Working Toward Wellness: Exploring Burnout and Resiliency in Physicians

In May I had the honor of addressing APA members at the Opening Session of the 2017 Annual Meeting in San Diego. I used that speech as an opportunity to lay out several priorities that I plan to focus on during my presidential year. One of these is to address an issue that has had an increasingly significant impact on physicians working in all medical specialties, particularly in the last 10 years: physician burnout.

Just hours before the Opening Session, Rick Summers and I hosted a town hall event on this very topic. I wanted to hear directly from our members about their experiences in their day-to-day lives, as well as what gives them feelings of satisfaction and overall wellness.

A substantial body of literature has documented the extent of the burnout problem across all physician disciplines. A December 2015 report in Mayo Clinic Proceedings found that in 2014, roughly 54 percent of the physicians in the study had at least one symptom of burnout. When compared with 2011, rates of burnout among physicians were higher in 2014, and satisfaction with work-life balance was lower (41 percent versus 49 percent).

We know that things like excessive productivity quotas, limits on the time that we can spend with each patient, and documentation requirements are major sources of dissatisfaction for physicians. Some stressors that adversely affect psychiatrists specifically include limited resources, high work demands, and patient violence. In contrast, experiencing collegiality, fairness, and respect leaves us feeling more satisfied with our work.

Most of us have felt some degree of compassion fatigue in our careers. Some of us may have even experienced deep and pervasive episodes of burnout that have had an impact both on our practice of medicine and on our home lives.

Afternoons at about 2:30 have been a challenge and a barometer for me personally. At one point in my career, I accepted a position in a local psychiatry inpatient setting. My thinking was that I could do rounds in the morning, and instead of keeping an outpatient afternoon practice as many often do, I could go home to be with my children after school. I thought I would be working three-fourths the hours for about the same money. Sounded good, and I loved the intensity and collegiality of the work. On many days, I initially was able to leave by 3 or 3:30. Often it was the unpredictable inpatient consultations that kept me there past the time I had planned to go home. On one day I particularly remember, I was called to see a suicidal 15-year-old who had just been told that she had multiple sclerosis. The dilemma: stay to sort out her situation and work with the family during a very intense time of despair for them versus make them wait so that I could be home with my own children on what was otherwise a routine day in my children’s lives. Compassion fatigue and burnout were just around the corner. Every day, decisions like this can have a cumulative effect on all physicians.

In the coming year, I aim to stimulate deep and wide conversations within our membership so that together we can explore the root causes of physician burnout and develop strategies to promote wellness and interventions that can mitigate the effect that they have on physicians not only in psychiatry but across all of medicine.

To that end, I’ve chartered a work group to develop recommendations for APA on addressing burnout and wellness in our membership. I’m hoping that by the end of my presidential year, we will have produced a robust set of tools and resources on this issue that we can share with our members as well as our colleagues in other specialties. These will take the form of educational materials, self-assessment tools, and potential interventions for our members.

Along the way, we’ll be searching for feedback on the materials that APA produces on burnout and wellness. We want members to tell us whether the tools and resources we produce resonate with their own experiences.

I hope you’ll be vocal in offering us your feedback, as it is an invaluable part of producing a truly useful member benefit. I managed my episodes of compassion fatigue by developing a close working relationship with the inpatient unit where many of the nurses were also working mothers, benefiting from the can-do attitude of my physician husband, having a great babysitter, being active with community psychiatry colleagues on list serves at night after the children’s bedtime, and eventually changing positions. In retrospect, there were several things I could have asked for or the hospital would likely have considered that would have influenced me to remain. Too often we physicians are tough and/or silent, and do not think about negotiating for accommodations and resources that would support our remaining in tough jobs.

A professional organization like APA can be a valuable resource for career-long professional development and satisfaction. We know that collegiality and respect often translate to satisfaction at work and better overall resiliency. We want to give psychiatrists something they can take back to their workplace and, in the spirit of collegiality, address this issue on their own level, face-to-face with the peers and administrators they work alongside every day.

For many of our members, psychiatry is a calling, and one from which they derive great satisfaction. My goal is to harness the resources of APA and reinforce that idea—that sense of purpose and fulfillment that we get from doing work that we know matters—to ensure that our members are happy, healthy, and doing the absolute best work they can for our patients. ■