Blog·Dr. Goldman's Blog

Getting help for burned-out doctors

A new U.S. charter on physician well-being aims to reduce rates of burnout. @NightshiftMD says the health-care system needs some healing too.
Last month, several leading medical organizations in the States recently released a charter they hope will address the problem of doctor burnout. (David Donnelly/CBC)

The Canadian Medical Association says more than half of Canada's doctors may be suffering from burnout. 

In the U.S, it's even higher with nearly two-thirds of doctors feeling depressed, burned out, or both. Last month, several leading medical organizations in the States recently released a charter they hope will address the problem. 

The charter on physician well-being was created by the Collaborative for Healing and Renewal in Medicine plus leading medical organizations like the American Medical Association.

The charter has a set of guiding principles. The main one is that you can't have good patient care without taking care of physicians, nurses, social workers and everyone else on the health-care team.

The charter also states that physician well-being is a marker for the quality of care a hospital delivers. High burnout rates mean lousy care. 

Remember the phrase, "Physician, heal thyself?" It's been replaced in favour of collaboration between doctors and hospitals, other members of the health-care team and the hospitals and universities where they work.

Doctors spread thin

There are several reasons why so many doctors are burned out these days. A survey by MDVIP — a U.S. company that surveys physicians — found that 83 per cent of doctors say they're spread thin and unable to spend enough time with their patients.

Seventy-five per cent say they're not getting enough sleep. They have expectations not to make mistakes and to be kind and empathetic at all times.

They went into medicine to make a difference by saving lives, end up providing lifesaving care to patients for whom it's futile.

I can also tell you that my colleagues are exposed repeatedly to the physical and emotional trauma experienced by their patients in everything from horrific car crashes to child abuse.

Women doctors who juggle medicine and motherhood may burn out because they don't get enough support at work or at home.

Sometimes, it's administrative paperwork and bureaucracy that lead to burnout. And sometimes, the problem is the government. In Quebec, family doctors who also work in the ER say the province is forcing them to see more patients in their family practices while doing the same number of ER shifts. 

Charter recommendations

The charter says that individual physicians need to do things like exercise and eat healthy. The charter also recommends mindfulness training, self-reflection, therapy and anything else that enhances the doctor's awareness of his or her emotions and those of others.

It calls on hospitals to support health professionals who try to get healthier by providing healthy meals and facilities and time for exercise. It says health professionals need to ask for mental health services. But it adds that hospitals need to provide confidential access to those services as well as time off to seek help as needed. 

The charter also says that hospitals and the people who run the health-care system need to streamline bureaucracy, reduce unnecessary paperwork and provide added personnel to offload some of the jobs doctors do. 

This is an American charter. Anyone who thinks this is going to happen in Canada anytime soon is mistaken. As André Picard pointed out recently in the Globe and Mail, Canada's spending on health ranks 7th among 11 industrialized nations.

The provinces would have to spend a lot more just to make us middle of the pack. To address the causes of burnout, the system could hire more people including international medical graduates who have been unable to practise in Canada. But the kinds of changes that the charter recommends will cost a lot of money.

The other issue is how far physicians and the system are willing to go to confront burnout. It means physicians have to own up to it, and trusted colleagues sometimes may need to confront them. Most physicians I know attach a great deal of stigma to having any sort of mental health problem including burnout. You'll have to convince them that the system will protect those who come clean. 

And what's at stake if the health-care system can't get a handle on burnout? The stakes couldn't be higher. A 2017 study suggests nearly one in five U.S. physicians intend to reduce clinical work hours in the next year. Roughly one in 50 doctors intend to leave medicine altogether in the next two years to pursue a different career.

The study's authors concluded that if physicians follow through on these intentions, it could profoundly worsen the projected shortage of physicians south of the border. Not only that, but there's evidence that burned out physicians make more mistakes and are less empathetic to patients and families. 

This issue may seem like inside baseball, but it affects patients in some profound ways.

We need to act.