Physician burnout: a surgeon’s story of exhaustion, recovery, and systemic change

An excerpt from Safeguarding Physician Wellbeing.

There are numerous books written by physicians of various specialties, primary care, and subspecialists, on the topic of physician burnout. Most physician authors, like me, have been inspired to write a book due to personal experience with a high degree of burnout, and/or have had academic interests and research on the topic. Writing such books can be cathartic, intended as a warning for our colleagues and future physicians in training. In fact, in addition to becoming an author, countless physicians have reinvented themselves to become physician coaches and speakers on this colossal epidemic impacting both the physician workforce and the patients we serve. I continue to be amazed that despite repetitive and voluminous headlines on physician burnout, intensified by the nursing and health care staff shortage crisis, most of the time when discussing with neighbors or anyone not in health care, the reaction is often a blank stare and even surprise.

Ironically, the year before I suffered medical disability, I had worked with HR in my last organization to create clarity for every employee and manager, including physician leaders, on how to take a leave of absence for ANY reason. On an early October late afternoon, alone in my office, I picked up the phone and called that number to activate leave and simply did it. No longer worried about how many patients I would impact, how much more burden I would place on my partners and team, and how many surgeries I would not be able to perform, I simply wanted “out.” I was exhausted from “hurting,” physically, emotionally, and mentally and did not see any light as I was told that surgery may be imminent for my degenerative cervical spine.

After taking a leave of absence for medical reasons under the Family and Medical Leave Act (FMLA) and after I resigned to focus on my health and healing, I devoted my time to my master in medical management program, writing this book, and guest hosted several episodes on Back Table ENT Podcast on topics covered in this book. I also joined several Facebook groups, including the incredible national Physician Side Gig with 106K members, the Physician Mom Group (PMG) with 81.3K members, the Physician Nonclinical Career Hunter Group (27K members), and the Female Physician Entrepreneur Group (10K members). Becoming part of these national physician networks allowed me to learn from the daily posts and conversations about pervasive reasons why physicians are leaving the workforce and the various nontraditional, nonclinical job opportunities available.

This has been the most informative experience leveraging social media as I read about other physicians’ experiences, perspectives, and what physicians are doing to help themselves and each other when they make the gut-wrenching decision to leave the practice of medicine. I am confident very few, including myself, wanted to walk away from patient and clinical care but did so when each of us reached that point of complete exhaustion and highest levels of frustration when our work environments may no longer be acceptable to us.

The universe is intentional, and I am grateful that during the immense stress of the pandemic onset, I applied and got accepted to the master’s in medical management program at Carnegie Mellon University Heinz College. My super smart husband Dave helped me with my health care finance and accounting classes, and our daughter Claire (a high school sophomore then) showed me how to use Canvas to access my coursework and submit homework! After the first four weeks, I realized I never successfully submitted the homework I had completed!

While the program was mostly remote, the few in-person weeks of classes provided such rich learning, from not only the instructors but from my incredible physician classmates from across the U.S. I slowly gained confidence through learning about health law, health policy, process, and variation control, strategy, culture, leadership, power and influence, and critically digital technology and several key topics related to health care. As we learned the drivers of the unrivaled increasing costs and expense of health care in the U.S. in exchange for the worst life expectancy without improvement in clinical outcomes, I found myself often angry or in moral distress as we learned how health care in this country has been hijacked by politics. There are a multitude of entities whose financially driven incentives and agendas occur at the expense of Americans and their health.

It is not the purpose nor intent of this book to fuel debates or convince readers why universal insurance (not universal health care, they are not the same) is truly the single most critical action to decrease cost and increase “health” and access to health care for millions of Americans or anyone who lives in the U.S.

Overexpenditure with underperformance is unacceptable for any business or industry including health care. Worse, physicians continue to commit suicide at the highest rate in America over other professions. Over 400 physicians die by suicide each year, and suicide deaths are 250 to 400 percent higher among female physicians compared to females in any other profession and have a rate equal to that of male physicians. This is not surprising if one is aware that women physicians have higher rates of major depression than age-matched women with doctorate degrees. It is alarming and disheartening that medical students develop high rates of depression within two years of entering medical school, from a baseline of good mental health. Suicide accounts for 26 percent of deaths among physicians aged 25 to 30, far greater than the 11 percent of deaths in the same age group in the general population.

As a surgeon, I am sadly aware of the fact that surgeons and anesthesiologists are the two specialties with the highest number of physicians committing suicide. What would it take for the American public, lawmakers, policy experts, administrators of health systems and insurers, private equity medical practice owners, hospital board members, and shareholders, to care enough to prioritize and implement broad and comprehensive systemic changes to protect the physician workforce? What are families of doctors willing to learn and do to help their loved one who chose a career to serve others?

Julie Wei is a pediatric otolaryngologist and author of Safeguarding Physician Wellbeing.

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