This article explores how we can keep the focus on changing the toxic healthcare system while also providing doctors with tools to help them recognize and solve physician burnout and other mental health challenges.
So I know I have blogged that physician resilience programs are a sticking plaster over the fungating tumor of a sick medical system. I say this because physicians are already resilient – you have to be to survive med school and our training hospitals.
Also, mandated courses are often misdirected and can be seen to be laying the blame back on the doctors for not being resilient enough. This is not the case. Even the most resilient Yoda-like physician will eventually burn out with enough exposure to a toxic environment.
So how do we go about solving physician burnout? Clearly, the environment has to change, and it’s got to change at all levels from how we provide care to how we pay for it, how we train physicians, and how we lead; how we manage expectations of the public, and how we look after our workers.
Expecting good doctors to pour from an empty cup in a system that is broken is simply wrong.
How can we keep the focus on changing a toxic system while also providing physicians with tools to help them recognize and treat their mental health challenges?
We need to recognize the dangers of sleep deprivation, working crazy hours, the culture of training by humiliation.
The US healthcare system is the most expensive and least efficient system in the world according to many sources and neatly summarized by the Right Care Alliance. Perhaps we can be big enough to learn from other countries’ successes?
Not that other countries are perfect, but the US does is an outlier for both low cost-effectiveness and high physician burnout and suicide rates.
Compared to our UK and EU colleagues, US physicians have higher rates of burnout, less holiday and time off work, and we work longer hours (and we are paid better).
Additionally, we have much less autonomy as professionals. Our healthcare revenue system, conflicts with insurers, EHR (2 hours admin to 1 hour patient contact), a crazy malpractice system, and politicians using healthcare as a political football.
We need more time off, guilt-free rostering, and good holidays. We need to care for patients, not EHRs and insurers to solve physician burnout.
We also need to recognize trauma to start to solve physician burnout. On an hourly basis, healthcare workers are exposed to a level of trauma that no other profession experiences outside of the military or police. I believe that this builds up and that we need to find a way to deal with it in a safe way.
Sharing our experiences as doctors in safe space groups is one way to do that. Learning new skills like mindfulness-based stress reduction and basic self-care is another. We’re developing courses as we speak on these topics and more.
Engaging with a peer group, a coach, or a mentor can make a huge difference to our mindset. We also hope that physicians who need clinical support will feel empowered to access it by hearing from others who have been there, gotten help, gotten better, and are living fulfilled lives.
Encouragingly, there is a wealth of evidence now supporting our approach. Here are three examples:
As we’ve already discussed, fear of professional consequences is a major barrier to struggling physicians getting the help they need.
The system needs to lower barriers for physicians to get help, or even discuss getting help, or even think that they might need it
Doctors’ regulators and employers either need to make it clear that disclosing our health issues will not be career-limiting, or they need to stop asking.
Asking just about mental health, or discriminating against physicians with mental health issues, is also potentially inequitable, and the underlying human rights need to be protected in legislation.
Then we should make accessing support normal for physicians, just like checking your cholesterol when you reach a certain age. Mutual support, non-judgmentalism, safety to be vulnerable, these all need to become part of medical culture, the opposite of what I see as the overcompetitive, money-focused, perfectionistic, superhero culture of medicine.
It will pay for itself many times over if it prevents one doctor from quitting, burning out, or worse.
Tackling physician burnout requires both systemic and, for some of us, personal changes. Finding a safe space to talk may be helpful for many.
We hope that Physicians Anonymous will fill the gap between suffering in silence and going for therapy.
But we want to make clear that peer support and coaching are not clinical interventions, and clearly some of us need these.
We strongly urge colleagues who think they may be struggling, if you need help, please find a way to get it. Start with someone trusted like your spouse, a family member, or your Family Physician.
If you are struggling or even suicidal, there is the Free & Confidential Physician Support Line 1 (888) 409-0141 in the US.