Physician work-related stress is a significant problem.1–3 U.S. physicians report higher than normal burnout rates7 and increased health problems, including alcohol use problems,5,6 excess weight,7,8 poor sleep,9 less exercise,8, and low career satisfaction.10 Physicians experience the burnout triad of:
- Emotional exhaustion (and depression) – Part 1
- Interpersonal disengagement (Depersonalization) – Part 2
- Low sense of personal accomplishment11 – Part 3
Emotional Exhaustion and Depression
The emotional exhaustion component of the burnout triad correlates with developing depressive symptomatology.12 Depression overlaps with burnout13 and often appears relatively late in its development.14 Depressive symptoms start in medical school for 27% of students,15 and increase to 29% of residents,13 and 11% of physicians17. Depressive symptoms correlate with suicidal ideation,18 and solutions often follow standard depression treatment.15
Depression is amenable to detection with established scales and to treatment.19 Strategies identifying depressive symptomatology and interventions are common in medical organizations19,20 as are interventions for physician well-being and guidance on local resources.21–26 Medical societies, as well, provide robust systems to assist depressed physicians. Unfortunately, as few as 50%27, avail themselves of such services, due to perceived stigma of seeking help27,28 and potential impact on their career from disclosure and concerns about confidentiality27, feeling they can handle it on their own, or feeling they are too busy.17,29 They often seek help late in the process when treatment can be more challenging.30
Depression is often a later stage in a downward spiral; medical systems have strategies to address depression in physicians. More emphasis should be placed on earlier stages of struggle. In Part 2 of this series, we will discuss interpersonal disengagement, or depersonalization.
How can Lift help?
While emotional exhaustion and depression are part of the burnout triad, we reject the view that these terms are crushing weights that you cannot handle or that you must build up a barrier in defense. This element of burnout is not out of your control. At Clinical Tools, we propose solutions that lift health care providers up, empower them, and build upon their existing strengths, talents, and experience. Start with who you are, lift yourself, your colleagues, and the healthcare profession up.
- Patel RS, Bachu R, Adikey A, Malik M, Shah M Factors Related to Physician Burnout and Its Consequences: A Review. Behav Sci (Basel). October 25, 2018;8(11). doi:10.3390/bs8110098. PMCID: PMC6262585. PMID: 30366419.
- Brigham T, Barden C, Dopp AL, et al. A Journey to Construct an All-Encompassing Conceptual Model of Factors Affecting Clinician Well-Being and Resilience. NAM Perspectives. January 29, 2018. doi:10.31478/201801b.
- Tawfik DS, Phibbs CS, Sexton JB, et al. Factors Associated With Provider Burnout in the NICU. Pediatrics. May 2017;139(5). doi:10.1542/peds.2016-4134. PMCID: PMC5404731. PMID: 28557756.
- Shanafelt TD, Boone S, Tan L, et al Burnout and satisfaction with work-life balance among us physicians relative to the general us population. Arch Intern Med. October 8, 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199.
- Jackson ER, Shanafelt TD, Hasan O, Satele DV, Dyrbye LN Burnout and Alcohol Abuse/Dependence Among U.S. Medical Students. Acad Med. March 1, 2016. doi:10.1097/ACM.0000000000001138. PMID: 26934693.
- Oreskovich MR, Shanafelt T, Dyrbye LN, et al. The prevalence of substance use disorders in American physicians. Am J Addict. January 2015;24(1):30-38. doi:10.1111/ajad.12173. PMID: 25823633.
- Mota MC, De-Souza DA, Rossato LT, et al. Dietary Patterns, Metabolic Markers and Subjective Sleep Measures in Resident Physicians. Chronobiology International. October 1, 2013;30(8):1032-1041. doi:10.3109/07420528.2013.796966.
- Peckham C Physician Burnout and Exercise. Medscape Physician Lifestyle Report. 2015.
- Vela-Bueno A, Moreno-Jiménez B, Rodríguez-Muñoz A, et al. Insomnia and Sleep Quality among Primary Care Physicians with Low and High Burnout Levels. J Psychosom Res. April 2008;64(4):435-442. doi:10.1016/j.jpsychores.2007.10.014. PMID: 18374744.
