By Tracey Drury – Reporter, Buffalo Business First
Jul 3, 2023
The death by suicide of a local physician recently highlighted a growing problem for the industry: Stress, burnout and other factors are pushing people out of the profession and causing significant psychological harm.
It’s a problem that’s been recognized for years but has been exacerbated since the pandemic, the growth of electronic medical records systems and the shortage of physicians.
“You can go back to the early journals in the 1800s and they talk about the plague of physician depression, alcohol abuse and suicide,” said Dr. Frank Dowling, a clinical associate professor of psychiatry at the SUNY Stony Brook School of Medicine. “The system is sicker than the sickest patient.”
Dowling sees the problem firsthand, not only among patients, but also as a mentor and trainer for the Medical Society of the State of New York peer to peer program, which provides confidential resources and a platform to address everything from anger and depression to substance abuse and post-traumatic stress disorder.
Just how bad is the problem? According to a report by Medscape, 53% of physicians reported burnout last year – up from 42% in 2018. The report was based on surveys last fall of 9,100 physicians across 29 specialties, with emergency medicine specialists leading the pack with a rate of 65%. Across all specialties, at least one third of all respondents reported burnout.
Besides MSSNY’s P2P program, nationally, the American Medical Association offers the Step Forward program, with a range of workshops and trainings online, as well as peer connections, to help physicians in need.
Dr. Mike Merrill is a primary care physician who serves as board secretary at the Medical Society of Erie County. He trained in internal medicine and practiced for 25 years as an internist in Batavia before leaving to become chief medical officer with Seattle-based tech company Brook Health, where he makes house calls and works on a far less busy schedule.
Speaking on his own behalf, he says burnout is a huge issue. Low rates and a need to remain profitable lead to squeezing in as many patients as possible during the workday, which means shorter appointments and more follow up work with documentation and updating the medical record. At the same time, they’re losing personal connection with patients, he said.
“Everybody on the frontline knows about it because you feel it,” he said. “At the extreme, it’s depression and self-destruction, it’s addiction, suicide, leaving the profession and doing anything they can to get away from the frontline.”
Among the potential tools that can help, Merrill points to staffing changes with more team-based care, the use of medical scribes as well as AI tools – anything that can take some of the work off physicians’ plates.
A secondary issue is getting physicians to acknowledge there’s a problem, and even more difficult – getting them to seek help. Just as there is stigma among the general population when it comes to addressing mental health issues, it’s especially challenging for physicians who fear being taken out of rotation or prevented from operating or otherwise practicing their profession.
Dowling says it’s gotten worse the past 15-20 years because of institutional stressors, such as prior authorization in managed care, lowering of reimbursements and the additional administrative and documentation requirements of electronic health records.
Catholic Health provides a range of wellbeing resources to its entire workforce through the CredibleMind website, with topics ranging from mental health and life changes to addiction and recovery, emotional health and personal growth.
Dr. Hans Cassagnol, executive vice president and chief physician executive at Catholic Health, said although everyone from nurses to social workers is affected, the fact remains that physicians are at the top of the pyramid.
“That does increase the level of burnout or stress on the physician,” he said. “That particular burden is a little different.”
In addition to its EAP program supports and making its pastoral team available for anyone who needs it, Catholic Health is also trying to do a better job at showing it is listening to address concerns. That includes leaders rounding through the hospital as well as just communicating with physicians and staff about new hires so they understand relief is coming to help ease the shortages.
“One of the things we need to do is communicate better and show people what we’re doing to try to address their pain,” Cassagnol said.
Kaleida Health has changed its processes when someone is having behavioral issues, which is often a sign of burnout. Instead of escalating those behaviors directly to a peer review, now a physician leadership committee steps in to ask what’s going on and if they need support.
“We’re not going to escalate to corrective action, instead it’s about what’s happening in your life and what can we do to support you,” said Dr. Michael Mineo, executive vice president and chief medical officer. “Before, we may not have seen the misbehavior as the root cause of their burnout or depression.”
Health systems are also addressing the root causes of burnout, including creating efficiencies within their electronic health records systems to reduce the number of clicks and implement short cuts. Kaleida has also created a physician adversity solutions committee to reduce administrative tasks and duplicative training between Kaleida, Erie County Medical Center and the University at Buffalo.
“We’re making it so it’s the same training to fulfill any legal or employer-based training, such as on diversity or sexual harassment. One training will go across all three,” Mineo said. “It’s all very well-meaning but every organization is functioning within a bureaucratic silo and the individual bears the burden of that so we’re breaking down those silos.”