some disillusionment”.
Take the case of a final-year resident doctor in New York, who spends a considerable part of his shift negotiating with insurance companies to justify why his patient needs the medicines he prescribed. “When I signed up to be a doctor, the goal was to treat patients, not negotiate with insurance providers,” he says.
US doctors, says Sinsky, have to compose patient notes which are four times as long as their counterparts anywhere in the world.
As a part of her ongoing research, Pamela Wible has been notified of 1,298 cases of medical doctors who died by suicide since 2012, but she believes the real number is higher. She works as a family physician in Oregon and runs a clinic to help young medical trainees who are experiencing suicidal tendencies.
She points out that the focus on burnout has helped the industry avoid discussions around mental health, despite the fact that the two are related.
Some experts argue that burnout is far less stigmatised, making it easier for the industry to address the problem, but the fear remains that it may lead to misdiagnosis of mental health ailments, which could be life-threatening.
“A person who has burnout could also be depressed and the two conditions may coexist,” says Tait.
Apart from the stigma associated with mental illness, US states’ medical boards, which are responsible for periodically renewing doctors’ licences to practice, could also be part of the problem.
Most ask doctors to reveal if they have been treated for mental illnesses such as depression. This, says Wible, is the biggest barrier for medical professionals looking for help.