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Physician burnout is real!

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Dr Pavan Madan, Psychiatrist, based in the US,  speaks his heart on the subject of physician burnout and mental health among healthcare providers

Those never-ending years of medical training, long working hours, significant patient responsibility, and zero training in anything else: it all adds up. Most doctors work very hard to care for their patients or to stay updated with the latest medical information. But, like a candle burning from both ends, they are burning out real fast.  

What do you mean by burning out?

Burnout is defined as a long-term stress reaction due to work and is characterised by:

  • Exhaustion: feeling emotionally or physically tired
  • Compassion fatigue or depersonalisation: feeling emotionally drained and not being able to care about anyone or anything as much as before.
  • Poor efficacy: feeling ineffective and unable to handle usual tasks.

Ok, how common is this burnout?

In short, very common. Indian physicians are increasingly battling burnout. According to a recent study, 45 per cent of Indian physicians expressed high levels of emotional exhaustion, 66 per cent reported significant depersonalisation scores, and 87 per cent did not feel accomplished by their work. Sadly, burnout is common in physicians across the globe. 

Why do physicians experience burnout?

There are many possible causes. Let us look at a few.

Work-life balance: Long working hours, a high number of patient-encounters, increasing paperwork and administrative requirements contribute to a poor work-life balance. Physicians get extensive training on how to care for their patients but are rarely taught how to care for themselves or their family. 

New information: Medical information is constantly evolving, and doctors feel the need to spend any they have in updating their knowledge base. 

Mistreatment: From being physically assaulted by patient’s family members to being poorly compensated by their employer, Indian doctors are mistreated by society on numerous occasions. The rising cost of healthcare and lack of medical insurance coverage acts as a hindrance for patients to pay for medical services and feelings of resentment towards professionals or institutions charging a fee for their expertise.  

GDP: While the World Health Organization recommends countries to spend at least five per cent of their GDP on public healthcare, India spends only around 1.28 per cent, even lower than it’s neighbouring countries. Lack of spending on healthcare leads to inadequately compensated physicians, understaffed medical facilities and lack of adequate equipment and resources. 

Vicious cycle: Lack of respect for the medical profession leads to physicians treating it as a job rather than duty, which leads to the increased focus on money oner healing, which leads to further lack of respect for doctors. If we need to stay healthy, we need to urgently figure out how to break this vicious cycle.

What are the consequences of burnout?

Effect on providers: Doctors have the highest rate of suicide among all professions. Let that sink in for a minute. While 30 per cent doctors experience depression at some point, 17 per cent have reported suicidal thoughts. Male physicians have 40 per cent higher risk of suicide compared to the general population, whereas the risk in female physicians is a whopping 130 per cent more. Physicians also have a 25 per cent higher risk of substance use disorders compared to the general population. Among different specialities, the highest rates of burnout are seen in critical care, neurology, and internal medicine, while the lowest rates are seen in preventive medicine, pathology, and dermatology. 

Patient care: Burnout leads to suboptimal patient care and satisfaction. Studies show that burnout rates are linked to the number of patient complaints and malpractice lawsuits. Malpractice suits are on the rise and hospitals should pay very close attention to this. 

Healthcare institution: Providers experience burnout more often change jobs than those who do not. Replacing physicians and training them is often time-consuming, expensive and a significant adjustment for patients and medical staff.   

How should we solve this? 

It is clear by now that the medical profession is not doing well and is need of help. Since the problem is multi-factorial, solutions need to be executed at different levels.

National and State Levels: Since the problem begins right from the day doctors start their medical training, the solution also needs to start at that time. Medical colleges should provide lessons in self-care and work-life balance. Medical students should have easy access to psychological services and necessary accommodations during their medical education. Moreover, following the lead of developed countries, resident doctors should be made to work for no more than 12-hour shifts. These measures need to occur in parallel with a shift in the medical training culture and an increase in healthcare spending.

Institutional Level: Institutes providing regular stress management training to their medical staff notice a significant improvement in patient satisfaction and a lower number of malpractice lawsuits. All public and private institutions should provide adequate security and safety measures to prevent violence against physicians. In locations that experience violence, measures should be immediately improved until violence is curbed. Institutions should try to make the workflow smoother and administrative duties easier so that physicians can complete these within their work hours.

Personal Level: Here are a few suggestions to consider. Be self-aware. Start with ensuring the basics: regular meals, hydration, exercise, breaks between patients, etc. Start your day with a list of 3 things you love about yourself. End your day with a list of three things you accomplished. Learn to have professional boundaries – ask patients, neighbours, and friends to consult you during business hours if possible. Build a support network at home and work. Have a “buddy” to check in periodically about how you are doing or feeling. Donate your time or resources to a personal cause. And lastly, be grateful to your family, coworkers, and patients. All our knowledge would be futile without their support. 

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