Medicine Must Start Caring for the Caregivers
Practicing medicine is bad for your health. Mounting evidence shows that stress-related burnout is a significant and growing threat to doctors – and their patients. If there is a silver lining, it is that the medical community is beginning to acknowledge and address the complex factors at play, recognizing that good health care must include caring for the caregivers.
Numerous studies reveal that physician burnout – generally defined as a loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment – is a major problem.
A Medscape survey found that 51 percent of doctors surveyed in 2016 said they suffered from burnout, an increase of more than 25 percent since 2013. This dovetails with a 2015 paper published in Mayo Clinic Proceedings, which reported a burnout rate of 54.4 percent in 2014, compared with a 45.5 percent rate in 2011. These burnout rates are almost twice as high as those found in the general population.
A 2015 Mayo Clinic study reported that roughly 40 percent of physicians suffer depression each year and almost 7 percent had considered suicide within the prior 12 months. It is estimated that 300 to 400 doctors take their lives every year.
The pain and suffering those statistics only hint at is bad enough. They are compounded by findings that burnout corrodes the doctor-patient relationship, resulting in lower levels of patient satisfaction, job satisfaction and productivity as well as higher levels of medical errors and disruptive behavior.
Many forces are driving this trend: long work days (doctors work an average of 50 hours per work, 10 more than other Americans), the demands of juggling busy careers with family obligations and the pressures caused by student debt (the average medical school graduate with student loans owes about $190,000 upon graduation).
These and other factors – especially the challenges of balancing work-home obligations – take a special toll on female doctors, whose burnout rates as twice as high as their colleagues, making them more likely to leave the profession.
Still, there is one significant new development that seems to be driving the recent increase in burnout: electronic health records (EHRs). It is no coincidence that the spike in burnout rates has come at the same time as the broad adoption of EHRs. Someday, EHRs may revolutionize health care by dramatically increasing our ability to share and review patient information. But today, EHRs are turning many physicians into clerks. It can take 32 clicks to order and record a single flu shot. Some studies show that doctors now spend about two hours on paper and desk work for every hour they devote to deliver direct patient care.
It is hard to overstate how much this dispiriting lack of personal contact, which is the major reason people choose careers in medicine, leads to the depersonalization and depression that are the hallmarks of burnout.
Perhaps the best evidence that practicing medicine is bad for one’s health is studies showing that medical students begin their training with stronger mental health profiles than their fellow college graduates. This advantage vanishes and a deficit emerges as they progress through their schooling, residency and professional practice.
As in medicine, we must identify the problem before we can treat it. A crucial step was taken in July when the National Academy of Medicine called on researchers to identify interventions that ease burnout. Many universities and academic hospitals have already been exploring ways to address the problem.
At the University of Michigan we established two groups earlier this year – one to look at burnout among our doctors, the other among our younger residents. It is still too early to say what might work. But ideas to help physicians achieve a better work-life balance, including more flexible scheduling that recognizes family commitments as well as better child care assistance, seem promising. So, too, does the use of “scribes” to handle some paperwork chores and drawing a sharper distinction between the care only doctors can deliver and that which can be provided effectively by physician’s assistants and other trained personnel.
Above all, we must allow doctors to ask for help and provide them with the care they need without penalty. Medicine has long been hampered by the ancient myth of invincibility – the notion that physicians must never show weakness, every embodying grace under pressure. This is not only wrong, it’s dangerous.
Physician burnout is a national crisis. Unfortunately, it does not offer a quick fix. Medicine will always be a uniquely demanding profession, requiring years of training and long hours of service to be ready to make life and death decisions.
Fortunately, a broad consensus has emerged in the medical community that doctors cannot provide the best care for their patients if we don’t figure out how to take care of them.
Marschall S. Runge, former Executive Dean of the UNC School of Medicine, is Executive Vice President for Medical Affairs and Dean of the Medical School for the University of Michigan.