An epi­demic of physi­cian burnout and sui­cides

The Fresno Bee (Sunday) - - Opinion - BY DR. LORI WEICHENTHA­L Dr. Lori Weichentha­l is as­sis­tant dean for grad­u­ate med­i­cal ed­u­ca­tion at UCSF Fresno.

Who needs a happy MD? We all do. More than one doc­tor a day dies by sui­cide in the United States and un­told num­bers of physi­cians burn out and leave the pro­fes­sion ev­ery year.

In a re­cent 2019 Med­scape sur­vey, more than 50 per­cent of the 15,000 physi­cians from across the coun­try who re­sponded re­ported symp­toms of burnout or de­pres­sion. Rates of burnout were high­est among our front-line physi­cians, in­clud­ing fam­ily medicine, ob­stet­rics and gy­ne­col­ogy, in­ter­nal medicine and emer­gency medicine.

This epi­demic of physi­cian burnout, de­pres­sion — and sui­cide — is tragic for physi­cian fam­i­lies and their med­i­cal com­mu­ni­ties, as well as pa­tients and so­ci­ety. A re­cent re­port by the Mass­a­chu­setts Med­i­cal So­ci­ety, the Mass­a­chu­setts Health and Hospi­tal As­so­ci­a­tion and the Har­vard T.H. Chan School of Pub­lic Health called physi­cian burnout a pub­lic health cri­sis.

Con­sider these reper­cus­sions: Burnout has been linked to more med­i­cal er­rors, less pa­tient sat­is­fac­tion with their care, and more health-care providers leav­ing the pro­fes­sion to find work in other are­nas.

Let’s look at this pos­si­bil­ity of health care providers leav­ing their pro­fes­sion and how it plays out in the San Joaquin Val­ley. The Val­ley has one of the low­est ra­tios of pri­mary-care providers as com­pared with other re­gions of Cal­i­for­nia. There are 133 ac­tive physi­cians (ex­clud­ing med­i­cal res­i­dents) per 100,000 pop­u­la­tion, com­pared with the state rate of 222 ac­tive physi­cians per 100,000 pop­u­la­tion, ac­cord­ing to a Health­force Cen­ter at UCSF re­port.

The sit­u­a­tion will only worsen in the com­ing years. Thirty per­cent of physi­cians in the Val­ley are over the age of 60 and are ex­pected to re­tire within the next decade.

In 10 years, Cal­i­for­nia is ex­pected to have a short­fall of up to 4,100 pri­mary-care clin­i­cians, ac­cord­ing to the Cal­i­for­nia Fu­ture Health Work­force Com­mis­sion. Re­cent stud­ies sug­gest that by 2030, the en­tire na­tion will ex­pe­ri­ence a physi­cian short­age of more than 40,000. Add to this the health care providers cut­ting their ca­reers short due to burnout, and this truly does look like a health care cri­sis for the San Joaquin Val­ley.

Fi­nally, add one more in­gre­di­ent, one that is not talked about as much. It is es­ti­mated that more than 400 physi­cians die by sui­cide each year. This is twice the rate of the gen­eral pop­u­la­tion. It is es­ti­mated that with the death of these 400 physi­cians, over 1 mil­lion pa­tients lose their doc­tors. And al­though not widely re­ported, many physi­cians in our Val­ley have lost their lives to sui­cide.

What is burn­ing out our health-care providers? It is not the di­rect care of pa­tients, a spe­cial ex­pe­ri­ence that draws most providers to this pro­fes­sion. It is an in­creased bu­reau­cratic load, more time spent with elec­tronic med­i­cal records, long hours and a grow­ing sense of lack of re­spect and au­ton­omy.

So what is the cure? Re­cent stud­ies have sug­gested that the an­ti­dote to burnout is en­gage­ment. Yes, physi­cians and other providers need to “prac­tice what they preach” and de­velop healthy prac­tices that sup­port their well-be­ing and re­silience.

They also need to feel that they are work­ing in health care sys­tems and a so­ci­ety as a whole that rec­og­nizes and sup­ports their work. They need to feel that they are part of the so­lu­tion to the many health-care is­sues that all mem­bers of our so­ci­ety face rather than just an­other cog in the wheel of the health-care sys­tem.

Physi­cian well­ness is a pri­or­ity at UCSF Fresno. We are com­mit­ted to cre­at­ing an en­vi­ron­ment that is safe, in­clu­sive and sup­port­ive. On March 20, 2019, UCSF Fresno will host na­tional ex­pert Dr. Dike Drum­mond, “The Happy MD,” who will present sev­eral work­shops for lo­cal health-care providers aimed at help­ing them lower stress lev­els, build a more bal­anced life and re-en­er­gize their pas­sion for prac­tic­ing medicine.

This event is part of on­go­ing ef­forts by UCSF Fresno to pro­mote physi­cian and health care provider well­ness. It is a com­mit­ment to our com­mu­nity: Happy doc­tors lead more con­tented lives and are vi­tal to im­proved pa­tient out­comes.

Changes will not oc­cur overnight. It be­gins with every­one un­der­stand­ing that we need happy MDs and health-care providers to be a healthy com­mu­nity.

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