Is your doc burning out? Survey: 44 percent in U.S. are

One doctor a day commits suicide in the United States on average, the highest suicide rate of any profession.

At 28 to 40 per 100,000, it's more than twice that of the general population.

"I am so very concerned about physician suicide. What a loss," said Coeur d'Alene family practitioner Dr. Irwin Steiger.

Medscape's 2019 National Physician Burnout, Depression and Suicide Report, released Wednesday, revealed 14 percent of the more than 15,000 doctors who participated in the study said they have had suicidal thoughts and 1 percent have attempted suicide.

"Being a physician is who a person truly is," Steiger said. "It is not really a job. I believe that those who consider ending it all feel a great loss of who they truly are as a person, and a loss of control over their lives. This is so sad."

While only 4 percent of the doctors surveyed reported being clinically depressed and 11 percent reported feeling “colloquially depressed” (feeling down), a whopping 44 percent reported experiencing burnout, which has been defined as "long-term, unresolvable job stress that leads to exhaustion and feeling overwhelmed, cynical, detached from the job and lacking a sense for personal accomplishment,” according to the report.

The top factors leading to burnout and low points include doctors being weighed down with too many bureaucratic tasks, spending too much time at work, the increasing computerization of their practices, lack of respect from patients, an emphasis on profits over patients, and feeling like just a cog in a wheel.

Doctors in urology, neurology, physical medicine and rehabilitation, internal medicine and emergency doctors were among the most burned out, as well as 50 percent of female doctors and 39 percent males overall.

Steiger, who works at Prairie Family Medicine and has been practicing for about 50 years, including military service, said the government and insurance companies interfering between physicians and patients is "a major cause."

"All of the paperwork and data, especially the electronic medical records, takes time away from patient care," Steiger said. "The end result is a shortened visit with a patient, with the provider typing away on a computer constantly. I refuse to do this, and I spend as much time with my patients as I can, in a face-to-face interaction. I talk to my patients. We both benefit from this experience."

Longtime Coeur d'Alene family physician Dr. Richard McLandress, program director of Kootenai Clinic Family Medicine Coeur d’Alene Residency, said there has been a major shift in how doctors get to know their patients and conduct business.

"It used to be doctors would know their patients by visiting with them and writing their stories with their fountain pen as the record was made," McLandress said Wednesday. "There was a lot more eye contact when a physician was seeing his or her patient."

He said what used to become part of a doctor's memory are now many pieces of documentation required by Medicare and other payers.

"It changes the feeling that doctors have when they see their patients," he said.

As well as depersonalizing a doctor-patient experience, that forced documentation follows doctors home.

"What happens in doing that is when the day is done and the patients are seen and there are many charts that are not yet completed, the average family physician, after seeing patients, spends about 2 ½ hours at the end of the day completing charts," he said.

Especially for female doctors, who are moms and have families to care for, this work stretches into the night.

"The new terminology is the 'pajama doctors,'" McLandress said, painting the picture of PJ-clad, off-duty doctors burning the midnight oil to get everything done before the next day.

The large volume of paperwork adds to the hours in a doctor's long day, which can lead to exhaustion and an inability to perform at the highest levels, like the patients — and the doctors themselves — expect of them.

That may be part of why many doctors don't seek help when they're feeling burned out. The Medscape report shows that 64 percent of doctors haven't gotten help for depression or burnout in the past, and they don't plan to in the future.

"Physicians tend to be people with high personal expectations of high performance, so for people who have high expectations, feeling like you're doing poorly is something that's kept to yourself," McLandress said. "One of the tricky parts is the concern that this may impact the physician's reputation or ability to continue working in a work environment" where it might be discovered that doctor is having depression or anxiety.

"There are many laws preventing me from looking in any patient's medical record who is not my patient, but that's a commonly reported fear that physicians have is that their medical record will not be kept confidential."

McLandress said all doctor communities address physician well-being. He said the fact that many doctors struggle in some way is not new, it's just being looked at more closely in modern times as the medical community has better ways of tracking it.

"The problem has been well identified," he said. "We're trying to find better ways to deal with it. It's a very intense training process for physicians and it’s an intense life; people get sick and get injured randomly, not on your schedule."

He said Kootenai Health has a physician wellness committee that’s developed a process to give doctors a confidential space to talk about their troubles.

McLandress, who has worked shifts that last longer than 24 hours, said hour limitations have also been implemented to protect residents in training from the sleep deprivation that leads to burnout.

Giving doctors the appropriate size of a back-up team also helps them have more control over situations, especially if they have a patient who requires more of their time.

"Physicians are real people. They care a lot about their patients and they want things to go well. When there are time pressures in that relationship, then it's stressful to the doctors," McLandress said. "It’s good for people to understand the new electronic health record documentation requirements.

"It's important for patients to know the healthcare community is doing something about this."

See the full report (free access but login required): https://wb.md/2RBngIx