Feel the Burn...Out

The big topic in medicine isn’t the wonder drugs for eczema or the latest in chemotherapy for advanced skin cancers…it’s physician burnout, a condition many of us are too tired, cranky, and mentally wiped out to deal with (oh wait, those are symptoms aren’t they)? Even in the happiest of specialties and the Disneyland of medicine (aka dermatology, where we sleep at home instead of at the hospital and turn our phones off, since there supposedly aren’t any emergencies) physician burnout is on the rise.

There are days at work, especially when combined with travel and meetings, where many of us came back to piles of paperwork, overdue research obligations, and endless emails that never seem to go away. The eyes get tired and droopy, the head hurts, and the mood gets more labile while the temper gets short. In the acute phase, one would say this is just fatigue with a side of type A overdoing it. But in the chronic phase, these represent the warning signs of burnout that need some attention.

I read some interesting quotes about this as I was preparing for an interview with Drs. Brian Berman and Neil Sadick for DermInsider (watch the episode—coming soon to DermTube.com/Insider).

If you think physician burnout is not a significant problem, consider these stats on physician depression and suicide in the United States from the American Foundation for Suicide Prevention:

• “Three hundred to 400 physicians die by suicide annually in the US.
• Female physicians have a suicide rate equal to male physicians.
• The rate of depression for medical students is 15 percent to 30 percent higher than the general population.
• Depression is a major risk factor in physician suicide.
• Bipolar disorder and alcohol and substance abuse are also risk factors in physician suicide.
• Physicians have a higher suicide completion to attempt ratio.”

Many experts define the difference between stressed out and burned out as being able to recover in your time off, and that burnout begins when the capacity to re-energize and rev the motor fails to get things in order. The “downward spiral” has three warning signs (actually symptoms): Physical and Emotional Exhaustion (carrying into the non-work day), Depersonalization (e.g. cynical attitude toward patients), and Reduced Sense of Personal Accomplishment. That doesn’t mean we are burned out if we are sitting around complaining about the last patient that drove us nuts or how MACRA is the new public enemy…as long as we are ready to go back to work after we vent.

The good Professor Berman reminds us that rates of burnout are exacerbated by the changes in healthcare that impair our abilities to correctly do our job: filling prescriptions, performing procedures, and directing care as a specialist have all become daily battles with sources less educated into our discipline and our patients’ real needs. The gradual erosion of these simple abilities for which we train endlessly slowly erodes our drive and our energy and makes our daily work lives more stressful, often at the hands of bureaucratic and profit-driven meddlers. But with every election campaign promise of improvement, we continue to see the government and the vandals of medicine erode away at our job satisfaction.

The presence of physician burnout has been shown to decrease physician’s professionalism, compromise the quality of medical care, increase medical errors and malpractice rates, lower patient compliance and satisfaction, and increase prevalence and consequence of physician substance abuse, suicide, and intent to leave practice…yet the cry that the increased burden of governmental regulations, pharmacy and prescription anguish, and insurance company bureaucracies are the leading causes of dissatisfaction continue to fall on deaf ears, with the age old adage being thrown back in our faces: “Doctors make plenty of money, what are you whining about?”

So in that case, all of you workaholics need to take a break: Use some of that hard-earned money and take vacation, or buy that fancy bottle of wine you’ve always wanted to try, or even the mid-life crisis car (and donate to SkinPAC (hint, hint)). Find a way to unplug from medicine when you get the chance. In this era where now the 40-year-olds are dropping dead of cancer and cardiac events, this is the time to enjoy life. Dermatologists are smart, driven, and most of us are really good people (don’t make me list the exceptions). We all have to adopt methods to avoid running out of gas as medicine continues to slip into the dark shadows of socialism. Let’s make sure we keep our game faces on when needed, but still put our own oxygen masks on before helping others.

In other words, the best way to avoid burnout is to recognize it, take the steps to recalibrate, and do what it takes to find joy in treating the skin. n

—Neal Bhatia, MD, Chief Medical Editor

1. https://afsp.org/our-work/education/physician-medical-student-depression-suicide-prevention/

2. https://www.thehappymd.com/blog/bid/295048/Physician-Burnout-Why-its-not-a-Fair-Fight

3. http://www.kevinmd.com/blog/2012/03/physician-burnout-fair-fight.html

4. http://dermatologytimes.modernmedicine.com/dermatology-times/news/why-burnout-increasing-among-us-dermatologists?page=0,1