Not only are a majority of physicians stressed, but the negative trend is getting worse, according to a recent survey of U.S. physicians conducted by Physician Wellness Services and Cejka Search. The results revealed 87% of respondents are moderately to severely stressed, while 63% say their stress has increased moderately to dramatically over the past three years.
Compounding the problem, says Alan Rosenstein, MD, medical director for PWS, is that only 15% of responding physicians say their organizations do anything to help them deal more effectively with their stress.
“This study shows that health care organizations are not providing support for their physicians, and the physicians don’t know where to go for help,” Rosenstein says.
But perhaps the most concerning issue is that far too often physicians don’t even realize they are burned out.
Nature of the beast
Rosenstein says that physicians have always been under stress to some degree or another, and either they don’t recognize it, or they simply believe they can handle it. In the past, however, the rewards were better, and the aggravation factors were lower, so they were willing to accommodate to the stress a s long as they were content in their careers and the rewards they were receiving, either monetary or respect.
“Remember, when you go into medical school, and you go throughout your training program, you don’t get any sleep, you’re fatigued, you’re constantly putting in all these hours, getting woken up in the middle of the night, and you’re having to make critical decisions, it seems like that has always been the way of doing business,” Rosenstein explains.
However, people are starting to realize that not only are physicians burning out, but it can compromise care and the ability to be a good doctor, he says.
Reality hit home in 2004 for Duane Gainsburg, MD, a neurosurgeon who operated a solo practice and now works as a locum tenens with Weatherby Healthcare. Gainsburg turned to his wife, who was also his office manager, one day and asked, “What are we doing this for?”
After two short exploratory stints doing locum tenens, he decided he’d found a better alternative. He closed his practice within a month, and has been doing locum tenens ever since. But, it wasn’t until after closing his practice that reality set in.
“I did not think of myself as burning out, or under stress that I didn’t need to be under,” Gainsburg says. “I kind of accepted it as a continuum of the time stresses that all of us go through in medical school, and then residency, and then after that, practice.”
He didn’t personally have an “ah-ha!” moment where he realized what was happening. Instead, Gainsburg thought it was time to do something different when he saw another physician.
“I saw somebody else who seemed to be satisfied in his way of doing medicine, so I thought, well, let me try it,” he says. “And then afterwards, when I stopped having to be a businessman, then I realized I was on my way to depression and anger and burnout; but I did not recognize it at the time.”
Rosenstein says talking about how rampant the problem of physician burnout is and how it’s getting worse is one thing, but it’s even more essential to talk about what should be done about it. If they are left to themselves, physicians realizing that they’re under stress and need to do something are like people saying they’re going to go on a diet.
“How many of them actually go through with it?” Rosenstein asks, rhetorically. “It’s all well intentioned, but the fact is that the system asks you to be on call, see one more patient, so your ideals are there, but very few physicians actually take the time and make it a priority that they need to do.”
But the first step, Rosenstein says, is recognizing there is a problem, which can be challenging in a smaller medical practice. He wonders if anyone in a three-physician practice actually realizes they’re so busy they need to do something. Once recognized, however, it’s critical to bring in someone who has the special skill set to address the issue.
“Some of that skill set is clinical understanding of what a physician’s life is like,” Rosenstein says. “Part of it is the conflict management and stress management, and part is really being trained as a coach. Sometimes you need to go outside your own walls if you want to have a greater chance of success.”
Ed Rabinowitz recently wrote One More Dance, a book about one family's courageous battle against time and glioblastoma brain cancer. Read more about the book here.