COMMENTARY

What's Driving Physician Burnout in 2018?

Melissa Walton-Shirley, MD

Disclosures

August 27, 2018

For a change, I'll start with what happened at the end of the presentation on physician burnout at the European Society of Cardiology (ESC) 2018 Congress. When the microphone was opened for questions, a physician from the United States took the floor.  "EPIC!" he said, with great emphasis, each word measured. "They have complete disregard and antagonism for physicians. Any concern is regarded as whining and belly aching by a bunch of people who they view as completely worthless…. Most of us like me…we get angry….  The angry physician is least likely to get support because they are angry," he bemoaned. 

That 1-minute tirade drew deafening applause from the jam-packed room of attendees.  Indeed, administrative and electronic health record (EHR) duties were among the most common issues mentioned that have destroyed the practice of medicine. Ultimately both physicians and patients lose.

This session on burnout was definitely the most unusual one I've ever attended at a cardiology meeting.  It was superbly chaired by Anthony DeMaria (San Diego, California), Patrick Verhorst (Enschede, the Netherlands), Peter Van Geel (Groningen, the Netherlands), and Malcolm Bell (Rochester, Minnesota). The discussion focused on a growing, potentially lethal diagnosis for physicians. It is a malady that can impact or clip short the career of those who do not recover.  These panelists expressed genuine concern about the escalating issue of physician burnout.

DeMaria started with the generally accepted definition: "A long-term stress reaction seen primarily in the human service profession resulting in depersonalization and reduced personal accomplishment."

Anthony DeMaria, MD, presenting at ESC 2018. 

He then reviewed the Medscape's National Physician Burnout & Depression Report 2018,  which revealed responses to a survey of more than 15,000 physicians.  Salient points included the following:

  • 42%  of respondents viewed themselves as burned out;

  • 3% of respondents were clinically depressed; and

  • 43% of cardiologist respondents were burned out. They are the least likely to seek help (17%) and the unhappiest of all physician specialists.

DeMaria projected that by 2030 we will have a critical shortage of physicians. "It takes the equivalent of two medical school classes just to replace the number of physicians who die of suicide every year," he said.

Patrick Verhorst and  Peter Van Geel then stepped to the microphone. "We aren't actors," Verhorst said.  Both practice in the Netherlands and are acquainted but don't work at the same facility. Verhorst turned to Van Geel and asked, "What happened?"

Patrick Verhorst (right) asks Peter Paul van Geel (left) about his experience with burnout. 

Van Geel described his bout of burnout that began with a full-fledged panic attack. He was attending a meeting in London. "It was like I was losing control, losing my mind. I checked my pulse. I couldn't breathe," he said. He went to a pharmacy and took a benzodiazepine. His family flew in to pick him up. Later in the interview he revealed that in London he was mourning the loss of his brother and had some issues with his parents. "I had an emotional breakdown," he said. He even described difficulty 1 week before the breakdown while doing a transesophageal echocardiography. "I was looking at the probe. I was wondering how did it work? I was blocked, but no one noticed," thankfully. 

The euphoria he experienced from the benzodiazepine was short lived. Eventually he went on an antidepressant but soon stopped it because of the side effects. Van Geel has been off work since February. He's feeling fine now and will return to work next week. His colleagues have been supportive and understanding, but he lost some perks. "I have to start back in clinicals,"  he said.   When asked if he thought he might relapse, he replied: "If you get cancer, you can get it again." 

Malcolm Bell said that at the Mayo Clinic, they hold regular town hall and group meetings to combat burnout. The staff completes a survey and benchmark with other institutions. "We have 160 cardiologists and meet with them twice per year," he said.

He pointed out that it is also important to improve practice efficiency and to decrease clerical and EHR  burden. He recommends the use of scribes and clinical assistants. "We've been trained to take a history, do an exam and make decisions. We shouldn't be typing. For every hour spent with a patient, it's another hour on the computer." 

At the conclusion of the formal presentation, some of the speakers offered their solutions. One concluded that we need to get off the computers. "We don't need to die at the hands of 1000 key strokes per day." DeMaria recommended that medical societies take up the cause and advocate for us. "The ESC and the ACC, for instance, need to get involved," he said.  Another audience member suggested that burnout be addressed in the medical school curriculum.  All are great suggestions.

If intelligent, caring individuals approach the issue with as much concern and caring as this panel, surely things will improve. If not, many of us will continue to burn out and make our way ultimately to extinction. I think most agree we have nowhere to go but up.

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