Doctor burnout: When it’s time to seek help

Burnout harms workers in all fields, but evidence indicates that incidence is higher in healthcare professionals. According to a review published in Local and Regional Anesthesia in 2020, an estimated one in three doctors is experiencing burnout at any given time—and studies have found that rates of burnout are as much as 10% higher in physicians compared with the general population.^[] Roughly 43% of physicians show symptoms, which include exhaustion, depersonalization, and diminished efficacy.

Physicians on the front lines of care, such as family medicine, internal medicine, and emergency medicine, tend to be at the greatest risk, wrote the authors. However, as noted in an article published in the American Journal of Medicine, “some believe the condition to manifest at some level in nearly all physicians.”[2]^[]

Indeed, doctor burnout is an ever-growing concern, with reports published annually on the most burned-out specialties. And then there’s burnout’s equally dangerous cousin: compassion fatigue.

Studies have shown that burnout is associated with an increased risk of major medical errors, as well as health risks for doctors. The condition has been linked to depression and increased risk of diabetes and coronary events.

Signs of burnout

A study published in the Journal of Clinical Psychiatry examined high rates of burnout among frontline caregivers responding to COVID-19, and found a number of symptoms that strongly predicted the condition.^[] Researchers concluded that fatigue, irritability, anxiety, and feeling “on edge” were most commonly associated with physicians who were burned out.

Researchers also identified symptoms that appeared to be related to specific burnout outcomes. For example, irritability and trouble concentrating best-predicted difficulties at work. On the other hand, negative expectations about oneself or the world, or feelings of self-loathing, best-predicted effects on personal relationships.

These signs may seem benign or like a part of everyday life, but if they persist, they can eventually lead to burnout.

The Local and Regional Anesthesia review notes that emotional exhaustion, depersonalization, and a sense of low personal accomplishment are also symptoms. Physicians can become exhausted and appear to stop caring about patients. Cognitive performance and motivation may also decline.

Authors of the review provided a five-stage model that illustrates the burnout progression:

• It begins with a period of enthusiasm, known as the “Honeymoon Phase.” The physician may feel an increased commitment to work, but this inevitably leads to added stress as the physician gets worn out.

• Without coping strategies, burnout leads to a sense of stagnation, followed by the onset of stress. Some days may begin to feel more difficult than others. Work becomes all-consuming and personal boundaries may become porous, leading to an erosion of social and familial relationships. Physical and emotional symptoms of stress and depression begin to emerge.

• After a while, chronic stress morphs into frustration. Physicians may develop feelings of failure, incompetence, or inadequacy.

• An apathy stage follows. The physician’s world becomes clouded with disillusionment and despair. They may believe that there is no way to resolve the situation and become distant and resigned.

• And finally, when the physical and emotional symptoms overwhelm the physician, they enter a phase of habitual burnout.

The key is to identify some of these red flags before you—or your colleagues—become overwhelmed. Mitchel Schwindt, MD, described some of these red flags in a KevinMD.com article, which details his experiences with burnout.^[] He ignored many symptoms at the time, including unexplained anxiety or nausea, feelings of dread days before a shift, and decision fatigue.

Barriers to seeking help

According to an article published by the AMA, healthcare tends to create a culture in which physicians are programmed to cope alone, and that doctors’ experiences in residency often breed a survival mentality.^[] These—along with imposter syndrome, which is prevalent among doctors—are some of the reasons why physicians skip seeking help.

Another barrier is the fear of facing future licensure problems stemming from mental-health stigma. Several years ago, the AMA adopted a policy to encourage “state licensing boards to require disclosure of physical or mental health conditions only when a physician is suffering from any condition that currently impairs his or her judgment or that would otherwise adversely affect his or her ability to practice medicine in a competent, ethical and professional manner, or when the physician presents a public health danger.”

However, a report written by Yalda Safai, MD, and published by ABC News in 2020, indicates that doctors are concerned about the professional effects of seeking help.^[] According to Safai, questions on past psychiatric treatment are common with state medical boards, hospital credentialing applications, and malpractice insurance applications.

While the Federation of State Medical Boards and American Psychiatric Association posit that current impairment and risk to patients cannot be inferred from a history of mental illness alone, professional applications for licensing, employment, disability, and more, continue to base decisions on these questions.

How to address burnout

Various studies and real-world case studies have established a number of coping strategies and intervention methods to combat burnout in physicians.

Evidence indicates that practices like mindfulness, stress management, and small-group discussions can help. For example, a study published in BMC Medical Education in 2020 explored the efficacy of an intervention that taught doctors-in-training how to manage work-life balance and trained them in self-care skills.^[]

Researchers used a cohort of 22 doctors who underwent workshops that included advice on physical activity, eating habits, sleep strategies, self-compassion, and mindfulness meditation. They also received training on digital well-being, which included “microboundary strategies” designed to help individuals keep their work and private lives separate.

Researchers found that the intervention produced a “statistically significant reduction in burnout” and improvement in boundary control during a 1-month follow-up. Participants reportedly benefitted from having a “safe space to discuss stressors,” and most had adopted digital well-being strategies and were practicing mindfulness methods such as walking in green spaces.

According to the Local and Regional Anesthesia review, focusing on relationships can keep burnout at bay. This means spending quality time with family and friends, and pursuing connections with colleagues. For some, this can mean practicing religion.

Of course, burnout prevention should not exclusively fall to physicians. As noted by the authors of the Local and Regional Anesthesia review, employers should offer help, too. Institutions—the policies of which are often among the key drivers of burnout—should provide adequate resources and support staff. Offering physicians more control over their work environments, as well as training on resilience strategies, are also drivers of employee well-being.

Act early

Reimbursement pressures and EHRs have led physicians to work longer hours than ever. As such, any burnout solution requires a systems-level approach. Until more robust efforts to address burnout begin, individual doctors should seek help before burnout takes hold. As the authors of the AJM review noted, “without our own oxygen mask in place, we cannot help those around us.”