By Gerri Donohue
There are myriad writings on physician burnout.
The words “physician burnout” have been well disseminated across the health care system. Preceding the COVID-19 pandemic, physician burnout was a well-known, albeit tragic, reality in the practice of medicine. The pandemic has served to exacerbate further an already critical assault upon physicians. Data tracked from The Physicians Foundation revealed that prior to the pandemic, in 2018, 40% of physicians reported experiencing burnout. Since the pandemic, the number has increased to 61%. Although vaccinations were viewed initially as an immediate solution to a potentially lethal virus, the medical landscape has become replete with distressing concerns for the unvaccinated and the emergence of COVID-19 variants.
How is physician burnout described? It is often marked by an absence of energy and a continuous experience of exhaustion. Joy is replaced with sadness. Meaningfulness becomes meaninglessness. Love and passion for the practice of medicine slowly slip away. Patients begin to be viewed as objects — their human qualities no longer center stage but rather seem redundant, remote and dissolving. Physicians describe a perplexing clinical situation: being at once present with their patients while at the same time feeling removed and numb by the experience. The Maslach Burnout Inventory or MBI is a valid tool used to measure the degree of burnout. The more emotional exhaustion, depersonalization and low personal accomplishment present, the higher the degree of physician burnout. The slippery slope from burnout to depression is evident.
Four hundred physicians die by suicide every year — a sobering statistic. Many believe the number could be substantially higher. Why would talented and gifted physicians wish to make a premature exit from life? Because physicians are unique and complex individuals, there are likely endless answers to this question. Physicians experiencing burnout could be at risk for significant depression or may have pre-existing depression. Depressed thinking can invite suicidal thoughts. With treatment for the depression, the suicidal thinking will often diminish. Are physicians receiving the needed emotional care and treatment?
Although having made headlines across the nation, it was New York that bore the devastating loss of Lorna Breen, MD, an emergency medicine physician in Manhattan. With the first surge of the newly-named lethal contagion striking rapidly with no known treatment, Dr. Breen was in a battle to save the lives of her patients. With an unprecedented healthcare crisis intensifying, Dr. Breen was unable to save her own life as she died by suicide. Dr. Breen’s family worked tirelessly with the legislatures to establish the Dr. Lorna Breen Health Care Provider Protection Act, which unanimously passed the US Senate on Aug. 6. This act aims to diminish suicide, burnout and other mental health conditions among healthcare professionals.
The passage of this act is an enormous achievement for providing the necessary funding for physicians and healthcare professionals to receive mental health care while protecting their professional reputations. Burnout is recognized as being at epidemic proportions. Government and state-wide organizations are openly discussing and exploring solutions to the burnout crisis. The World Health Organization’s release of the ICD-11 acknowledges burnout as a syndrome related to workplace stress that has not been successfully managed. What has long been understood is the need for physicians to have outlets for the often-unbearable stress they handle daily.
Physicians receive great relief from their suffering by talking with other physicians. The understanding that occurs between doctor-to-doctor is exceptional. No one knows better than another physician what it is like to confront suffering and death daily. When physicians speak with each other, the often-disabling sense of isolation will diminish. Exhaustion decreases. Joy begins to return and replace sadness. Meaninglessness transforms into meaning as passion for the profession of medicine returns.
Gerri Donohue, MS, RN, CPHRM, is Vice President for Education at EmPRO Insurance Company. She founded the Physician Peer Support Program under the tutelage of Harvard’s Jo Shapiro, MD. A clinical nurse specialist, Donohue holds a Master of Science degree in psychiatric-mental health nursing from Adelphi University, Garden City, NY. For more information, visit myempro.com.