Category: Physician Burnout

A Scary Time To Be A Doctor!!!

Check this out. What you will see is pretty much what you would expect during the Covid-19 pandemic. Dr. Hartsock, the physician pictured above, is a Hospitalist. And she is scared to go to the hospital every day. Scared for herself and scared for other healthcare workers. Scared because 10% of the infected patients in Italy, a country which we seem to be mimicking, are healthcare workers. AND. Scared because, for some reason, when people on the frontlines of fighting this pandemic get the COVID-19 virus, they get it BAD! And yes she is asking for donations of PPE (Remember when we didn’t know what that acronym stood for?). Like I said, pretty much what you would expect a physician in this position in March 2020 to be saying.

So why do I refer you to this post if its content is so predictable? Answer? Because it got me to thinking. You see, I have a “stock speech” about physician mental health that I have given several times at conferences, as a Webinar, etc. In it, I cover physician suicide, depression and burnout. Such manifestations of physician mental health issues are of great concern due their frequency and impact on the practitioner AND on patient care.

SO. Against this backdrop, I am pondering the longer-term impact of the COVID-19 pandemic and the practitioner fear it is understandably causing. Will rates of physician suicide, depression and burnout increase significantly? I am thinking PTSD here.

And will rates of “compassion fatigue” increase among the nurses who are working amazingly long hours, afraid of getting sick themselves and having to hold dying patients’ hands since no visitors are permitted? Again, I would think, a resounding yes.

Bottom Line. My prediction? Those of us who deal with health care providers, as professionals and as patients, are going to be dealing with the psychological sequalae of COVID-19 long after the virus itself has been beaten into submission!

Do Not Resuscitate

Check this out.  What you will see is the story of Critical Care Nurses caught in a whipsaw. Their lives are hectic, responding to beeping alarms, responding to demanding patients, having to ask permission to go to the bathroom. BUT. Amidst all of this, they still find the time to have compassion for an old man, sitting in the corner of the hospital cafeteria, wrestling with saying goodbye to his dying wife.

Bottom Line. Fascinating. When I give my presentation on Physician Burnout, which I will be doing again in a Webinar on April 2, I always point out the differences in the reasons that physicians burn out versus the reasons nurses burn out. While doctors burn out largely due to administrative hassle, nurses burn out from “compassion fatigue.” Being up close and personal with patients and their backstories and still having to do their jobs.

I am thinking every day should be National Nurses Day!

Kara The Physician Wellness Coach

Check this out. What you will find is yet another one of a kind person we have talked about before. A physician who by her own report became “numb” practicing medicine. All of her emotions went flat. No joy, no pain, no anxiety. Just nothingness. And what did she do about that state of affairs? Like other physicians we have discussed, she left clinical practice and became a “Physician Wellness Coach.” 

In this role, she claims to be “at the cutting edge of dealing with physician burnout.” More specifically, in 50-minute one-on-one sessions, she helps doctors deal with “burnout, impostor syndrome, perfectionism, workflow and efficiency, work-life balance, career transition, exhaustion, loneliness, relationships, etc.”

Bottom Line. As I wandered around Kara’s website, I was wondering…

I looked at the “career transition” coaching offering in her repertoire, and I was curious as to whether she is trying to convince other physicians to bail out on medicine like she did.  

And I also wondered…how helpful are these wellness coaches? To what extent can they actually improve the lives of physicians who, if they remain in the practice of medicine, will have to keep going into an environment that systematically wears them down?

I am guessing that somebody ought to study that!

And Now, Medical Students

In the last couple of posts, we have talked about “little things” that can be done to reduce physician burnout. First, we covered practicing Physicians with Dr. Wible. Then we covered Residents with Dr. Orlovich. Now it is time to look at medical students with Dr. Choi.  

Check this out. What you will see is the Dean of a medical school telling you that medical students are, at their tender age, already burning out. Many numbers being bandied about here. One study reports 56% of medical students are burned out. At the University of Pittsburg, 1 out of every 6 medical students has received mental health services. And it’s getting worse. At the institution where Dr. Choi is Dean, the number of medical school students reaching out for an appointment with a Psychiatrist has increased 60% in the last four years.  

What to do? Clearly, providing accessible mental health services is important, but relying on that is dealing with the result, rather than the cause, of an environment that burns out medical students.  Coming up with “resilience training” programs does the same. 

SO. Is this like the last two posts, where manipulating some “little things” might make a big difference? Like, as is suggested here, grading courses on a pass/fail basis, thus reducing arguably meaningless academic competition?

