Subtitles section Play video Print subtitles It has been nearly two full years since the coronavirus pandemic began and our doctors are burned out. It’s to the point now where many physicians are even considering leaving medicine altogether. But is COVID solely to blame for this burnout epidemic, or is there more to the story? Dr. Jubbal, MedSchoolInsiders.com. Today we’re going to talk about physician burnout. We’ll cover what it is, why you should care, and what we can do about it. Let’s get into it. Burnout can be defined as a state of emotional, mental, and physical stress caused by prolonged or repeated workplace stress. It is characterized by feelings of exhaustion, low productivity, and cynicism towards work. According to recent polls, nearly half of all physicians in the United States report feeling burned out, and about one in five have considered leaving medicine altogether. What is perhaps most alarming about these numbers is that they come at a time when our healthcare system is already strained and we’re experiencing physician shortages across a wide range of specialties. The AAMC predicts that if we don’t take steps to lessen this gap, we will face a shortage of up to 124,000 physicians by the year 2034. Thus far, the focus has largely been on increasing the number of medical school and residency positions; however, if we don’t figure out how to keep our physicians practicing, all this work could be for nothing. Burnout is a common precursor to depression and suicide and physicians already have some of the highest suicide rates out of any profession. According to one survey, as high as 13% of physicians have had suicidal thoughts with 1% of physicians reporting that they have actually attempted taking their own life. These are incredibly worrisome statistics when you consider that anyone who has attempted suicide is at a greater risk of completing the act sometime in the future. It’s not just the well-being of our physicians at risk either. If burnout is affecting half of our physicians, then it’s also indirectly affecting half of our patients. Physicians who are burned out or depressed are more likely to make medical errors which can have adverse effects on their patients’ safety. So now that we know what burnout is and why it’s a problem, is COVID-19 to blame for the burnout epidemic? According to Medscape’s 2021 Physician Burnout & Suicide Report, of the 42% of physicians who reported feeling burned out, only 21% reported that it started after the pandemic. This means that the vast majority of physicians were already experiencing burnout long before COVID-19. This isn’t to say that coronavirus hasn’t made things much more difficult for many doctors, but rather to point out that physician burnout has been a problem for years. Physicians who have been working on the front lines seeing COVID patients have experienced higher patient loads, longer hours, lack of personal protective equipment, and grief over losing patients which have all added layers of extreme stress and exhaustion that have contributed to burnout. Even physicians who haven’t been directly treating COVID patients have not been immune to the effects of the pandemic. Many have lost income due to restrictions on elective procedures and struggled with reduced hours over the past 2 years. There has even been a small percentage of physicians who were laid off due to decreased workloads in their specialty. But regardless of how each specialty was affected specifically, it is evident that some specialties were hit harder than others. The top 5 specialties with the highest burnout rate in 2020 were urology, neurology, nephrology, endocrinology, and family medicine. In 2021, these changed to critical care, rheumatology, infectious disease, urology, and pulmonary medicine with family medicine, internal medicine, and emergency medicine following close behind. From 2020 to 2021, we can see a shift towards front-line specialties like critical care, infectious disease, and pulmonology feeling more burned out. But despite these trends, most physicians still reported that their burnout began before the coronavirus pandemic. So, if COVID isn’t to blame, what’s really causing our physicians to feel so burned out? According to Medscape, the top 5 reasons for physician burnout in 2021 were: too many bureaucratic tasks, too many hours at work, lack of respect from administrators and colleagues, insufficient compensation and reimbursement, and lack of autonomy. Causes of burnout related to the pandemic such as stress related to social distancing, treating COVID-19 patients, and government regulations were still within the top ten but were much lower down on the list. What is interesting though, is that the top 5 reasons for burnout have remained largely unchanged since 2016 - long before the pandemic began. Physicians have been working long and difficult hours for years. They’ve spent several hours each day filling out charts and paperwork to meet hospital and insurance company requirements. In some specialties like primary care, as much as two-thirds of their day is spent charting. These reasons don’t exist in isolation either. As one physician summed it up: “it’s all of these causes; its death by 1000 cuts.” The biggest sources of burnout amongst physicians have been the same for years and COVID is just another issue added to the laundry list. To address the burnout pandemic, we need to look at solutions both on an individual and a systemic level. At an individual level, there are a few actionable pieces of advice. The most consistent finding throughout the scientific literature is that social support reduces burnout. If you believe you are burned out, depressed, or suicidal, the first thing you should do is seek professional help. The second is to seek support from your friends, family, and colleagues. Sleep duration has also been inversely correlated with rates of burnout, meaning the more you sleep, the less likely you are to be burned out. I have an entire playlist on sleep going over the best ways to optimize your sleep and wake up feeling significantly more refreshed. Link in the description. Exercise is another popular way to cope with burnout with approximately 45% of physicians reporting this as their preferred method. Exercise has been correlated with improved well-being and decreased psychological distress, stress, and emotional exhaustion. That being said, burnout is ultimately more of a systemic issue than a personal one. While we must take responsibility to mitigate it in our own lives, the fact that burnout amongst physicians has been consistently rising for decades points to a systemic cause. More and more healthcare systems are promoting wellness programs to address the issue of burnout. Although well-intentioned, these programs push the narrative that burnout is the physician’s problem - a failure to properly engage in self-care, sleep, exercise, and mitigate stress. And ironically, requiring physicians to attend a one-hour wellness lecture tends to reduce their time and ability to engage in more meaningful self-care behaviors. These solutions, although helpful, only address the symptoms of burnout, not the root causes. In 2021, administrative burdens, too many hours at work, and a lack of respect from administrators and colleagues were the leading causes of physician burnout. No amount of self-care, sleep, or exercise is going to provide a sustainable solution to those. We need health care policymakers, regulators, and standard-setting bodies to work with physicians to help identify and eliminate areas that contribute little to no value to patient care. This would decrease administrative burden and let doctors spend more time being doctors and less time being typists or clerks. Instead of focusing on documenting every minute detail to fulfill a billing code, we need to put the focus back on the patient. We also need to de-stigmatize mental health diagnoses amongst physicians. Despite having some of the highest rates of depression and suicide out of any profession, many physicians never reach out for help - even though they know they need it. Many state medical license applications ask questions regarding mental health history and its effect on a physician’s competency, even though this goes against the Americans with Disabilities Act. As such, many physicians never seek professional help for fear that it will negatively impact their ability to gain licensure. Within the past few years, the Federation of State Medical Boards has come out with new recommendations to help address this issue and omit such questions from licensing applications. There have been numerous states that have adopted some of these recommendations; however, very few have adopted them fully. This is a step in the right direction, but we still have a lot of work to do before our physicians can feel safe seeking help. Although the coronavirus pandemic has surely added to the issue of physician burnout, we can’t use it as a scapegoat and blame it entirely. This is an issue that has been decades in the making and many physicians are starting to reach their breaking point. We need to take a good hard look at the root causes of physician burnout and start making strides to improve them. Only then will we be able to make meaningful progress towards happier and healthier physicians. Thank you all so much for watching. If you enjoyed this video, be sure to check out my video on How to Manage Stress as a Student or Why Are Doctors Miserable? | The Burnout Epidemic. Much love and I’ll see you guys there.