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In a recent workforce survey of more than 12,000 physicians across 29+ specialties, 50% of rheumatologists reported significant burnout or depression, making rheumatology the second-highest ranking field for burnout (after critical care).
Burnout is technically defined as energy depletion or exhaustion, feeling mental distance from or negative feelings about your job, and reduced professional efficacy. That experience is a result of chronic stress in your workplace and with life. Feeling burned out is very common in medicine, rheumatology in particular. In a recent workforce survey of more than 12,000 physicians across 29+ specialties, 50% of rheumatologists reported significant burnout or depression, making rheumatology the second-highest ranking field for burnout (after critical care).1 The increasing pressures of the pandemic have only made matters worse. One study indicated that 22% of physicians know another physician who has committed suicide, 8% have considered self-harm, and 18% have increased their use of medications, alcohol, or illicit drugs.2 This latter poses significant health risks where 10-15% physicians will misuse drugs or alcohol at some point in their career.3
Intense professional pressure, demanding hours, heavy workloads, expectations for self-sufficiency, and the high-stress culture of your profession all contribute to the risk for burnout and self-destructive behavior/impairment and these same factors also make you less likely to seek mental healthcare when you need it. The stigma associated with complaints of depressed mood and burnout is intractable as early as medical school. There, medical students report fears of embarrassment if their peers knew about their mental health needs and believe that disclosing their mental health struggles could adversely impact their professional development.4 That stigma continues into practice. One survey of 5,800 physicians applying for or renewing licensure reported that 40% of them were hesitant to seek necessary mental healthcare because they were concerned it would negatively impact their medical licensure.5
Burnout and professional impairment are often thought of as 2 sides of the same coin. Burnout is an occupational syndrome related to the external work environment that can often be resolved by taking breaks, setting limits, and practicing self-care. For some, the exhaustion, cynicism, and stress of burnout can indirectly lead to more serious issues like depression, anxiety, and suicidal thoughts. If the symptoms of burnout become more acute and start to interfere your practice and personal life, there is greater concern for impairment. Ongoing symptoms may be an indicator that it is time to seek professional help.
Despite the attitudinal barriers to mental healthcare for medical professionals, you obviously have a commitment to competence and self-regulation that requires you to recognize and address impairment. Recognizing and addressing your own burnout will be addressed in part 2 of this column since it is sometimes easier to act on behalf of your colleagues than it it for yourself. Hubris being what it is, we are lousy at self-reflection but are actually quite skilled at recognizing these needs in our colleagues. You may notice changes in their mood, hygiene, their practice or organization. You may hear complaints about poor sleep, fractious relationship dynamics, and self-destructive behaviors.
Invite your colleague to a non-judgmental conversation to express your concerns clearly. The first step can often be a simple “How can I help?” Encourage your colleague to get a consultation with a mental health colleague who understands the unique pressures of working in healthcare. Certainly you can access your internal EAP programming but, for anonymous treatment options, the Emotional PPE Project and the Therapy Aid Coalition have searchable directories to connect physicians to free, confidential mental health services targeted towards healthcare professionals.
When more immediate care is warranted or if your worry is about impairment and not burnout, consider referring your colleague to your state’s Physician Health Program. Physician Health Programs (PHPs) work with state medical boards to advocate for the physician, arrange treatment, and monitor physician impairment. PHPs deliver treatment to practicing physicians – they make no disciplinary or punitive actions and can operate confidentially as long as no patient harm has occurred. Like any other health complaint, early identification and intervention are key for successful outcomes. Perhaps the most important message that you can give an impaired colleague is that you see their distress and that help is ready.