By Rotem Olsha
When it comes to mental health, doctors are often forgotten patients. The stress associated with the immense workload, societal pressures, and liability for their patients directly affects their ability to treat the ill. These providers experience a loss of passion for the profession, combined with typical symptoms of depression intertwined with emotional and physical exhaustion. The commonly used, and widely accepted term used to describe this phenomenon is burnout. Unlike the diagnoses in medical textbooks, burnout has no individualized solution, making it difficult to identify and treat. Ultimately, it comes down to the ways in which physicians are trained and the system in which they are forced to work in. Occupational burnout has changed the way sick people are treated, worsening healthcare as a whole. After all, if the physicians themselves are unable to care for the sick, who is?
The Ripple Effect
The effects of burnout trickle down and impact the entire medical system. From physicians to patients, nurses, and certified nursing assistants (CNA). In many instances, healthcare providers are forced to treat more patients than they can realistically provide personalized, satisfactory care for. In an interview with Janette Godwin, a nurse from Raleigh, North Carolina, she discusses one reason why burnout is so common among nurses:
“Definitely patient-to-nurse ratio, too many patients, same thing in the hospital, high-acuity patients and seven patients to one nurse. The CNA sees the patient, the nurse gives the medicines, assesses the effects, documents, gives the next round of medications, assesses the effects, and then you do with, you know, any trauma situation in between. If a patient starts crashing, you monitor them and do the best you can, but that’s a lot of stress on somebody for twelve hours, three days in a row and then four days in a row the next week. That’s a lot of stress.” (Godwin, 0:47:53)
Beyond the immense stress caused by the patient-to-provider ratio, burnout is contagious (Bodenheimer & Sinsky). The inability of one provider to properly accomplish basic tasks causes fellow providers to make up for them, increasing the workload of fellow health care providers. In a survey conducted by the American Organization for Nursing Leadership (AONL) during the COVID-19 pandemic, 67% of nurse leaders reported that maintaining the mental health and wellbeing of staff was a “major challenge”. Not only are nurses required to care for patients physically, but they also typically provide emotional support for those experiencing unexplainable pain and discomfort. The added burden of providing emotional care leaves little time for doctors and nurses to take time for themselves. Additionally, nurses form bonds between patients who, ultimately, may not survive. The impact of losing a patient then becomes a psychological strain that can further hinder a nurse’s ability to provide effective patient care. In the same survey, conducted by AONL, most surveyed nurses reported that being overworked and understaffed are key factors contributing to their poor resilience and stress levels in the workforce. When one provider experiences burnout, those around them must bear the consequences until they eventually burn out themselves.
The unfortunate truth is that occupational burnout is nothing new, if anything, it has only gotten worse. Marie Flynn Vargo describes her experience as a nurse in Chapel Hill in 1984. She shares that she left her job because there were times when she was the only nurse on call, making her the sole person responsible for all the patients in her unit. Not only were these experiences risky for her, but they also posed a risk for every patient in her care. If the working conditions under which nurses are trained and forced to work in are ones that cause them to leave, solving the nurse shortage problem seems highly unlikely.
In addition to poor working conditions, the competitiveness of the medical profession contributes to unproductive workspaces. Of course, competition enforces high standards that shape medical advancements, but pitting nurses and doctors against each other promotes unhealthy outcomes; suicide rates in physicians are at an all-time high and are continuing to rise (Schernhammer, Colditz). Three out of every 20 physicians reported being “extremely dissatisfied” with their job (Hughes, 2019) and depression rates are among the highest in nurses from any occupation. In the words of Jill Lepore, a writer for The New Yorker, we live in a “world that requires people to strive to the point of self-destruction”. Providers are simply products of the economic system that pressures them to work against each other in the hope of getting above each other.
Not only does competition impact the providers’ lives, but it also changes their perception of the profession as a whole. Holding altruistic views is a crucial part of providing adequate care— without the ability of health care workers to put others first, medical treatments become unethical and their authoritative role may overpower their relationship with a patient. Studies show that physicians who report burnout fail to hold altruistic views on their role in society (Dyrbye, Massie et al., 2010). Administrative duties and the loss of face-to-face interactions between patients and healers cause patients to lose precious time with their providers, decreasing the ability of a doctor to retain their altruistic views and increasing the probability that subtle changes in a patient’s condition are overlooked. The inability to follow a patient through their illness and understand their story prevents providers from pinpointing their role in individual cases, and therefore from providing the best care possible. The loss of time spent talking to patients leads to inadequate treatment options, “Modern medical practice is a petri dish for medical error, patient harm, and physician burn-out” (Ofri). In an efficient medical system, both health care workers and administrators must work cohesively, yet individually. Stressful workloads cost physicians, hospitals, patients, and families— resources are wasted, recovery is prolonged and, ultimately, lives are lost.
The Loss of Personalized Care
“I think that the United States is in a mental health crisis because, you know, funds have been cut and services have been taken away, hospitals have been closed… People are not getting the mental health care that they should.”
