Medscape recently published an article by Kate Johnson, on the rate of burnout amongst Canadian physicians (1). This article summarized well the findings of the most recent Canadian Medical Association survey (2) on the topic, which found that since the onset of the pandemic, burnout amongst Canadian MDs has almost doubled. In 2017 the rate was quoted as 30%, and in November 2021 this had grown to 53%. A not-so-surprising statistic indicates that 43% of the physicians surveyed intend to decrease their clinical practice over the next two years.
I say not-so-surprising, because from the point of view of an Emergency Physician working in an understaffed and overpopulated Emergency Department, our workload is exhausting. When we consider the triad of burnout being emotional exhaustion, depersonalization and a reduced rate of personal accomplishment, it is easy to see that a large proportion of my colleagues are in some stage of this.
What does burnout do to us, as doctors? What does it do to our patients, to society at large?
Imagine this: a recently graduated, young parent who is also a physician, signs on to work at a clinical site. In medical school and residency, life as an attending looks rosy, almost cushy, and is the goal learners all strive towards. There is the thought that once the training is done, we will have more control over our lives, our careers, and our finances. It's exciting!
Now, imagine that same excited, motivated young doctor a few years later, trying their best to push through in a system where there aren't enough doctors to care for all the patients, and there aren't enough bodies to fill all the shifts. It's starting to get taxing, heavy, and at times disheartening. But they push through, keep their chin up, keep foremost in their mind the altruistic nature of being a physician.
Now, imagine being suddenly thrown into a global pandemic, working in a hospital already short-staffed, worrying not only about your patients but also about your own health and the health of your family. That tired, hard-working, selfless young physician starts to get even more burdened. Colleagues start getting sick and more shifts need coverage. Family members, children, get ill but the physician must go to take care of strangers instead of their own family. Work duty feels like it must come before family duty.
That once happy go lucky, eager, enthusiastic doctor starts to get frustrated. Nothing is fun anymore at work. It feels like a slog, just to get through a shift. They start to snap at colleagues, start to harangue consultants, begin to lose patience with learners. They get annoyed easily with nurses, lose empathy for the suffering of their patients, and start to really dread putting their scrubs on to go to work. During the work day they cut corners, forget things, hurry past important issues and make errors. Patient care starts to suffer.
Coming home at the end of the day, the emotionally drained doctor drives slowly, takes the extra long route, and then sits in the driveway listening to the radio before daring to go inside. Getting in the door means entering job #2, or so it can feel. Once inside the threshold, the ravages of the day must be pushed deep down and the issues of all the others who depend on this young parent must come to the forefront. This extremely tired individual must summon courage and strength to move ahead with the second half of existence. So they push away their feelings about their day, put up a wall, and march inside wearily but with a shuttered smile.
Burnout amongst physicians can look like what I just described. It can look like pieces of what I just wrote. It can also manifest itself in so many other ways, including alcoholism, drug abuse, depression, broken relationships, and more. Physician suicide is a very real and sadly quite pervasive outcome of burnout.
What can we do to help our physicians? How can we rebuild what this pandemic and an overtaxed medical system have torn down?
Physician peer support programs are one way to assist. A confidential, non-judgmental, free resource, a peer support program offers physicians an outlet. A peer supporter on the other end of a phone line, or sitting down with a colleague for coffee, offers a listening ear and a sounding board. Discussions of moral injury, difficult cases, patient complaints, personal issues can all be had with the safety of knowing that the conversations are not recorded in any way and will not be used to the detriment of a doctor's career or reputation.
Having a figurative or real shoulder to lean on, in this way, is one tool in the repertoire of healing our physician colleagues.