Burned Out

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Has a week passed since you heard a friend or colleague or family member say they just felt burned out? Probably not. And if you interface with health care in any manner, you are more than familiar with the impact of burnout on health for providers and patients.

Physician burnout is epidemic with about half of all doctors reporting that they suffer from anxiety, depression, and related conditions at least some of the time.

This grave problem may get worse in the coming years because of troubling mental health trends – especially among younger Americans, which includes the next generation of physicians.

I fear we are nearing a point of no return in addressing the needs of our physicians to have a normal life. If we do not commit to major change and adapt to this threat to our profession, it will become a reality.

This difficulty takes on added significance because of the troubling increase in mental health diseases, especially among the young.

A range of studies show that the same symptoms associated with physician burnout – including stress-related anxiety and depression – are proliferating, especially among college students.

A 2017 American College Health Association Survey reported that 40% of college students surveyed reported being so depressed they “struggled to function,” while 60% felt “overwhelming anxiety” during the previous year. Another study published last year in Depression & Anxiety “observed a 24% rate of suicidal ideation and approximately 9% rate of suicide attempts reported among our undergraduate sample.”

These troubling trends are especially worrisome for health care. Medicine is a rewarding field, but also taxing – both physically and mentally. Those affects begin to emerge in medical school. The American Medical Association reports 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.

Physicians are expected to put their patients first – even ahead of even family and friends. They must never say no. That’s why most physicians work 40 to 60 hours per week, with nearly 20 percent saying they log 61 to 80 hours per week. These long hours have always been a major cause of burnout, even in the past, when most physicians were men trained in the culture of medicine that considered complaints a form of weakness. While it may be that we recognize burnout more readily than in the past. And we at least give lip-service to the importance of life/work balance.

This is especially true for women, who now comprise more than half of all medical school students. The burnout rate for female doctors is twice as high as that for their male colleagues, making them more likely to leave the profession. More often than men, generally women physicians bear the brunt of major responsibilities outside of work. This well-documented fact likely contributes to an increased prevalence of burnout among women physicians.

Like many other institution, the University of Michigan has recognized the urgency of the problem. Unfortunately, we have made little progress in combating it.

Why is that?

First and foremost, burnout is complex. Just as heart disease, cancer, and stroke are umbrella terms for what we now know are a range of ailments – “cancer,” for example, covers more than 200 diseases. Burnout, likewise, encompasses a range of symptoms. Like other complex ailments, it does not have a single cause. Instead it results from the interaction of a mix of environmental factors – including the frequency and strength of external stressors, how much we sleep, what we eat, the air we breathe – and each person’s individual genetic makeup that influences how we respond to those factors.

Hence, there is no one “cure.” 

In response, hospitals, physician organizations, and academic health have adopted an approach that has been highly effective in reducing medical errors: addressing burnout on a case-by-case basis. What my institution and others have been reluctant to do is to seriously consider how broader, systemic factors – the long hours, work comes first, never say no culture of medicine – contribute to burnout. Inconclusive results from early efforts, including the lack of proven benefit from reducing long trainee work hours, has led many to hang on to a status quo, “I told you so” attitude.

That is not a productive response to a problem that will likely only become more urgent. 

Currently, my institution has two groups studying burnout – one looking at doctors, the other at young residents – that are generating ideas on how to help doctors achieve a better work/life balance. This is just an important step in a process that will be tough, will require flexibility, will be costly (financial and other) and will at best limit rather than eliminate the problem of burnout.

There can be a happy ending to this story. Medicine is a field filled with bright, dedicated and innovative people. Now is the time to utilize that creativity to create a future that maintains our ability to provide the best in health care for our patients and ourselves. We can do that by looking at the data along with examining ourselves and our culture.

Marschall S. Runge, MD, PhD, is Executive Vice President for Medical Affairs and Dean of the Medical School for the University of Michigan.  He serves on the Board of Directors for Eli Lilly and Company.

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