(Miller, 0:38:52)
Amber Miller, an emergency room nurse, brings a financial perspective to the impact of mental health in the American healthcare system. As more hospitals are being bought by private equity firms, local hospitals and nursing homes are shutting down. Patients are sometimes required to drive hours away to centralized hospitals that are required to care for more patients than they can handle. The added stress is not typically justified by added compensation, leaving physicians unsatisfied and more likely to leave their practice. The cost associated with retraining and rehiring physicians takes away from funding that could be used towards new technology, resources, and support systems within hospitals and clinics (Bodenheimer & Sinsky).
Straightforward Solutions to a Complicated Problem
Solving burnout begins with recognizing the problem and acknowledging how embedded it is in the healthcare system. After spending several hours researching the effects of provider burnout, it has become clear how incomplete physicians’ perspectives are. The lack of primary resources describing how doctors are affected by the immense workload and stress of their jobs has prevented the problem from being recognized. Unfortunately, there is still a lot of shame associated with admitting that a physician is mentally unwell (Paquette, 2015). This has directly affected the lack of reporting, and therefore the lack of evidence for physician-specific burnout.
Secondly, more doctors need to be properly trained. Medical schools need to change their admission process to accommodate more students from more diverse backgrounds. In a series of interviews conducted by a group of public health researchers in a rural Appalachian town, residents identified that physicians working in larger city hospitals prioritize profits over the well-being of patients (Efird et al., 2021). Increasing the number of physicians who come from small towns may increase the likelihood that they will return to work there later in their careers. Simply admitting more people into medical schools who aim to work in rural and suburban towns can help decrease the workload of providers. In teaching and hiring more doctors, problems such as the one Amber Miller identified can be solved.
Communication between health care providers and government officials needs to be encouraged. Legislators have the power to change these harmful cycles by changing policies and regulations that promote burnout. Money can be allocated toward hiring more administrators, social workers, long-term caregivers, nurses, and physicians. The ways in which providers are trained should be adjusted to prevent moral injury. Resources must be properly allocated, and individualized care should be at the forefront of nurse and physician training. It is the only way to address the mental health crisis causing provider burnout in the medical field.
Occupational burnout affects everyone, from physicians and nurses to patients and their families. Although it has been around for many years, it continues to get worse; nothing is being done to combat the negative effects of overworking and underpaying hospital staff. The competitiveness of medical schools contributes to a loss of passion for the profession and consequently physicians lose their altruistic views. Removing the stigma surrounding mental health among providers involves major, systemic changes that increase communication between government organizations and those on the front lines. The solutions are at our fingertips, the question is, are we too burnt out to solve it?
References
Bodenheimer, Thomas, and Christine Sinsky. “From triple to quadruple aim: care of the patient requires care of the provider.” Annals of family medicine vol. 12,6 (2014): 573-6. doi:10.1370/afm.1713
Dyrbye LN, Massie FS, Eacker A, et al. “Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students.” JAMA. 2010;304(11):1173–1180. doi:10.1001/jama.2010.1318
Efird, Caroline R., et al. “Loss of Obstetric Services in Rural Appalachia: A Qualitative Study of Community Perceptions.” Journal of Appalachian Health, vol. 3, no. 2, 2021, pp. 4–17.
Flyn Vargo, Marie. Interview with Narrator. 28 June 2018 (Y-0133). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill
Godwin, Janette. Interview with Maddy Kameny. 26 June 2018 (Y-0025). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill
Hughes, Jonathan Ford. “How Satisfied Are U.S. Physicians with Their Career and Pay?” Physician Sense, 2 Oct. 2019, https://www.mdlinx.com/physiciansense/how-satisfied-are-u-s-physicians-with-their-career-and-pay/?msclkid=5a9bd501c33f11ec8aa43475b824c545 .
Lepore, Jill. “Burnout: Modern Affliction or Human Condition.” The New Yorker, May 2021, https://www.newyorker.com/magazine/2021/05/24/burnout-modern-affliction-or-human-condition.
Miller, Amber. Interview with Emma Miller. 22 July 2019 (Y-0075). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill
Ofri, Danielle. “Perchance to Think.” New England Journal of Medicine, vol. 380, no. 13, Mar. 2019, pp. 1197–99, https://danielleofri.com/perchance-to-think/.
Paquette, Andrea. “Doctors Are Affected by Mental Illness Stigma Too.” Healthy Place, 27 Apr. 2015, https://www.healthyplace.com/blogs/survivingmentalhealthstigma/2015/04/doctors-are-affected-by-mental-illness-stigma?msclkid=dcab2356c50811ec91f3395d3c6b4fcb.
Schernhammer, Eva S, and Graham A Colditz. “Suicide rates among physicians: a quantitative and gender assessment (meta-analysis).” The American journal of psychiatry vol. 161,12 (2004): 2295-302. doi:10.1176/appi.ajp.161.12.2295
Symplr Authors. “How Nurse Burnout Impacts Patient Safety.” Symplr, 6 May 2021, https://www.symplr.com/blog/how-nurse-burnout-impacts-patient-safety#:~:text=%20The%20effects%20of%20burnout%20on%20nurses%20and,emotional%20job%20that%20involves%20a%20high…%20More%20.