Bottom Line. SO. If two points determine a line, how about three? We have now heard three knowledgeable authors opine that from medical school through residency and into practice, manipulating “little things” might help to reduce burnout.  

How about if we “chip in” and help?

Why Is This Resident Smiling???

Check this out. What you will learn is that he is the “Chief Resident of Wellness” at Stanford University. Interesting in and of itself. But the plot thickens. Continuing on the theme of my most recent blog, wherein I referred you to Dr.  Pamela Wible’s presentation on practical things that can be done to reduce physician burnout, Dr. Orlovich recounts a study that found that simply granting Resident physicians a handful of “wellness days” every year can actually reduce their burnout rate.  

Could it be that we could significantly reduce physician burnout by chipping away, one by one, at the laundry list of “little things” that cause it? Note the comment made to Dr. Orlovich by a physician coming to Stanford from another residency program. “Do you know how much they charged us to park there every month?” Overcharging in the cafeteria, no call room, other little things about her previous program just, well, made her nuts!

Bottom Line. There is no question that training to be a physician is inherently hard. BUT. What happens if we reduce the nonsense that has nothing to do with the training process?

Dr. Wible told us in the previous post that such improvements can reduce burnout rate for practicing physicians. Seems that the same thing might be true for Residents.  

Is there a learning here???

Replacing Physician Suicide With Physician Wellness

As I have mentioned previously, on February 5th of this year, I had the opportunity to give a presentation on physician burnout and suicide at the Pharmaceutical Marketing Research Conference in Newark, NJ. It was a very interesting experience.  Amidst the Conference’s presentation after presentation on research methodologies, I spent my 35 minutes telling attendees that their physician customers/respondents were not as mentally healthy as everybody assumes they are. This was a new idea for most, and after the presentation I heard a number of comments indicating that the presentation had struck an important chord. Several participants asked if anybody is doing anything about the fact that 400 physicians in the U.S. commit suicide in an average year, and 50% of physicians report being burned out.

Answer? Yes! Check this out. What you will see and hear is a presentation made by Pamela Wible, M.D.  Pamela has been studying physician suicide throughout her career. More importantly, she has been developing suicide prevention interventions that work, unlike the resiliency programs, meditation courses, and other nonsensical attempts that are currently being foisted on physicians by their “administrators.”  

Bottom Line. Although Dr. Wible’s presentation lasts an hour, I think you will find it a very good use of your time. As pharmaceutical marketers and marketing researchers, I believe that we have a responsibility to make sure that we understand the mental health issues bedeviling our physician customers, to do what we can to help and, at the very least, to make sure that our presence in the physicians’ psychological space doesn’t make the problems of burnout and suicide any worse.  

I hope you agree!

Compassion Fatigue

You know, timing really is everything. I was sitting at the Airport Marriot in Newark, NJ last week. I was preparing for the first day of the Pharmaceutical Marketing Research Conference there. I was speaking on the topic of physician burnout. Widespread. About 50% of doctors in the U.S. Etc. You know my riff on this.

BUT. I shared a new slide, drawn from the 2019 Medscape Survey of Physician Burnout, Depression and Suicide. Fascinating. Look at slide 5. What you will see are the factors that are listed by physicians partaking in the survey as the “major causes” of their burnout. The factors here parallel what you usually see listed as causes. Administrative stuff, EMR’s, cog in the wheel, too much time not enough money, etc. Very little about providing medical care per se.  

BUT. Now take a look at this. This piece introduced me to a term I had never heard before. “Compassion Fatigue.” If you are a nurse, that is what is getting you down. Being up close and personal with patients, their suffering, their backstories, their condescending attitudes.  

Bottom Line. Fascinating juxtaposition. Doctors weighted down by bureaucracy, nurses by the providing of medical care itself. Like I said, Compassion Fatigue is sort of a new thought for me. I need to think about why doctors are weighted down by “stuff” and nurses are weighted down by “real stuff.” 

You should too!

Physician Suicide Is Not Just An American Problem

Check this out. What you will see is that a single hospital in Israel, pictured above, has had four physician suicides since 2018. Amazingly, two of the physicians weren’t just Residents, who kill themselves with an extremely unfortunate regularity due to the stresses of training, uncertainty and long work ours. Nope. One headed Plastic Surgery, the other Soroka hospital’s Cardiac ICU.

