“Death by 1000 Cuts”

A January 2021 Medscape post entitled “Death by 1000 Cuts” reports the most recent survey of physician burnout and suicide. Over 12,000 physicians were included in the survey. 42% of the physician survey reported that they were burned out, a number that has remained relatively stable over the last five years area. Not surprisingly during […]

A January 2021 Medscape post entitled “Death by 1000 Cuts” reports the most recent survey of physician burnout and suicide. Over 12,000 physicians were included in the survey. 42% of the physician survey reported that they were burned out, a number that has remained relatively stable over the last five years area. Not surprisingly during this time of Covid 19, the specialties most affected included critical care, infectious disease, rheumatology, pulmonary medicine, family medicine and internal medicine.

As in previous studies, women physicians reported burnout more frequently than men and the discrepancy has increased this year. Although women have always assumed more responsibility in the home than do men, there are increased pressures this year as many children are home from school. Many women physicians now find themselves in the role of teacher as well as mom and there is more pressure to find childcare so they can fulfill their professional responsibilities. In addition there is the anxiety about catching the disease and bring it home to the family.

Interestingly, although 26% of physicians state that their burnout began during the pandemic, the majority did not. Stress from treating Covid-19 patients had only a minor contribution (8%) to physician burnout. The main causes of physician burnout form a familiar refrain. These include bureaucratic workload (58%,) overwork (37%,) lack of respect from coworkers and administrators (37%,) insufficient reimbursement (32%,) and lack of control/autonomy (28%.)

The level of happiness as decreased precipitously from 69% pre-pandemic to 49% at the time of the survey. Work-life balance remains a primary concern (45%) followed by adequate compensation (20%.) Approximately 20% of surveyed physicians reported feeling depressed as a result of being burned out but a majority of these physicians report that it has not affected patient care. The vast majority do not seek professional help because of concerns about colleagues finding out, or being reported to the medical board. Strategies to maintain happiness and mental health included doing enjoyable activities or hobbies (66%,) exercising (65%,) support from friends and family (63%,) and self-care including sleep and nutrition.

So what’s the bottom line here? Despite the stress imposed by the pandemic, the vast majority of causes of physician burnout are systemic and institutional, and need to be addressed at that level. Individual physicians can help relieve their stress through individual practices such as meditation and journaling, but that will not have a major effect on physician burnout until the systemic problems are resolved. In the meantime physicians who are stressed or burned out and don’t need specific psychotherapy or medication, may find that coaching with a professional coach who understands physicians may help them recover from burnout and change their working environment to make it less stressful. It should be noted that coaching is not therapy or a substitute for therapy, and as such is not reportable.

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