More Physicians Are Experiencing Burnout and Depression

Christine Lehmann

Medscape.com

Originally poste 1 FEB 23

More than half of physicians reported feeling burned out this year and nearly 1 in 4 doctors reported feeling depressed — the highest percentages in 5 years, according to the 'I Cry but No One Cares': Physician Burnout & Depression Report 2023.

"Burnout leaves you feeling like someone you're not," said Amaryllis Sánchez, MD, a board-certified family physician and certified physician coach.

"When someone is burned out, they experience extreme exhaustion in the workplace, depersonalization, and a sense that their best is no longer good enough. Over time, this may spill into the rest of their lives, affecting their relationships as well as their general health and well-being," said Sánchez.

When feelings of burnout continue without effective interventions, they can lead to depression, anxiety, and more, she said.

Burnout can persist for months to even years — nearly two thirds of doctors surveyed said their burnout lasted for at least 13 months, and another 30% said it lasted for more than 2 years.

The majority of doctors attributed their burnout to too many bureaucratic tasks, although more than one third said it was because their co-workers treated them with a lack of respect.

"This disrespect can take many forms from demeaning comments toward physicians in training to the undermining of a physicians' decade-long education and training to instances of rudeness or incivility in the exam room. Unfortunately, medical professionals can be the source of bad behavior and disrespect. They may be burned out too, and doing their best to work in a broken healthcare system during an extremely difficult time," said Sánchez.

The info is here.

High rates of burnout among college mental health counselors is compromising quality of care, survey says

Brooke Migdon

thehill.com

Originally posted 17 FEB 22

College counselors and clinicians are reporting increasingly high levels of burnout and stress as the pandemic enters its third year. Experts say it’s going to get worse before it gets better.

Just under 93 percent of clinicians on college campuses reported feeling burned out and stressed during the fall semester this year, according to a survey by Mantra Health, a digital mental health clinic geared at young adults. More than 65 percent of respondents reported a heavier workload and longer hours worked compared to the fall semester in 2020. 

Another 60 percent said their workload had compromised the quality of care they were able to provide to students in the fall.

Caseloads aren’t expected to fall anytime soon, as overworked clinicians are leaving the field at a rate similar to that of students asking for help, according to David Walden, the director of Hamilton College’s counseling center. Qualified candidates are also hard to come by.

“Over the last year college counseling centers have seen an uptick in professionals leaving the field and a smaller pool of applicants to refill their positions while the demand from students seeking treatment continues to rise,” he said Thursday in a statement.

Walden noted that, importantly, clinicians are also contending with their own pandemic anxieties that impact their ability to care for themselves, let alone others.

It is “increasingly difficult for directors and clinicians to avoid burnout while institutions of higher education are having increasing trouble hiring and retaining quality mental health staff,” he said.

With college-aged students reporting alarming rates of depression, anxiety and substance abuse, providing quality on- and off-campus care is critical.

The info is here.

Physicians aren’t ‘burning out.’ They’re suffering from moral injury

Simon G. Talbot and Wendy Dean
STAT News
Originally published July 26, 2018

Here is an excerpt:

The term “moral injury” was first used to describe soldiers’ responses to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Journalist Diane Silver describes it as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”

The moral injury of health care is not the offense of killing another human in the context of war. It is being unable to provide high-quality care and healing in the context of health care.

Most physicians enter medicine following a calling rather than a career path. They go into the field with a desire to help people. Many approach it with almost religious zeal, enduring lost sleep, lost years of young adulthood, huge opportunity costs, family strain, financial instability, disregard for personal health, and a multitude of other challenges. Each hurdle offers a lesson in endurance in the service of one’s goal which, starting in the third year of medical school, is sharply focused on ensuring the best care for one’s patients. Failing to consistently meet patients’ needs has a profound impact on physician wellbeing — this is the crux of consequent moral injury.

The information is here.

Is compassion fatigue inevitable in an age of 24-hour news?

