Burnout threatens the primary care workforce and the mental health of physicians

Kaiser health news

If you or someone you know is experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing “988” or the Crisis Text Line by texting “HOME” to 741741.

Melanie Gray Miller, a 30-year-old doctor, wiped away her tears as she described the isolation she felt after losing a beloved patient.

“It was at the end of a night shift, when bad things always seem to happen,” said Miller, who is training to be a pediatrician.

The boy had been ill for months in the Medical University of South Carolina’s pediatric intensive care unit, and the possibility that he might not get better was obvious, Miller recalled during an April meeting with doctors and hospital administrators. But the suddenness of her death still caught her off guard.

“I have family and friends that I talk things through,” she said. “But nobody really understands.”

Doctors typically don’t take the time to grieve at work. But during that recent meeting, Miller and his colleagues opened up about the insomnia, emotional exhaustion, trauma and burnout they experienced during their time in the pediatric ICU.

“This is not an ordinary place,” Grant Goodrich, director of hospital system ethics, told the group, acknowledging an occupational hazard that the industry often downplays. “Most people don’t see children die.”

The recurring conversation, timed for early-career physicians coming out of month-long pediatric ICU rotations, is one way the hospital helps staff cope with stress, according to Alyssa Rheingold, clinical psychologist empowered leader of its resilience program.

“Often the goal is to teach someone how to do yoga and bathe,” she said. “That’s not welfare at all.”

Burnout in the healthcare sector is a widespread problem that long predates the covid-19 pandemic, although the chaos introduced by the spread of the coronavirus has made matters worse, doctors and psychologists said. Healthcare systems across the country are trying to lift morale and prevent doctors from quitting or retiring early, but the stakes are higher than workforce shortages.

Doctor suicide rates, fueled in part by burnout, have been a concern for decades. And while burnout occurs in all medical specialties, some studies have shown that primary care physicians, such as pediatricians and family doctors, may be at greater risk.

“Why get into primary care when you can make twice the money doing something with half the stress?” said Daniel Crummett, a retired general practitioner who lives in North Carolina. “I don’t know why anyone would go into primary care.”

Doctors say they are fed up with the demands imposed by hospital administrators and health insurance companies and are concerned about the notoriously grueling shifts assigned to resident physicians during the early years of their careers. A long-standing stigma prevents doctors from prioritizing their mental health, while their work requires them to deal with death, pain and trauma on a regular basis. The culture of medicine just encourages them to put up with it.

“Resilience is an awkward word for me,” Miller said. “In medicine, we’re just expected to be 24/7 resilient. I don’t love that culture.”

And although the pipeline of doctors entering the profession is strong, the ranks of doctors in the United States aren’t growing fast enough to meet future demand, according to the American Medical Association. That’s why burnout exacerbates workforce shortages and, if it continues, could limit some patients’ ability to access even basic care. A 2021 report released by the Association of American Medical Colleges projects that the United States will lack up to 48,000 primary care physicians by 2034, more than any other single medical specialty.

A survey released last year by The Physicians Foundation, a non-profit organization focused on improving health care, found that more than half of 1,501 physicians who responded had no positive feelings about the current or future state of the medical profession. . More than 20% said they plan to retire within a year.

Similarly, in a 2022 AMA survey of 11,000 doctors and other medical professionals, more than half reported feeling exhausted and indicated they were experiencing a great deal of stress.

These numbers appear to be even higher in primary care. Even before the pandemic, 70% of primary care providers and 89% of primary care residents reported feelings of burnout.

“Everyone in healthcare feels overworked,” said Gregg Cooodley, a primary care physician in Portland, Oregon, and author of the 2022 book “Patients in Peril: The Demise of Primary Care in America.”

“I’m not saying there aren’t problems for other specialists as well, but in primary care it’s the worst problem,” she said.

The high level of student debt that most medical graduates carry with them, combined with salaries more than four times the average, deter many doctors from dropping out of medicine mid-career. Even primary care physicians, whose salaries are among the lowest of all medical specialties, are paid significantly more than the average American worker. That’s why, instead of leaving the profession in their 30s or 40s, doctors often stay put but retire early.

“We go into medicine to help people, to take care of people, to do good in the world,” said Crummett, who retired from the Duke University hospital system in 2020 when he turned 65.

Crummett said he would have liked to work until he was 70 if it weren’t for the bureaucratic burdens of practicing medicine, including having to get pre-clearance from insurance companies before providing care, navigating cumbersome electronic health record platforms and logging administrative work hours outside the exam room.

“I enjoyed seeing the patients. I really enjoyed my colleagues,” she said. “Administration was certainly a major factor in burnout.”

Jean Antonucci, a primary care physician in rural Maine who retired from full-time work at 66, said she, too, would have continued working if it weren’t for the hassle of dealing with hospital administrators and companies. insurance.

Once, Antonucci said, he had to call an insurance company — landline and cell at the same time, with a phone in each ear — to get pre-authorization to perform a CAT scan, while his patient in need of an appendectomy waited. in pain. The hospital wouldn’t do the scan without insurance approval.

“It was just maddening,” said Antonucci, who now practices medicine only one day a week. “I could have continued working. I just got tired.”

Collective supplier burnout is a crisis being kept under wraps by design, said Whitney Marvin, a pediatrician who works in the pediatric intensive care unit at the Medical University of South Carolina. You said hospital culture implicitly teaches doctors to repress their emotions and “keep moving.”

“I shouldn’t be weak, and I shouldn’t cry, and I shouldn’t have all these emotions, because then maybe I’m not good enough at my job,” Marvin said, describing how doctors have historically thought about their mental health.

This mindset prevents many doctors from seeking the help they need, which can lead to burnout and much worse. According to the American Foundation for Suicide Prevention, approximately 300 doctors die by suicide each year. The problem is particularly pronounced among female physicians, who die by suicide at a significantly higher rate than women in other professions.

A March report from Medscape found that, of more than 9,000 doctors surveyed, 9 percent of male doctors and 11 percent of female doctors said they had suicidal thoughts. But the problem is not new, the report notes. High suicide rates among physicians have been documented for 150 years.

“Ironically, it’s happening to a group of people who should have the easiest access to mental health care,” said Gary Price, a Connecticut surgeon and president of the Physicians Foundation.

But the reluctance to seek help isn’t unfounded, said Corey Feist, president of the Dr. Lorna Breen Heroes’ Foundation.

“There’s something known in residency as the ‘silent curriculum,'” Feist said describing an oft-unspoken understanding among physicians that seeking mental health care could jeopardize their livelihoods.

Feist’s sister-in-law, emergency room doctor Lorna Breen, died by suicide during the first few months of the pandemic. Breen sought inpatient mental health treatment once, Feist said, but she feared her medical license could be revoked for doing so.

The foundation works to change laws across the country to ban medical boards and hospitals from asking doctors invasive mental health questions on job or license applications.

“These people have to be taken care of by us, because nobody really takes care of them,” Feist said.

In Charleston, psychologists are made available to doctors in group meetings like the one Miller attended, as part of the resilience program.

But solving burnout also requires a culture shift, especially among older clinicians.

“They’ve had worse and we know it. But it’s still not good,” Miller said. “Until that changes, we’re going to continue to burn doctors within the first three years of their careers.”




Kaiser health newsThis article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization not affiliated with Kaiser Permanente.

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