Physicians Anonymous

Physician burnout and illness

Physician burnout and illness

In this article, we explore the link between the burnout syndrome as it relates to doctors, and the impacts on their physical and mental health. Starting with the premise that burnout is an occupational stress-reated condition, it is unsurprising that the well-established chronic stress-related conditions that we see in our patients also manifest in ourselves and our colleagues. The links between physician burnout and illness have important implications for ourselves, our patients, and wider society.

Definition and prevalence

First, let’s start with a definition. Now generally accepted as a chronic occupational stress-related disorder “that has not been successfully managed”, burnout is typically described by the WHO as including the triad of:

  • Emotional exhaustion
  • Depersonalization/distance from one’s job or cynicism/negativity
  • Reduced performance

Prevalance rates in physicians (in the global West) are around 40%, with higher rates among women doctors, and an age peak in the 50s.

Physician burnout definition: impact on patients

Physician burnout is associated with an increased risk of major medical errors. A recent meta-analysis involving more than 42,000 physicians found that physician burnout doubled the risk of adverse patient safety incidents and led to poorer overall quality of care and decreased patient satisfaction.

Burnout in doctors costs an estimated $5 billion (USD) per year due to reduced clinical productivity and increased physician turnover

Physician burnout: impact on physical health

In addition to worsened patient outcomes and satisfaction, and higher costs, physician burnout and illness may be affected by the long term stress effects of a toxic medical system.

Physician burnout is associated with increased risk of motor vehicle crashes and near-miss events, even after adjusting for fatigue.

meta-analysis of 36 studies across different occupational groups (not physicians) found that burnout was a significant predictor of the following physical consequences:

• Hypercholesterolemia
• Type 2 diabetes
• Impaired glucose tolerance
• Coronary heart disease
• Hospitalization due to cardiovascular disorder
• Musculoskeletal pain
• Changes in pain experiences
• Prolonged fatigue
• Headaches
• Gastrointestinal issues
• Respiratory problems
• Severe injuries
• Mortality below the age of 45 years
• Increased alcohol, tobacco, and drug consumption.

It is likely that we physicians are no different to the populations studied above. We have the same anatomy and physiology after all, being human beings (a fact sometimes forgotten!).

In addition, markers of abnormal glucose metabolism are found in physicians with symptoms of burnout.

Physician burnout: impact on mental health

Clearly, physician burnout and illness does not stop at the physical. The mental domain is strongly represented. 

The same meta-analysis reported the psychological effects of burnout as:

  • Insomnia
  • Depression
  • Anxiety disorders
  • Use of psychotropic and antidepressant medications
  • Hospitalization for mental disorders
  • Other psychological ill-health symptoms.

Concerningly, physician burnout is associated with physician impairment more broadly, including a 25% increased odds of alcohol abuse/dependence, and a doubled risk of suicidal ideation.

Doctors are at increased risk of suicide compared to the general population, with the suicide rate amongst male physicians being 40% higher than other males in the population and the suicide rate amongst female physicians being 130% higher than other females in the population.

Undoubtedly, the 300-400 yearly physician suicides –  we are losing one colleague a day by their own suffering – is underpinned by our poor mental wellbeing and barriers to reaching out for help.

Effort-reward imbalance

Recent research has focused on the link between the “reward” for job performance and “work effort” (the effort required to meet job demands). An imbalance in the relationship between effort and reward (effort-reward imbalance, or ERI) has been linked to negative health outcomes.

  • Elevated ERI was found to be linked to a significant decrease in peak, average, and total cortisol production in a population sample.
  • Effort-reward imbalance has been linked to increased risk of depression (odds ratio [OR] 1.49; 1.23-1.80, P < .001) in a meta-analysis of 8 cohort studies involving almost 85,000 subjects.
  • A roughly two-fold increase in the rate of new employment disability was found in individuals with ERI among over 40,000 workers followed for 3 years.

Hypothalamic-pituitary axis dysregulation may be the mechanism by which job stress causes [physician] burnout — and illness. And our hearts seem to be at risk.

Effort-reward imbalance and cardiac health

ERI been associated with increased risk of coronary events in multiple populations. In one primary care sample,  those workers who reported either ERI or job strain had a statistically significant 16% increase in relative risk for symptomatic coronary heart disease, and those who reported both job strain and ERI had a 41% increase in risk for coronary events relative to those workers who reported neither risk factor.

Physician burnout: impact on health ecosystems

Burnout in doctors costs an estimated $5 billion (USD) per year due to reduced clinical productivity and increased physician turnover (excluding medical litigation costs).  

Job dissatisfaction, absenteeism, new disability pension, job demands, job resources and presenteeism are all linked to burnout across the professions, but doctors have some of the lowest absenteeism rates despite our high rates of distress markers.

Physician burnout and the resultant decreased productivity may exacerbate the previously predicted shortfall of 45,000 to 90,000 physicians in the United States by 2025.

Doctors’ professional groups like the American, Canadian, and British Medical Associations, have all highlighted the burning issue of burnout and illness, and they have developed local strategies to tackle this enormous and complex issue of relevance to us all.

How to reduce physician burnout and illness?

Following on from the chronic stress hypothesis, it makes intuitive sense that successful stress reduction should help reduce the health impact of physician burnout.

These interventions have an evidence base for stress reduction:

  • Mindfulness-based stress reduction (MBSR)
  • Self-compassion practice
  • Balanced exercise
  • Work breaks – i.e. weekends and holidays!
  • Peer support
  • Counseling
  • Therapy
  • Self care (check out our related article here).
HOWEVER: these are ways individual physicians can care for themselves and others. They do not solve the chronic, toxic, modern medical system that plays a major role in the epidemic of physician burnout. 

Focusing exclusively on individual vulnerability to excessive stress removes the responsibility of the organizations — healthcare services — causing the stress for many well documented reasons.

Resultantly, solving burnout (and associated health issues) requires systemic solutions and not just yoga classes, resilience programs, or pizza nights.

Conclusions

This article has explored the links between physician burnout and illness – physical and mental (as if there were a difference!?!) – and why this is important for patient care, society, and crucially, ourselves and our loved ones.

We have listed a number of stress management strategies for physician burnout and illness that may normalize your cortisol and stress hormones, and in turn reduce the impact of work stress on your health.

In turn, a healthier you means a healther parent, partner, colleague, and physician.

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