Elisa Gabbert
The Guardian
Originally posted August 2, 2018

Here is an excerpt:

Not long after compassion fatigue emerged as a concept in healthcare, a similar concept began to appear in media studies – the idea that overexposure to horrific images, from news reports in particular, could cause viewers to shut down emotionally, rejecting information instead of responding to it. In her 1999 book  Compassion Fatigue: How the Media Sell Disease, Famine, War and Death, the journalist and scholar Susan Moeller explored this idea at length. “It seems as if the media careen from one trauma to another, in a breathless tour of poverty, disease and death,” she wrote. “The troubles blur. Crises become one crisis.” The volume of bad news drives the public to “collapse into a compassion fatigue stupor”.

Susan Sontag grappled with similar questions in her short book Regarding the Pain of Others, published in 2003. By “regarding” she meant not just “with regard to”, but looking at: “Flooded with images of the sort that once used to shock and arouse indignation, we are losing our capacity to react. Compassion, stretched to its limits, is going numb. So runs the familiar diagnosis.” She implies that the idea was already tired: media overload dulls our sensitivity to suffering. Whose fault is that – ours or the media’s? And what are we supposed to do about it?

By Moeller’s account, compassion fatigue is a vicious cycle. When war and famine are constant, they become boring – we’ve seen it all before. The only way to break through your audience’s boredom is to make each disaster feel worse than the last. When it comes to world news, the events must be “more dramatic and violent” to compete with more local stories, as a 1995 study of international media coverage by the Pew Research Center in Washington found.

The information is here.

Over half of doctors have symptoms of burn-out: survey

Lynn Desjardins
Radio Canada International
Originally published August 28, 2017

A recent survey suggests that 54 per cent of Canadian doctors have symptoms of burn-out and it’s a problem that physicians themselves don’t like to talk about. This was a topic much discussed at the annual meeting of the Canadian Medical Association which represents more than 80,000 doctors.

‘Very frustrating and annoying’ interventions required

“First and foremost, it’s about the inability that physicians have sometimes to get what the patient actually needs in a timely way,” says Dr. Granger Avery, immediate past president of the Canadian Medical Association.

“So, that’s whether looking for a consultation, following up on an operation, whether it’s transferring a patient from one level of service to another, these things often require the doctor to make repeated phone calls, repeated interventions to get what should be a relatively simple piece of work done. So, that’s very frustrating and annoying for a physician who’s been brought up and trained and focused on helping people, not doing that administrative work.”

The article and the podcast are here.

Moral distress in physicians and nurses: Impact on professional quality of life and turnover

Austin, Cindy L.; Saylor, Robert; Finley, Phillip J.
Psychological Trauma: Theory, Research, Practice, and Policy, Vol 9(4), Jul 2017, 399-406.

Abstract

Objective: The purpose of this study was to investigate moral distress (MD) and turnover intent as related to professional quality of life in physicians and nurses at a tertiary care hospital.

Method: Health care providers from a variety of hospital departments anonymously completed 2 validated questionnaires (Moral Distress Scale–Revised and Professional Quality of Life Scale). Compassion fatigue (as measured by secondary traumatic stress [STS] and burnout [BRN]) and compassion satisfaction are subscales which make up one’s professional quality of life. Relationships between these constructs and clinicians’ years in health care, critical care patient load, and professional discipline were explored.

Results: The findings (n = 329) demonstrated significant correlations between STS, BRN, and MD. Scores associated with intentions to leave or stay in a position were indicative of high verses low MD. We report highest scoring situations of MD as well as when physicians and nurses demonstrate to be most at risk for STS, BRN and MD. Both physicians and nurses identified the events contributing to the highest level of MD as being compelled to provide care that seems ineffective and working with a critical care patient load >50%.

Conclusion: The results from this study of physicians and nurses suggest that the presence of MD significantly impacts turnover intent and professional quality of life. Therefore implementation of emotional wellness activities (e.g., empowerment, opportunity for open dialog regarding ethical dilemmas, policy making involvement) coupled with ongoing monitoring and routine assessment of these maladaptive characteristics is warranted.

The article is here.

Why are doctors plagued by depression and suicide?

By Judith Graham @judith_graham
STAT News
Originally published July 21, 2016

Here is an excerpt:

The starkest sign of the crisis gripping medicine is the number of physicians who commit suicide every year — 300 to 400, about the size of three average medical school classes. Male doctors are 1.4 times more likely to kill themselves than men in the general population; female physicians, 2.3 times more likely.

The grim tally is probably an under-count, since many suicides aren’t listed as such on death certificates. And it doesn’t include suicides among medical students, which aren’t tracked systematically in the United States.

