The Docs Aren't Alright.

The mental health and suicide crisis among clinicians and first responders is a public health emergency that we must urgently address.

In the relentless world of healthcare, an insidious crisis is unfolding: healthcare provider burnout. This issue isn't just about doctors, nurses, and PAs feeling stressed or overworked; it's a full-blown public health emergency with far-reaching implications for the well-being of every individual and the entire healthcare system.

The demands of the healthcare system, administrative pressures, and relentless exposure to trauma contribute to compassion fatigue and emotional exhaustion. This silent crisis threatens the well-being of those who are essential to our communities. Prioritizing their mental health is crucial for both them and the patients they serve. This topic is near and dear to my heart. 

My husband, Ethan, is an emergency physician. For years, I have watched him put on his scrubs and head to the hospital like a soldier heading into battle. He got into medicine for all the right reasons, and he is the type of doctor that people dream of encountering if they find themselves in the emergency room. But I don’t think I can quite articulate the look in his eyes when he returns from the frontlines after his shifts. Working nights, weekends, and holidays– often going without breaks, rest, or even time to tap a sip of water or use the bathroom– all while giving every fiber of his being to deliver the highest quality of care so that his patients can leave the emergency room in better shape than when they arrived. But the US healthcare system often prioritizes efficiency over care, pushing clinicians to see a high volume of patients within limited timeframes. This emphasis on quantity sacrifices meaningful patient interactions, leaving clinicians with little time to process the emotional weight of the life-altering situations they witness daily. Let’s discuss.

Recently, media outlets have highlighted concerns with doctor burnout, and two particular studies – from Medscape and Athenahealth (in conjunction with Harris Poll) - shed some light on the struggles being faced by doctors every day. The CDC also conducted a study on this topic in their General Social Survey Quality of Worklife Module for 2022.

In the different surveys, between 45.6% to 93% of physicians surveyed said that they feel burned out on a regular basis. Per the Athenahealth survey, doctors reported that “they spend an average of 15 hours per week working in “pajama time” or outside their normal work hours”.  When asked about their current employment situation, “a majority (56%) said they have considered leaving the field or remaining in the field but no longer seeing patients”. This finding is in line with the Medscape survey (~50%) where doctors said “their burnout was so bad they would leave healthcare altogether.”

What is at the heart of clinician burnout?

Doctors in the U.S. are struggling to contend with feeling overwhelmed with administrative tasks (e.g. charting, electronic health record (EHR) systems, insurance paperwork), long working hours (in residency and beyond), loss of autonomy as a doctor, staffing shortages, insufficient compensation (with staggeringly high student debt), and lack of respect from administrators/employers, colleagues, and even patients. All of this combined is rapidly and very seriously impacting the mental health of doctors. Some physicians have revealed that this feeling of burnout has persisted for over 1-2 years in the large majority of physicians (>70%) per the Medscape survey. Since 2018 until now, doctor burnout rates have been somewhere between 40-50% and even higher in some surveys and many physicians report feeling depressed (at least 20%).

P.S. We’ve previously done posts on the provider shortage in the US and the payment structure of the US healthcare system (and more)— which are undoubtedly contributing to clinician frustration.

What does this mean for patients?

Doctors cite the heavy burden placed on them by insurance companies to fill out paperwork to approve routine patient therapy or interventions, differing healthcare models/payor models that reduce their ability to spend the appropriate amount of time with patients, and the growing complexities of their patients as reasons they are not able to treat their patients at the levels that they believe are sufficient. This adds up to a phenomenon called moral injury that doctors and healthcare professionals experience and leads to further worsening of their underlying mental health.

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Moral injury: This occurs when one feels they have violated their conscience or moral compass when they take part in, witness, or fail to prevent an act that disobeys their own moral values or personal principles. 

For a doctor or other healthcare professionals, moral injury contributes most heavily to their burnout as this mismatch of their desire to help people and in fact, being unable to do so to the best of their abilities causes very notable and serious damage to their mental health and personal well-being.

When graduating from medical school, doctors recite the Hippocratic oath:

I shall work with my profession to improve the quality of medical care and to improve public health, but I shall not let any lesser public or professional consideration interfere with my primary commitment to provide the best and most appropriate care available to each of my patients.

The ethical dilemmas that are drowning doctors today to meet the high standards of this oath are causing a great deal of distress and burnout.

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Many doctors say that they feel they do not have enough in-person time with their patients, and more than 75% reported feeling “exasperated” and overwhelmed by patients’ excessive communication demands, such as frequent texting, calling, and emailing outside scheduled visits per the Medscape and Athenahealth surveys. Additionally, a burned-out doctor makes documentation mistakes (e.g.missed medical history, poor charting), can be openly frustrated in front of patients, and can make mistakes that can harm patient safety (e.g. medication errors, insufficient diagnostic accuracy). Patients feel this frustration and time constraint with their doctors and it is causing them to feel their quality of care is suffering as a result. We often talk about this as a reason many patients are turning to practitioners outside of traditional healthcare and into the “alternative” and “influencer” spaces as patients feel heard and receive the attention they believe they deserve from these resources as medicine in their eyes is failing them. 