When I visited Israel years ago, I had the opportunity to visit with one of the world’s most renowned spine surgeons and his OR RN wife. We had sort of an amazing conversation. Routine in Israel is to work 6 days a week, taking only the sabbath off. Both the Doctor and his wife did that without complaint. Amusingly, his only concern, and it was a serious one for him, is that he got paid no more by the government for his expertise than did a Dermatologist who “just pops pimples.”  

But scroll forward a couple decades. We see doctors in this Beersheba hospital working 430 hours a month to keep up with their surgical and training schedules. And yes, the hospital put in a program to try to prevent further suicides. And yes, the hospital says that the doctors are their “top priority.” But no, that doesn’t really cut the mustard when you still have physicians working well over 100 hours a week.

Bottom Line. Around the world, we seem to have the same problem. Administrators (Who I am guessing are notworking 430 hours a month!!!) are installing “Resiliency Programs,” when what they really need to be doing is to make physicians’ work lives more manageable.  

In a couple of weeks, I am going to be making a presentation at PMRC on the three reasons why pharmaceutical marketers and marketing researchers need to start to include physician burnout in their understanding and segmentation of physicians. I am going to begin by expressing my frustration at the fact that although I have been writing about suicide and burnout for several years, nobody in our industry seems to care.  

We should!!!

The Overnight Shift In The ER

Check this out. Trigger warning! This piece gets a little long and tedious, but do me a favor and read it to completion. You sort of need to do that to get the full impact of this article. For me, the full impact here is the sheer number and variety of issues that an ER doctor needs to deal with during one overnight shift. Most not really emergencies at all. Just “stuff” that needs a doctor’s attention when no place else with an MD is open. Bloody nose, urinary tract infection, etc. As the author laments, the throughput in an average ER is increasing so rapidly that even new ones are undersized before they are built. The author compares ER’s with popular restaurants. While waiters are frantically turning over tables in the latter, doctors are equally frantic in their efforts to clear stretchers in the ER. Treatment room access is sufficiently strained that “private” exams are often being conducted in hallways.

Bottom Line. Over the past decade, numerous surveys have found ER physicians to have among the highest burnout rate of all of the medical specialties. Funny. As I have been looking at that statistic, I have been thinking about ambulances rushing into ER bays, sirens screaming, unloading  a cargo of heart attacks, gunshot wounds, and other critical cases. No wonder ER doctors are burned out, right?

Wrong! As exemplified by this article, the vast majority of patients going through the ER come in under their own power, NOT by ambulance. So, what is actually burning out the ER doctors is not the Herculean rescue efforts in which they occasionally become involved. Nope. It is slogging through the morass of 16 patients lined up in the waiting room for attention, the vast majority of whom have relatively mundane problems, and many of whom will be seen in the ER again within a few days of discharge, despite the best efforts of the attending physician.  

Yup. That IS what is burning out ER doctors. Understandably so!

Physicians Aren’t Burning Out…They Are Suffering “Moral Injury”

Check this out. What you will see is a fascinating comparison between PTSD and physician burnout. And the resulting conclusion that it is more appropriate to talk about physicians suffering “moral injury” than it is to describe them as “burning out.” Here’s the line of reasoning.

The term “moral injury” was first used to describe what often happens to combat soldiers. Normal people don’t kill other people that they don’t even know. It goes against everything in their upbringing and moral fiber. The result? As one journalist described it, “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.” As viewed from the outside, that’s PTSD!

The plot thickens. According to this article, physicians also go into battle every day. And, although they are not killing strangers, they are increasingly being prevented by the “health care system” from providing optimal care. Subtle things, like not being able to provide enough time to really deal with the patient as a human being due to scheduling pressures, or to provide the best drug for a condition because it isn’t reimbursed. The result of all of this is a condition we unfortunately refer to as “burn out.” Unfortunate because this terminology suggests that what we are seeing is a personal failing on the part of the “burned out” physician. Unfortunate because it suggests that “hospital wellness programs,” meditation, side job income and other band-aid measures can fix the problem. Unfortunate because it leaves the real problem, a broken healthcare system, unattended to.

Bottom Line. As usual, word choice matters. What other than systematically suffering moral injury could cause physicians to have a suicide rate twice that of active duty military personnel?  

The proposed recommendation? Stop doing silly little things to try to turn around a “burn out” rate that, according to some studies, is approaching 80% of practicing physicians. Instead, fix the underlying problems with the U.S. healthcare system to eliminate moral injuries.   

Sounds right!