In one study of six medical schools, nearly 1 in 4 students reported clinically significant symptoms of depression. Almost 7 percent said they had thought of ending their lives in the last two weeks.

The article is here.

Physician Burnout Is a Public Health Crisis

Arthur L. Caplan
MedScape
Originally published on March 4, 2016

Here is an excerpt:

We've got a problem in this country with doctors. It's kind of an epidemic, but no one is talking about it. It is burnout. A recent study from the Mayo Clinic showed that in 2011, 45.5% of doctors reported that they felt burned out, and that number has now risen to 54.4% in 2014. More than half of all doctors in this country are saying, "I really feel that some aspect of my work as a doctor is making me feel burned out."

This is really trouble. It's trouble because a doctor who feels this way can commit more errors. They suffer from compassion fatigue, or just not being able to empathize with others because they have their own emotional issues. They may retire early, thereby reducing the workforce. They may have problems managing their own lives; 400 doctors committed suicide last year, which is double the rate of the population average. There's trouble for patients in having a workforce that's burned out. There's trouble for doctors in terms of their own health and well-being. We don't talk about it much. We like to think that doctors can handle everything, but it's clearly not true. It's a problem and there ought to be some solutions.

The article is here.

Compassion fatigue resiliency training: the experience of facilitators

Potter P, Pion S, Gentry JE.
J Contin Educ Nurs. 2015 Feb;46(2):83-8.
doi: 10.3928/00220124-20151217-03

Abstract

This qualitative evaluation examined compassion fatigue facilitators' perceptions of the effects of a compassion fatigue resiliency training program in an urban medical center in the midwestern United States. Nine months after completing a compassion fatigue resiliency facilitator training program, 15 participants wrote short narratives describing how the program affected them. Participants described how the training program benefited them both personally and professionally. Two main themes were identified from the narrative analysis: self-improvement and application of resiliency. All of the participants described one or more self-improvements as a result of the program, particularly in regard to emotional health. All of the participants also described how they regularly applied one or more of the resiliency skills taught in the class to improve their ability to manage stress and prevent compassion fatigue. This program shows promise in ameliorating compassion fatigue and burnout in health care providers.

The entire article is here.

Impact of Burnout: Clinicians Speak Out

Deborah Brauser
Medscape
Originally posted February 10, 2015

Professional burnout has serious negative consequences not only for affected clinicians but potentially for patient care and outcomes as well, new research suggests.

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In addition, those who reported higher levels of depersonalization were significantly more likely to report that burnout affected their interaction with patients.

Interestingly, emotionally exhausted clinicians were significantly less likely to report an impact on patient outcomes.

The entire article is here.

How Patient Suicide Affects Psychiatrists

By Sulome Anderson
The Atlantic
Originally posted January 20, 2015

It’s hard to listen to a psychiatrist who sounds so broken. I expect a mental-health provider to seem healthy, detached. But even over the phone, the weariness in Dr. Brown’s voice is palpable.

“This is what we do when people die,” he says. “Even if they die an expected death, it seems to be human nature to go back over [it]. What should I have said that I didn't, or shouldn’t have said that I did? Could I have done more or did I do too much? This seems to be a part of the grieving process. I think it's especially intense in a situation where you have direct responsibility for helping the person get better.”

Brown lost a patient to suicide last year. She was a long-term client of his, the mother of a large, loving family. Right after a session with him, she went home and killed herself. Two months later, Brown’s son did the same thing.

The entire article is here.

Mental health workers don't recognise their own burnout

British Psychological Society
Press Release
Originally published January 9, 2015

Some mental health workers find it difficult to recognise their own burnout and even when they do they struggle to admit it to others says a study presented today at the British Psychological Society Division of Occupational Psychology annual conference in Glasgow.

The study was undertaken by PhD student Ms Marieke Ledingham and colleagues Associate Professor Peter Standen (Edith Cowan University, Australia) and Associate Professor Chris Skinner (University of Notre Dame, Australia).

Ms Ledingham explained: “Burnout has long been a problem in mental health workplaces and remains so despite much research and considerable knowledge of it amongst professional employees. Despite working in this sector employees struggle to avoid burnout and we wanted to study how work places could improve support.”

The entire pressor is here.