A few months ago, Penny Stern, MD, had an eye-opening exchange with one of her colleagues. It was late at night, and she received an email from a doctor who was still at work.
While staying late happens in health care, the conversation that ensued was certainly not standard. The physician on the other end referred to himself as a “piñata” and “being beaten from all sides.”
“I promised this person that I would do whatever I could do to help their situation,” said Dr. Stern, Northwell’s director of preventive medicine and president of the Faculty Council at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. “This was so poignant to me.”
Deep fatigue. Exhaustion. Losing all meaningfulness and enjoyment of your job. These are the hallmark signs of burnout, a diagnosis tied to the mental and physical strain on your body. Burnout is onset by chronic stress. Some who can’t recover have taken their own life. In fact, doctors are committing suicide at twice the rate than people in any other profession, according to data presented at the American Psychiatric Association.
Physician burnout and suicide have become a national issue and has captured media attention. The statistics are real:
“Everybody is under the same pressures,” said David Battinelli, MD, senior vice president and chief medical officer. “We are expected to do more with less. We are under more public scrutiny and we are under a lot more legal scrutiny. On top of that, the disparities between specialists and sub-specialists has widened — but the demands on everyone’s time continue to grow. To me, it’s the perfect storm.”
Various factors have been identified as reasons for the increased prevalence of burnout, which some are calling an epidemic. Mostly, physicians and administrators reference the dynamic shifts in health care that include the need to document patient information in electronic medical records, which has increased demands on doctors’ time during direct patient care.
“Burnout is real and can be caused by changes in medical practice, like the loss of professional autonomy and the changes in the way we practice medicine,” said Ira Nash, MD, a practicing cardiologist and executive director of Northwell Health Physician Partners. “What doctors are asked to do on a day-to-day basis and the time vs. production pressure combined with financial pressures have increased stress. Add in the fact that electronic health records weren’t designed to make life easier. It’s a complicated problem.”
There’s no easy fix to the burnout issue. The condition is not easy to diagnose and requires individuals coming forward to explain feelings of depression and despair. “It’s not a sign of weakness,” said Mark Jarrett, MD, senior vice president and chief quality officer. “Coming forward is a sign of strength.”
Dr. Jarrett says fixing physician burnout will entail a significant culture change, which is currently underway at Northwell. But to really address the problem, you need to understand where and how this started.
With medicine being around as long as people have been getting sick, it’s easy to question how the field has gotten here. Perhaps the biggest reason is that today’s medicine is not what doctors expected when training in medical school or residency.
Doctors are trained from day one to confidently navigate the most challenging situations — even death — without hesitation or fear.
“We were raised to be perfect and there is no room for failure,” said Jacqueline Moline, MD, the health system’s vice president of occupational medicine, epidemiology and prevention. “There has always been this thinking that if you seek counseling your career is over, when in fact it’s a sign of compassion and strength. We need to recognize that none of us have to strive for pure perfection because it is unattainable.”