Helping Physicians Recognize They're Burned Out

April 9, 2018

Burnout remains a prominent concern for physicians. Here's how to recognize the early signs, get help, and avoid disastrous consequences.

Physician burnout is not an isolated phenomenon. According to a 2015 Mayo Clinic study, nearly 55 percent of physicians reported at least one symptom of burnout including emotional exhaustion, depersonalization, or a sense of decreased personal accomplishment.

By 2017, a MDVIP survey found that 68 percent of physicians say that work stress is negatively affecting their lives with as many as 41 percent having contemplated leaving the field entirely. Not only do these intense feelings potentially lead to lower job satisfaction and increased medical errors, they can also strain personal and professional relationships as well. 

Here's how physicians and those close to them can identify burnout before it takes its toll.

Basis of burnout
In addition to the long hours and high-stress environment, burnout may further take hold because physicians feel isolated and expected to singlehandedly and successfully solve all presenting problems. "Physicians are taught to power through adversity and never ask for help, which makes us more prone to suffering in silence," said Aparna Iyer, MD, a board-certified psychiatrist in Frisco, Texas, who facilitates individual counseling sessions and group support for physicians coping with burnout. 

Instead of being able to focus on the wellbeing of their patients and connect on a meaningful level - which is why many went into medicine in the first place - physicians are constantly strapped for time due to increasing administrative tasks and large patient volumes. Many physicians are unprepared to tackle such stressors which leave them with unfulfilling or rushed patient interactions and less downtime overall.

"The medical field has become increasingly demanding of physicians […] and these demands are often not consistent with better patient care," said Iyer. "We are also never taught to balance work responsibilities with life responsibilities [and] physicians seem to […] struggle to find the time or willingness to engage in self-care."

Signs and symptoms
Self-identifying the signs and symptoms of burnout poses a significant challenge, particularly for physicians already overwhelmed and grappling with feelings of exhaustion or discontentment. While some may have a single cataclysmic event that prompts them to seek treatment, most will experience a slow process of emotional, psychological, and physical degradation that can take months or years to fully materialize.

For Shawn C. Jones, MD, a board-certified otolaryngologist in Paducah, Ky., and author and consultant on physician and medical school student burnout, his experience followed the latter path. "My burnout experience was more like that of a very slow leak punctuated by intermittent acute episodes," he said. "There was no single seminal event that sent me over the edge. It was an accumulation of detritus that had been collected over a long time."

By keeping a close eye on the emergence of any red-flag behaviors, physicians may be able to prevent such a long downward spiral. For example, there is often an increased propensity for "checking out" - as was the case with Jones - where the physician experiences a generalized numbness toward life and mentally and emotionally disconnects, engaging less with family and friends and well as with staff and patients. 

The signs don't stop there though. "The everyday picture of burnout can look like a […] decreased connection to work, decreased quality of patient care, irritability, anger, depression, lack of compassion or empathy, and even suicidal thoughts," said Iyer. Others may turn to addictive behaviors such as drinking, drugs, and gambling or become involved in extramarital affairs in an attempt to cope. Changes in appearance, weight gain or loss, insomnia, and headaches are all signs that the stress may be becoming unmanageable. 

Screening and diagnosis
Routine screening for symptoms of burnout can reveal subtle clues that a physician is struggling to maintain work-life balance. "Physicians should check in with themselves about how much they're enjoying family time and hobbies, how much they're able to relax during time off, how easily they can list the rewarding aspects of their work, and physical signs of too much stress," said Sylvie Stacy, MD, a board-certified preventive medicine physician and consultant in Bessemer, Ala.

Stacy is the founder of an online community for physicians called Look for Zebras, which aims to help physicians find more fulfillment in their careers, often through the pursuit of less traditional jobs opportunities. She also recommends physicians use this time to identify key personal and professional goals as well as their progress toward achievement.

Unfortunately, it can be challenging to objectively analyze your own emotions and circumstances, experts say. While online assessment tools are available and may assist physicians through this self-evaluation, it frequently takes a third party to help physicians fully identify the gravity of their situation and steer them toward treatment.   

Due to the long hours together and shared workspaces, staff members and colleagues have the potential to recognize early on the day-to-day changes in a physician's personality and serve as a sounding board and support system. "One big step in supporting our physician colleagues is being open to asking questions and expressing genuine concern," said Iyer. It's important to keep these conversations low-key and non-confrontational, so the physician has an opportunity to candidly discuss their feelings or simply vent about their day without feeling judged or embarrassed.  

Family members can hone in on burnout symptoms quickly also. "It can be hard to see changes in yourself, but your spouse may have noticed that you're smiling less often, less interested in your hobbies, etc.," said Stacy. "And many kids will be brutally honest with you if you ask them." The former was true in Jones' case, where it was his wife who initially recognized the change in his demeanor and supported him in pursuing professional treatment for burnout.

Seeking treatment
There is a stigma that prevents many physicians from seeking help, but there are an increasing number of avenues available for support and treatment. Many large hospital systems have implemented programs to assist physicians in maintaining work-life balance and managing stress.

Physicians outside of those health systems may benefit from professional counseling or therapy, either in an individual setting or by joining an informal support group like those offered by Iyer. "These support groups […] appeal to physicians of all ages [and] specialties, in various points in their careers," said Iyer. "The groups build a unique level of camaraderie [and help] physicians identify exactly how they are struggling."

For others, burnout can signal it's time to explore additional career options and find a position that more closely aligns with your mental, emotional, and physical needs. "There are a lot of opportunities out there for physicians, with such a broad range of responsibilities, workplace cultures, schedules, topic areas, etc.," said Stacy.

If you choose to stay in your current position, Stacy recommends renegotiating your work schedule and responsibilities with your employer along with finding a counselor or life coach to assist in working through residual burnout concerns. Ultimately, taking action is the only way to break the cycle. "Do not remain silent and attempt to fight this alone," said Jones. "Seeking help is a reflection of strength. It is exactly what you would recommend to a patient."

Steph Weber is a freelance writer hailing from the Midwest. She writes about healthcare, finance, and small business, but finds her passion for the medical field growing in sync with the ever-changing healthcare laws.