A large majority of physicians also cite poor staff retention and staffing shortages that are affecting their organizations. This means doctors must work even longer hours and physically see more patients than is safe, contributing to their physical and emotional exhaustion and burnout. It was not until 2003 that the Accreditation Council for Graduate Medical Education (CGME) capped trainee hours to a maximum of 80 hours per week - while surgical trainees were exempt in many cases and could work 100 hours per week (and more). In 2017, the CGME reinstated the possibility that first-year residents could again do 24-hour shifts which matched the more experienced resident schedule of 28-hour shifts - all while still working a monthly average of 80 hours per week (which means they can exceed this at times as long as it averages out). After training, the median working hours put in by physicians range between 50 - 59 hours/week with over 36% working from 60 to over 80 hours per week per a Statistica survey in 2021. 

Doctors who work this long and over continuous schedules risk being sleep deprived and this can impair physician performance. Working long hours and 24-hour shifts has been shown to lead to more serious medical errors and more serious diagnostic errors than working shorter shifts. Additionally, working hours that exceed 60 hours per week have been noted to drastically increase burnout scores in doctors. Extended shifts also expose trainees and physicians to a higher risk of car accidents as they drive home from work and as noted in the various studies from the CDC, Medscape, and Athenahealth, which are contributing to serious personal stress, depression, burnout and even suicidality when physicians are at home with their families and loved ones (if they have anyone at all). 

Why Should You Care?

Think of provider burnout as a chronic, untreated infection. It weakens the very foundation of our healthcare system, leading to:

• Eroding Quality of Care: Exhausted providers struggle with focus, decision-making, and empathy, and increasing the risk of medical errors and poor patient interactions.

• Shrinking Workforce: The grueling pace in many medical settings drives providers to leave the profession prematurely. With doctors retiring younger, especially in high-stress fields like emergency medicine, shortages in vital services become the norm. Additionally, the aging population is outpacing the supporting workforce and will reach critical mass in 2033 per the American Hospital Association.

• Waiting times drastically increase: the more doctors are calling in sick, if they are leaving medicine altogether, and if the current workload remains, the time to see the doctor is increased.

• Skyrocketing Costs: The financial burden of burnout is immense. From medical errors and staff turnover to decreased productivity, costs cascade through the system, impacting taxpayers, insurance companies, and patients.

It's a Mental Health Crisis, Too

Beneath the surface of burnout lies a devastating mental health toll. Doctors and nurses are experiencing alarming rates of depression, anxiety, and tragically, suicide. We are losing dedicated healers to a system that pushes them past their breaking point.

Unsustainable for Everyone

The bottom line: this model is not sustainable for providers or the people they care for. If we ignore this crisis, the ripple effects will undermine healthcare for everyone:

• Difficulty Finding Doctors: Longer wait times, gaps in specialist care (e.g. OB/GYNs), limited appointment options - especially in underserved and rural areas.

• Compromised Public Health: Reduced ability to manage chronic diseases, respond to emergencies, and prevent illnesses.

How are physicians dealing with this stress and burnout?

One of the most intriguing findings of the Medscape survey was that the majority of physicians are “unsure” or “would not” discuss their burnout or depression with their colleagues. What is clear is that they suffer as well from the stigmas around depression - it is viewed as “weakness”, it is a “negative reflection on the doctor”, “others will think less of them”, people will “doubt their abilities”, and medical boards/employers will find out. Just like everyone else, doctors are human and it cannot be that they are left to fight this alone while also trying to counsel us as well!

Doctors, like anyone with depression and/or burnout, need to be able to healthily deal with and maintain their mental health. Spending time with their family and friends, finding a hobby outside of work (e.g. sports, reading, etc), regularly exercising, getting adequate sleep, maintaining a good diet, avoiding excess alcohol/drugs/cigarettes, and getting therapy are many of the interventions noted in the Medscape survey and serve as a start. Although this survey and the CDC report noted that many doctors are not always able to cope and are suffering from chronic absenteeism, prolonged depression, turning to unhealthy behaviors like drinking, eating junk food, binge eating, etc, and even considering or completing suicide.

Tackling burnout isn't just about telling doctors to "try harder." This is a systemic issue demanding policy changes that reduce administrative burdens and streamline processes to give providers back their time with patients. Cultural shifts prioritizing provider well-being, destigmatizing mental health struggles, and building supportive work environments. Interestingly, in many of the studies, most physicians reported that their managers, administrators, and healthcare systems did not recognize that there was an issue. Investment in resources that allow access to mental health support, programs to help with work-life balance, and adequate staffing to prevent overwhelming workloads.

