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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Burnout is a major issue among physicians, and recent tragedies of physician suicide show just how extreme and how devastating this situation remains. More than 15,000 physicians in over 29 specialties told Medscape about their degree of burnout and depression, how they cope with it, and whether they've had thoughts of suicide.

Some totals in this presentation do not equal 100% due to rounding.

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Burnout has been defined as long-term, unresolvable job stress that leads to exhaustion and feeling overwhelmed, cynical, detached from the job, and lacking a sense of personal accomplishment. In Medscape's 2019 report, 44% of physicians reported feeling burned out; 11% were colloquially depressed and 4% were clinically depressed. (Colloquial depression refers to feeling down, blue, or sad. Clinical depression is prolonged severe depression that is not caused by a normal grief-associated event.)

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Last year, critical care (48%), neurology (48%), family medicine (47%), ob/gyn (46%), and internal medicine (46%) were among the most burned-out specialties. Among the least burned out last year were plastic surgeons (23%), dermatologists (32%), and pathologists (32%).

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

"Numerous factors may contribute to these observations," says Carol Bernstein, MD, psychiatrist at NYU Langone Medical Center. "Women are more likely to admit to psychological problems and seek help, and thus may be more likely to acknowledge burnout than their male counterparts. Second, women generally acknowledge more challenges with work-life balance than do men. Childcare and family responsibilities are disproportionally assumed by women, despite increasing numbers of men who are more involved than in previous generations." Last year's results were similar (men: 38%; women 48%).

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Many factors can cause burnout, but by far, having too many administrative tasks as well as working long hours, working with EHRs, lack of respect and insufficient compensation are major players.

"There's so much redundant work due to incompetent third parties' data collection." –Endocrinologist

"It's too hard to schedule time off; the rules on clinic cancellation plus poor administrative support to help organize and plan anything make it impossible." –Internist

"All that paperwork sucks all of the enjoyment out of being a doctor." –Family physician

"Fear of litigation, bad reviews, and complaints make everything worse." –Dermatologist

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Long hours are the norm for physicians. The percentage of physicians who are burned out rises with the number of hours they work each week.

"Burnout is mostly due to lack of sleep because the EHR takes so much time. I used to be able to chart on a patient in 5-10 minutes for established patients. Now it takes 20-40 minutes to chart on an established patient." –Internist

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Medscape looked at which physicians work more than 51 hours per week. Those who worked the longest hours were also among those with the highest incomes, according to Medscape's 2018 Physician Compensation Report.

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Solo practices often allow physicians more autonomy than do groups or organizations, which may partly account for why doctors in solo practices report less burnout. According to an American Medical Association physician benchmark report, only 16.5% of physicians were in solo practice in 2016, compared with 18.4% in 2012.[1]

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

More physician comments:

"I need to take a lot of time away from the office to find balance and re-energize. It was never an issue 15 years ago." –Pulmonologist

"It's getting worse every year. Data collection is more important than patient care to everyone except the physicians actually practicing." –Nephrologist

"I've lost enthusiasm for patient care." –Neurologist

"It has made me plan for an earlier, more austere retirement." –Cardiologist

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Physicians use both positive coping skills and maladaptive techniques to deal with burnout. Adaptive coping methods improve functioning; maladaptive coping techniques reduce symptoms but maintain and strengthen the problem. Exercise and talking with family, the most frequently chosen activities, are positive coping skills.

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Male physicians are more likely to exercise; females are more likely to talk with friends and family. Men and women are about equally unlikely to use maladaptive coping behaviors, other than eating junk food, which women are more likely to do.

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Almost half of physicians who are depressed say there is no impact on their patient care. However, about a quarter of physicians say they may be less careful about taking patient notes, and 14% say they make errors they might not normally make.

In general, depressed employees exhibit more job loss, premature retirement, on-the-job functional limitations, and absences compared with their nondepressed coworkers, according to a report in the Journal of Occupational and Environmental Medicine.[2]

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

More than two thirds of depressed physicians say their depression affects their workplace behavior. Depression affects an estimated 1 in 15 adults (6.6%) in any given year. And 1 in 6 people (16.6%) will experience depression at some time in their life, according to the American Psychiatric Association.[3]

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

The equivalent of one doctor per day commits suicide in the United States, the highest suicide rate of any profession. And the number of physician suicides—28-40 per 100,000—is more than twice that of the general population, research shows.[4] According to the Substance Abuse and Mental Health Services Association, 9.8 million American adults had serious thoughts of suicide in 2015, 2.7 million made suicide plans, and 1.4 million made nonfatal suicide attempts.[5]

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

More than half of physicians who had thoughts of suicide told someone about them. Among the general public, between 50% and 75% of people who attempt suicide talk about their suicidal thoughts, feelings, and plans before they act, according to the American Foundation for Suicide Prevention.[6]

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

The majority of physicians don't seek help. "Medical training teaches us to 'suck it up,' so help-seeking is not a well-honed skill among doctors," says Pamela Wible, MD, a leading voice in combating the physician suicide epidemic, from Eugene, Oregon. "Because the majority of doctors are overworked, exhausted, and discontent, they've normalized their misery and pretend that it's not as bad as it seems."

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Of those physicians who are burned out or depressed, psychiatrists are most likely to seek help.

Notably, of those least likely to seek help were three groups among the top five with the longest hours: surgeons, nephrologists, and urologists.

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Anecdotally, some physicians have admitted that they received mental health care but have kept it a secret. They drove at least an hour away from their home town, did not use insurance, and sometimes even used a different name.

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

"If it were known that I need mental health treatment, it could have serious repercussions for my career." –General surgeon

"Counseling won't change the EHR, or the physician shortage, or the expectations of patients. The system is broken, not my psyche." –Emergency physician

"I am not the problem. The medical system is the one that needs help." –Nephrologist

"I don't see how a professional can help. Attitude adjustment does not solve the problem." –Anesthesiologist

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Healthcare organizations and academic or government facilities have become more proactive about helping their clinicians who are feeling burned out and stressed. Many hospitals now offer physician wellness programs. A study published in JAMA Internal Medicine found that "organization-directed interventions were more likely to lead to reductions in burnout" as compared with physician-directed ones.[7]

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Of those physicians who said they have sought help or would seek help, they would most likely see a psychiatrist or non-MD therapist.

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Approximately half of physicians fall about in the middle range between burnout not interfering with their life and burnout being so severe that they are thinking of leaving medicine.

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Many physicians have taken positive steps to deal with their work-related pressures, such as changing their own or their office's workflow or speaking to those in charge about lessening the productivity pressure. Almost a third of physicians have reduced their work hours to help lessen their burnout.

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

Many physicians are, overall, happy at their jobs. Three specialist groups that are some of the happiest—dermatologists, pediatricians, and public health and preventive medicine physicians—are also among those who work the fewest hours.

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

More comments from physicians:

"I'm starting locums work." –Internist

"I've transitioned to more administrative duties." –Cardiologist

"I'm pursuing an MBA to gain more control." –Urologist

"I started to do house calls with self-pay prices." –Family physician

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

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Medscape National Physician Burnout, Depression & Suicide Report 2019

Leslie Kane, MA | January 16, 2019 | Contributor Information

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