- Keeton K, Fenner DE, Johnson TRB, Hayward RA Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. April 2007;109(4):949-955. doi:10.1097/01.AOG.0000258299.45979.37. PMID: 17400859.
- Bohman B, Dyrbye, L, Sinsky, CA, et al. Physician Well-Being: The Reciprocity of Efficiency, Resilience, Wellness Culture. NEJM Catalyst. August 7, 2017.
- Wurm W, Vogel K, Holl A, et al. Depression-Burnout Overlap in Physicians. PLoS One. March 1, 2016;11(3). doi:10.1371/journal.pone.0149913. PMCID: PMC4773131. PMID: 26930395.
- Koutsimani P, Montgomery A, Georganta K The Relationship Between Burnout, Depression, and Anxiety: A Systematic Review and Meta-Analysis. Front Psychol. March 13, 2019;10. doi:10.3389/fpsyg.2019.00284. PMCID: PMC6424886. PMID: 30918490.
- Kraft U Burned Out. Scientific American. June 2006. doi:10.1038/scientificamericanmind0606-28.
- Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. December 6, 2016;316(21):2214-2236. doi:10.1001/jama.2016.17324.
- Mata DA, Ramos MA, Bansal N, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. December 8, 2015;314(22):2373. doi:10.1001/jama.2015.15845.
- Kane, Leslie Medscape National Physician Burnout, Depression & Suicide Report 2019. Medscape; January 16, 2019.
- Loas G, Lefebvre G, Rotsaert M, Englert Y Relationships between anhedonia, suicidal ideation and suicide attempts in a large sample of physicians. PLoS One. March 27, 2018;13(3). doi:10.1371/journal.pone.0193619. PMCID: PMC5870971. PMID: 29584785.
- NIMH Depression. Mental Health Information. July 21, 2020.
- Maurer DM Screening for Depression. AFP. January 15, 2012;85(2):139-144.
- Hobson K New Medical School Programs Help Students Battle Burnout. US News & World Report. 2015.
- Tucker T, Bouvette M, Daly S, Grassau P Finding the sweet spot: Developing, implementing and evaluating a burn out and compassion fatigue intervention for third year medical trainees. Eval Program Plann. December 2017;65:106-112. doi:10.1016/j.evalprogplan.2017.07.006. PMID: 28763733.
- Dyrbye LN, Shanafelt TD, Werner L, Sood A, Satele D, Wolanskyj AP The Impact of a Required Longitudinal Stress Management and Resilience Training Course for First-Year Medical Students. J Gen Intern Med. December 2017;32(12):1309-1314. doi:10.1007/s11606-017-4171-2. PMCID: PMC5698225. PMID: 28861707.
- Ng R, Chahine S, Lanting B, Howard J Unpacking the Literature on Stress and Resiliency: A Narrative Review Focused on Learners in the Operating Room. J Surg Educ. August 24, 2018. doi:10.1016/j.jsurg.2018.07.025. PMID: 30146461.
- Farouk A Stopping burnout a top priority for physicians in training. AMA Wire. November 16, 2015.
- AMA Wire Student SOS: 6 ways to avoid “distress” in medical school. AMA Wire. May 15, 2015.
- Hu Y-Y, Ellis RJ, Hewitt DB, et al. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. N Engl J Med. 31 2019;381(18):1741-1752. doi:10.1056/NEJMsa1903759. PMID: 31657887.
- Nanda A, Wasan A, Sussman J Provider Health and Wellness. J Allergy Clin Immunol Pract. December 2017;5(6):1543-1548. doi:10.1016/j.jaip.2017.05.025. PMID: 28734859.
- Dyrbye LN, West CP, Sinsky CA, Goeders LE, Satele DV, Shanafelt TD Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions. Mayo Clin Proc. 2017;92(10):1486-1493. doi:10.1016/j.mayocp.2017.06.020. PMID: 28982484.
- Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. June 2010;251(6):995-1000. doi:10.1097/SLA.0b013e3181bfdab3. PMID: 19934755.
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Founder, President, and Vision Leader: Bradley Tanner, MD, ME