Shining a light on the crisis of emergency medicine physicians leaving the profession in droves

Emergency medicine has always been a demanding field and the recent Medscape study found that 63% of the EM doctors with the highest burnout rates. With a close-tied second place at 53% for obstetrics/gynecologists  (OB/GYN) and oncologists. Doctors face the constant pressure of making split-second decisions in a chaotic environment where anything can happen. They witness intense suffering, manage unpredictable cases, and sacrifice their personal lives for long, grueling shifts. It's a recipe for burnout even in the best of times.

Then came the pandemic. Emergency rooms were inundated with waves of desperately ill patients, stretching resources and staff to their limits. Doctors risked their health with inadequate protection, all while carrying the weight of unimaginable suffering and difficult ethical decisions. This relentless pressure pushed many over the edge. Burnout rates skyrocketed, leading experienced doctors to walk away and jeopardizing the stability of emergency care for everyone. Emergency medicine was always challenging, but the pandemic pushed it past the breaking point.

• Burnout Rates: EM consistently reports some of the highest burnout rates among all medical specialties. Studies indicate that well over 50% of EM physicians experience burnout symptoms.

• Attrition Crisis: Emergency departments are seeing unprecedented levels of doctors walking away, either quitting clinical medicine or switching to less demanding specialties.

• Staffing Shortages: This mass departure exacerbates pre-existing shortages in emergency rooms, leading to critical staffing gaps that put patients at risk.

 Why Emergency Medicine is Ground Zero for Burnout

• Unpredictable & Intense Work: EM physicians face a relentless onslaught of high-acuity cases, erratic schedules, overnight shifts, and the emotional toll of trauma and death. Not to mention they experience harassment regularly and even violence on the job.

• Administrative Burdens: Excessive documentation requirements, navigating complex insurance systems, and constant productivity pressures steal time away from patient care.

• Increased Patient Volume & Complexity: Overcrowded ERs, patients coming in with more complex medical needs, and a rise in behavioral health cases adds to the strain.

• Litigation Risk: EM doctors face a disproportionate risk of lawsuits, adding immense stress even when they provide excellent care.

Medscape Study 2024 – Physician Burnout

Image reproduced with permission from Medscape (https://www.medscape.com/), Medscape Physician Burnout & Depression Report 2024: 'We Have Much Work to Do', published January 26, 2024, online at: https://www.medscape.com/slideshow/2024-lifestyle-burnout-6016865. 

Domino Effects of This Exodus

• Longer wait times: Fewer doctors mean patients languish in ERs for hours (we have all experienced this!), delaying care that might be time-sensitive, and during peaks in patient loads (e.g. during tripledemics (RSV, COVID & Flu), holiday seasons, mass casualties, etc), this becomes even more catastrophic.

• “Boarding” exacerbation: when a patient remains in the emergency department after the patient has been admitted or placed into observation status at the facility, but has not been transferred to an inpatient or observation unit. Inpatient boarding has serious consequences for patient care and well-being and many high-profile media reports have recently highlighted deaths of patients during our very hard-hitting respiratory infection season from late 2023 into 2024.

• Compromised quality: As stated previously, exhausted, overworked doctors are more prone to errors with potentially devastating consequences.

• Rural areas hit hardest: The closing of many “unprofitable” rural hospitals means that the nearest hospitals can be hours away for the average person. A new solution for this called “rural emergency hospitals” hopes to help the acute issues of EM, but with no actual inpatient beds, this means patients must still travel long distances for adequate care for chronic or non-emergency conditions.. Compounding this, shrinking EM workforces leave rural communities without adequately staffed emergency care, again likely forcing people to travel dangerously long distances to receive adequate care.

• Ripple Effects on Specialists: Burned-out EM docs clog up the system when patients have nowhere else to go, straining specialists who are called for consults in the ER to help cope with the unsustainable patient load. Despite what we see on shows like Gray’s Anatomy - most specialists are not normally chilling out in the emergency room!

The Bleak Outlook

The EM physician shortage shows no signs of abating. This is not just a problem for those working in the field, it has a direct impact on overall healthcare costs as inefficiencies, longer ER stays, and worsening health outcomes drive up costs for everyone. Even worse, these prolonged issues significantly erode patient trust. A strained ER system means patients wait increasingly longer and are dealing with woefully understaffed, stressed-out healthcare providers who are viewed as not being able to meet the needs of patients or their loved ones.

The ER is the safety net of our healthcare system. Without swift action to address the exodus of EM doctors, that net will start to unravel with significant consequences for everyone.

Where do we go from here?

Fixing this crisis demands systemic change, not just band-aid solutions and certainly NOT laying all the blame on the doctors themselves!

