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You don’t need to be a healthcare storm chaser to realize we are in the midst of a turbulent tornado when it comes to patient care in the United States. In fact, the perfect storm is not brewing, it’s here.
We presently find ourselves dealing with the dangerous combination of rising patient demand and not enough doctors to deliver care. In fact, new research published by the Association of American Medical Colleges (AAMC) reveals a growing physician shortage in primary care, medical specialties, surgery, and other specialties.1 “This year’s analysis reinforces the serious threat posed by a real and significant doctor shortage,” said AAMC President and CEO Darrell G Kirch, MD.2
While there is little we can do about the rising demand for care, perhaps there are ways to proactively address the issue of the dwindling number of doctors available to deliver that care. One such strategy includes an honest analysis of how to address physician burnout.
If you have experienced or are experiencing physician burnout, you’re not alone. Here are some sobering statistics from the 2016 Survey of America’s Physicians:3
- 80% say they are overextended or at capacity
- 54% rate their morale as somewhat or very negative
- 49% report often or always experiencing feelings of burnout
- 49% would not recommend medicine as a career to their children
- 48% plan to cut back on hours, retire, or take other steps to limit patient care
Effects of Physician Burnout
In 2019, a Medscape report on physician burnout, depression, and suicide found that 59% of physicians identified as either burned out, colloquially depressed, or clinically depressed.4 According to this report, 44% of physicians say they are presently experiencing burnout. Some estimates show that the worldwide percentage is as high as 76%.5
In May 2019 the World Health Organization announced that burnout is now included in the 11th Revision of the International Classification of Diseases (ICD011) as an “occupational phenomenon.” They identify 3 dimensions of this phenomenon:6
- Feelings of energy depletion or exhaustion
- Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
- Reduced professional efficacy
While these dimensions may seem subjective or vague, the reality is that there are serious consequences associated with physician burnout that affect the physician, the patient, and the entire healthcare system.
“Burnout can contribute to a broad range of psychological and physiological symptoms all of which can impact a physician’s quality of life and lead to lower productivity, absenteeism, sick leave, and job turnover, with a consequent reduction of quality of patient care and enormous economic costs on the health system,” state the authors of a 2018 review published in Open Medicine.4
A potential serious outcome of physician burnout is suicide. In fact, physician suicide has been increasing dramatically to the point where, according to the 2019 Medscape report, in the United States, one doctor commits suicide every day, which is the highest suicide rate of any profession and more than twice that of the general population.3
What Causes Physician Burnout?
Getting to the root cause of physician burnout can be challenging because there are so many factors associated with this highly individualized condition. According to the authors of a 2018 systematic review regarding intervention strategies, when it comes to physician burnout, organizational factors seem to play a bigger role than individual personality traits.4
Daniel Lander, ND, FABNO, a naturopathic oncologist and associate professor at the Canadian College of Naturopathic Medicine, agrees. “Despite exceptional coping skills, if you clash with the fundamental organizational values you work in, it will only be a matter of time before burnout sets in,” Lander told us in an email.
Getting to the root cause of physician burnout can be challenging because there are so many factors associated with this highly individualized condition.
Radiation oncologist Matt Mumber, MD, told us about 3 key causes of physician burnout he has witnessed:
- Increased emphasis on productivity
- Expanding regulatory burdens and oversight
- Insurance companies limiting costs regardless of patient care
In Mumber’s case, burnout came when there was a lawsuit filed against him. “It was difficult because I felt that the trust I had placed in the doctor patient relationship was breached in pursuit of blame for an unwanted outcome,” Mumber said, who has been in clinical practice for 23 years.
A 2018 review published in the Texas Heart Institute Journal adds to Mumber’s list by including loss of autonomy, overreliance on computer data, and electronic health records as contributing factors to burnout.7 “As a result, physicians are quitting in large numbers, further increasing the stress on those still practicing,” concluded the authors.
Burnout in Small Integrative Health Practices
While it is often thought that being a part of a large healthcare organization can be stressful, starting and running a small integrative practice also has its share of challenges.
Women’s health expert Tori Hudson, ND, has been in practice for nearly 35 years and explained to Natural Medicine Journal that the high overhead, high debt, and high pressure of creating and running a clinic can be stressful. “As a result of the high overhead and debt, there is a tendency to take on too many patients in too short of a time period, which can add to the stress,” said Hudson.
