By Charles Wilmer, M.D., FACC, FSCAI
I recently returned from the Medical Association of Georgia’s summer legislative seminar in Blairsville, where we had 75 physicians interacting with 37 of our legislators to better understand the political climate and opportunities for growth and improvement in patient care.
Some of these individuals were over 60 years of age and yet still fully engaged. Why aren’t they burning out? Why have they not retired? What makes them keep going? The answer appears to be “they still have a purpose to accomplish something greater and larger than themselves.”
We are losing the services of some of our best physicians when they retire. The patients have the most to lose but the physicians lose as well. Not only do the patients break a long-term bond with their physician, but they have to find a new doctor as well, all very stressful.
Some people feel that life and work are predestined. “We are here to live and die – there is nothing you can do about it.” When you can afford to retire, you go for it. As physicians we become frustrated with life’s challenges, especially as we age. We get tired of fighting “the same old things – EMRs, insurance companies, prior authorization for generic drugs, the threat of malpractice suits – and new things such as the PDMP, Press Ganey scores and being targeted by unknowns on the internet – sound familiar?
According to a January 2018 Medscape report on national physician burnout and depression, burnout rates are higher among women (48 percent versus 38 percent for men), and more than half of the physicians in the U.S. are burned out.
Burnout rate climbed for physicians ages 45-50 (50 per- cent burnout rate) versus the younger physicians 28-34 years old (35 percent burnout rate). Of the nearly two-thirds of U.S. physicians feeling “burned out,” 42 percent were just burned out, 15 percent were depressed and 14 percent were both burned out and depressed. Fifty-six percent of respondents suggested they would benefit from fewer bureaucratic tasks, and 39 percent said working fewer hours would help reduce burnout risk.
Recent reports of primary care physicians spending half of their workday fulfilling EHR records (annals of family medicine) are just one example of wasting physician talent. “The day they start medical school, medical students are happier and better adjusted than their education-comparable peers,” says Philip Shayne, professor of emergency medicine and assistant dean for Graduate Medical Education at Emory School of Medicine. “Then there is this big rise in burnout and depression that continues into their 50s.”
The “culture blame” where we single out the individual physician who makes a mistake but ignore the systemic issues that can too easily lead to unsafe behaviors and practices is a major problem in today’s medicine. Instead, we need to focus on learning from our mistakes versus punishment as a means to prevent errors.
We have to be careful about the goals we strive for. Titles, how many patients we see or number of procedures performed may ultimately lead us down the road to depression. History reminds us of the famous tennis player, Boris Becker, and the famous novelist, Jack Higgins – men who were both famous in their “volume” of success and empty in their lives.
Proven antidotes to burnout include promoting autonomy, creating a sense of collegiately and community and allowing time for meaningful work. “An individual organization that is committed to this at the highest level of leadership and that invests in well-designed interventions, can move the needle and run counter to the national trend of early physician burnout,” noted Taite Shanafelt, chief wellness officer at Stanford Medicine in a recent address to Emory physicians.
Exercise and talking with family members and close friends, along with rest and a good night’s sleep, are necessary to reduce burnout. Empathy for others and ourselves is a requisite for long-term satisfaction in this marathon of medicine.
Standing up for our patients, their success and their protection, is one of the most honorable things to do – it saves their lives and ours as well. It gives us a purpose that is greater than ourselves.
Change will be constant. We need to help each other build a better health system and expect a little disruption in the process. We cannot afford to lose our prized physicians who have so much valuable experience.
Solutions for burnout are available, and the medical world is ready for them. Let’s keep our standards high and our purpose for life guarded in our hearts. Together we can defeat burnout.