• Managers, administrators, and leaders in healthcare systems MUST recognize and acknowledge physician burnout. Nearly 50% of doctors surveyed by Medscape noted their institutions simply did not recognize the issue at all. There is now even Online Training - Understanding and Preventing Burnout among Public Health Workers | NIOSH | CDC that is geared towards those who are leaders in healthcare systems in helping them to create a better environment to work in and to help prevent burnout before it can worsen.

• Prioritize burnout prevention: Support systems, mental health resources, and workflow changes focused on physician well-being. The National Institute for Occupational Safety and Health’s (NIOSH) Impact Wellbeing™ campaign kicked off in 2023 and gives hospital leaders evidence-informed solutions to reduce healthcare worker burnout, sustain wellbeing, and build a system where healthcare workers thrive. 

• Address the work environment: Reduce non-clinical burdens, improve staffing models, and create cultures that value EM physicians.

• Policy Changes: Tort reform is needed to reduce frivolous lawsuits, and better reimbursement models to prioritize patient care versus the fee-for-service payor model.

• Add the right technology with or without artificial intelligence, that is intuitive, tested, and/or created WITH physicians, and that is well mapped with the entire hospital, IT, and care pathways or ecosystems which will help clinicians perform their jobs better.

• Make information easier to find: the majority of doctors are currently so overburdened by information that it raises their stress levels and for many, this information overload is a growing cause of their regular burnout.

Technology in Healthcare – Friend or Foe?

In the Athenahealth survey, 83% of doctors said they believed AI could help solve issues. Physicians think the technology could eventually streamline administrative work, improve the accuracy of diagnoses, identify patterns and anomalies in patient data, and more.

There are also several other ways that technology could prove helpful to physicians and other healthcare professionals and it should focus on improving internal and patient communications (e.g. secure messaging, health information exchanges between treating clinicians, etc), making ease of data collection on patients easier (e.g. wearables, apps, websites), support automation within patient care pathways and internal workflows, and support with better decision making by healthcare professionals. Many technology providers can support this, but these solutions need careful consideration for the needs articulated by the physicians and other healthcare team members to meet the gaps and to solve the problems that exist in their specific healthcare setting. This is not a top-down decision-making process - it must be collaborative - and once the needs are identified, they should be carefully mapped WITH the healthcare providers for feasibility and usability in real clinical practice.

Things like telehealth and assistive AI tools (e.g. medical imaging support, augmented/virtual reality, assisted decision-making support) can also help, but the issues around reimbursement and clarifying their places in the real-life workflow of a clinician in the patient pathway need careful consideration and to be addressed upfront to prevent the confusion and disappointment that comes when these issues are not addressed proactively.

Many doctors say their biggest concern about AI is that it could lead to a loss of human touch in health care, and they are also concerned about the technology’s robustness, ease of use in their day-to-day activities, and protecting most importantly patient data and privacy. In practice, there are great examples where technology is supporting and impacting the lives of doctors and their patients, but there are just as many examples of instances where good intentions are leading to more burden than before and creating much more frustration and anxiety (e.g. poorly executed electronic health records systems). Healthcare is highly regulated, complex, bureaucratic, and most importantly impacts directly the health and safety of patients. Using technology to support our stressed-out doctors makes sense, but it must fix the problems they have, be intuitive and straightforward to use, and must not interfere with their ability to do their most important job - support and treat patients.

In conclusion…

The current crisis of burnout among healthcare providers isn't simply a staffing shortage; it's a looming threat to patient care itself. The next decade holds a stark reality if we fail to act. Mental health struggles shouldn't be a silent battle for those we entrust with our well-being.

This isn't a one-size-fits-all solution. We must create a comprehensive support system within healthcare workplaces. This means empowering administrators to monitor staff well-being, streamline administrative burdens, and ensure appropriate staffing levels. Rethinking reimbursement models, like moving away from fee-for-service, could incentivize better care. Technology solutions, co-created with physicians, can alleviate administrative headaches.

Most importantly, we need to foster a culture of open communication. Clinicians need to feel safe seeking help for mental health challenges, free from stigma or retribution.

Let's Hear from You

This isn't just about top-down solutions. We want to hear from the heart of the healthcare community. Share your experiences, the interventions that have worked, and the challenges that persist. Together, we can build a future where our healthcare providers can provide exceptional care, while also prioritizing their well-being.

Healing The Healers, Havas Lynx

You are not alone. If you need immediate support, the following resources are available now:

1. The 988 Lifeline provides 24/7, free, and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States.

2. SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders. Call 1-800-662-HELP (4357)

3. Physician Support Line: 1 (888) 409-0141. Psychiatrists help our US physician and medical student colleagues navigate the many intersections of our personal and professional lives. Free, Confidential & Anonymous.

Special thanks to Michelle Bridenbaker for co-authoring this important article.