For retired naturopathic physician Rena Bloom, ND, managing the clinic while seeing patients and participating actively in naturopathic legislative work at times took its toll. Bloom also had her own breast cancer diagnosis to contend with.
“About two years ago a new patient called to schedule an appointment with me to discuss her fatigue,” explained Bloom in our interview with her. “For a brief moment, I honestly didn’t really care about her fatigue and it was at that time when I said to myself ‘Honey, you might be done here’.”
An Integrative Approach to Physician Burnout
According to Lander, who often speaks on this topic and also works with medical students to reduce risk of burnout, “It’s so common among physicians these days that my advice is to expect it as a constant threat and continuously work to prevent it. Ignoring it or trying to simply ‘suck it up’ doesn’t work.”
“Many times over my 35-year medical career, I have courted burnout,” integrative health expert Ronald Hoffman, MD, told Natural Medicine Journal. “The long hours and the challenges of being responsible for the care of innumerable patients with serious conditions inevitably take their toll.” For Hoffman, and many other integrative physicians, it’s a case where practicing what you preach can go a long way in overcoming physician burnout.
Integrative practitioners are in a unique position when it comes to reducing risk of physician burnout. They can apply their medical philosophy and tools of the trade to their own personal lives.
“Nutrition and supplementation were always a part of the solution for me,” said Hoffman. “I don’t think I could’ve sustained my energy and motivation if I’d followed the standard American diet.”
For Lander, “maintaining a spiritual connection through meditation, prayer, or spending time in nature has also been crucial for me.”
Bloom, who was in private practice for 28 years before retiring, offers this advice to young physicians just starting out:
- Be open to change and allow your practice to evolve and grow over the years.
- Create strong boundaries between work and home.
- Connect with colleagues and professional organizations in person.
- Remind yourself of the good you are doing. Bloom kept a drawer of thank-you cards from patients that she would read occasionally.
- Nurture your life outside of your practice. For Bloom, it was singing in the choir.
According to the 2018 systematic review published in Open Medicine, successful burnout interventions include:4
- Training of coping strategies
- Training of interpersonal skills to increase social support
- Managing negative emotions
- Improving communication skills
- Discussing specific professional high-stress situations with colleagues or in a group setting
- Use of relaxation techniques
For most integrative practitioners, attitude is equally important. The recognized connection between mind, body, and spirit often fuel the passion and commitment that integrative physicians share with their patients. But being optimistic takes effort, especially when a physician is in the throes of battling burnout.
“Cultivating a positive outlook and a sense of humor is essential in order to have longevity in a healing profession,” said Lander. “Especially for me, working in the field of oncology, losses need to be acknowledged, grieved, and processed effectively, but it’s also important to learn how to keep the positive aspects of the work and the successes in the forefront.” Lander believes this doesn’t just happen; physicians need to consciously and consistently work at it.
Nurturing mental health is also key to Hudson, who recommends seeing a mental health counselor on a regular basis. She believes preventing burnout is all about doing “work that you want to be doing, with the people you want to do it with, and where you want to be doing it.” She said that when you add in healthy food, daily exercise, adequate sleep, and getting out in nature, you have a recipe for success.
For Hoffman, being a doctor and hosting his radio show throughout his career fueled his excitement about learning and communicating. “I was continually reinvigorated and my writing, learning, and educating gave me an endorphin rush,” said Hoffman. Hoffman’s advice is to make time for a frequent “brain rinse,” where you engage in enjoyable activities outside of work.
Using integrative self-care strategies—techniques that integrative practitioners know intimately—can help reduce the risk of burnout and can also help successfully treat burnout. These strategies allow physicians to see the light at the end of the burnout tunnel so they can break free and continue on the path to help others. Hopefully, it will also mean they will not quit or retire early due to burnout.
A Personal Pledge
In 1948, the World Medical Association adopted the Physician’s Pledge that states, among other things, “I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.”
To shine a light on the dark cloud of physician burnout and then take proactive steps to prevent and treat it is just another way that physicians can honor their Hippocratic Oath. Integrative physicians, in particular, are perfectly poised to take the lead in this effort.
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