Physician Depression, Burnout and Suicide
For healthcare providers, providing support to their patients has become routine, but what they sometimes forget is that they need to take care of their health, both physical and mental, as well. Over the years, there has been an upward trend of the number of physicians reporting some level of burnout or depression (either colloquial or clinical), and there is still a high predominance of physician suicide. Dr. Zvi Margaliot is a hand and wrist surgeon, and he believes that there is a need for change within the healthcare system, to better help both patients and physicians.
Burnout and Depression
Burnout is defined as “long-term, unresolvable job stress that leads to exhaustion and feeling overwhelmed, cynical, detached from the job, and lacking a sense of personal accomplishment.’’ While burnout encompasses a wide-range of general symptoms and it can be difficult to accurately assess it, it’s generally considered to be a loss in three key categories: physical energy, emotional energy, and spiritual energy.
The constant exhaustion can lead to cynicism and the loss of empathy and care for patients, leading to doubt and fear that the work one does is irrelevant. Dr. Zvi Margaliot found that in a 2019 survey of over 15,000 physicians in 29 specialties, 44% responded that they felt burned out, 2% higher than the same survey from a year before.
While many feel that burnout and depression are the same, burnout more specifically refers to the long-term exhaustion from work stressors, while depression is much broader. In the survey, 14% reported feelings of depression, and 4% were clinically depressed. The highest rates of burnout were seen in Urology and Neurology, both with over 50% reporting burnout, and the lowest in Public Health and Preventative Medicine. The survey also showed that female physicians were significantly more burnt-out than their male counterparts.
Dr. Margaliot notes that in America there is one physician suicide daily, the highest of any profession. In the 2019 survey, 14% of respondents said that they had thought about suicide, 6% did not want to answer, and 1% of physicians had attempted suicide. Of the 14%, it was found that over half of the physicians had spoken to someone about these thoughts.
It was also found in the same survey that over 60% of respondents did not plan to seek help and have never in the past. When put together with the rates of burnout and those that are clinically depressed, this is alarming as the reported rates of burnout and suicide thoughts are high, there is still a large disparity in those that say they feel depressed and are clinically depressed, and they are not seeking help. Dr. Zvi Margaliot states that this shows that there is still a stigma around burnout and depression within the healthcare field, and that physicians unfortunately feel that this a norm for them, and something that they must learn to deal with.
Leading Causes according to Dr. Zvi Margaliot
It has been found that the number one leading cause of burnout that physicians feel is administrative work such as charting and paperwork, followed by spending too much time at work. Physicians within a healthcare organization and those in outpatient clinics were found to be the most burnt-out.
Ways to reduce rates
Exercise and talking with family members or close friends have been found to be the top two ways that physicians cope with burnout. It was found that males tend to use exercise more, while females prefer to speak with others.
Unfortunately, over 40% reported that they cope by isolating themselves, a coping mechanism that was used almost equally by both males and females. Dr. Zvi Margaliot expresses that the problem with this is that with isolation comes more depression, stress and eventually leading back to burnout. Some physicians noted making changes to alleviate burnout, some of which include reducing work hours, making staff changes to help with workload or hiring additional staff, limiting the number of new patients they are accepting, taking more time off to de-stress, and those in academic centers sometimes will give up education-related activities in favor of their clinical responsibilities.
Ultimately, however, the best way to deal with burnout or impending burnout, is to recognize the problem, seek help, and re-evaluate and re-align personal values. Dr. Margaliot strongly feels that there must be a paradigm shift in medical education, to acknowledge the problem, discuss burnout and its consequences directly in medical school, residency programs, and in mandatory continuing medical education courses. There must be a concerted effort to acknowledge and remove the stigma associated with seeking professional help.