TRANSCRIPT: DRIVE TIME DEBRIEF with The Whole Physician, Episode #1
Well, hello. Welcome to our first episode of the DriveTime Debrief. We'll briefly introduce ourselves. I'm Dr. Amanda Dinsmore. I'm Dr. Laura Cazier and I'm Dr. Kendra Morrison. We are all three emergency physicians who have been…we have over 50 years combined clinical experience in level one trauma centers…and we have all been personally victimized by working in medicine. At some point we decided we've learned some things and we are in a much better place now. It became important to all of us to teach what we know to our people. And so the idea we threw around was to come up with a podcast that you could listen to on the way home or while doing laundry, or even driving into work that could teach you these things, so hopefully when you get home, you're in a better place than when you got into the car.
So in the meantime, we wanted to tell you some statistics of why we're doing this, and why it's so important to us. Kendra found a great article in Medscape that we'll go over in this podcast.
Yeah, it was interesting cause it was very timely. Medscape put out a survey, recruited physicians from June 29th, 2021 through September 26th, 2021, which happened to be also a time locally for us to be in a COVID surge with lots of patients, not enough staff, all of the things. So they were invited, the doctors were invited to participate in a 10 minute online survey. The only requirement was that they were practicing in the United States. This sample size amazingly was 13,069 physicians across 29 specialties. And there was a nice distribution across the US with almost every state represented. So they put out the survey and then collated the results.
That is what we want to present for you here, some of the most striking images and data that they presented in this article. So turns out we weren't the only ones that were personally victimized by working in medicine. Turns out we are not alone. We will attach the article link to the show notes, but we'll go over them briefly.
So, the specialty that is the most burned out is Emergency Medicine. Shocker. Yeah. So 60% are burned out. Emergency medicine, critical care, OB GYN, infectious disease, family medicine, physical medicine and rehabilitation, and diabetes and endocrinology were all 50% or greater burned out. So being alive and being one of those doctors working, you are more likely to be burned out than not. So that was very striking. The one doing the best is public health and preventative medicine, which I'm a little bit surprised, but I don't know. Maybe, maybe they were just in the zone for the past couple of years.
The second slide that we'll go over is- it's asking are more women or men physicians burned out, and we kind of, we're onto this definitely before this survey came out. 41% of men are reporting physician burnout, 56% of women. We know that. Male physicians are 40% more likely to commit suicide than the general population (of men). It's even worse for women. It's 140% compared to the general population (of women). So we have some theories of why it seems to be so hard for women. Maybe it's because you don't get to come home and turn it off. There's still home responsibilities. Maybe it's just that the system has been set up more, you know, in a more male friendly manner than for females. I don't know, but it does turn out that statistically women (physicians) are not thriving as well as our men are. Men also are not thriving, but women are even worse.
And then the third thing we wanted to talk about is: they surveyed what contributes the most to your burnout. And 60% of doctors said too many bureaucratic tasks.Like for instance, charting paperwork. I know that the great hope was that the electronic health record would fix things for us, but I know there's a lot of dissatisfaction with doing that. I had heard of one place that said that they documented how much time they were spending with patients and at least twice as much time was spent in charting. Secondly a sense of lack of respect from administrators, colleagues, or staff at 39%. 34% of people said too many hours at work. 32% said, lack of control or autonomy over life. And it goes down for them from their insufficient salary, increase in computerization of practice, lack of respect from patients, which I think that's got to be a relatively new thing. I just don't remember that being an issue in residency, as much as it is now. Government regulations, stress from social distancing stress from treating COVID-19 patients, and then at the bottom was 8% other.
So somewhere in there was also an opportunity for doctors to actually put in their own words the burnout conditions. There were several examples such as. “I barely spend enough time with most patients, just running from one to the next.” And then, “after work, I spend hours documenting, charting, dealing with reports- I feel like an overpaid clerk.” Someone else said, “staff calls in sick. We're all running around trying to find things and get things done. It never ends.” Someone else said, “home is just as busy and chaotic as work. I can never relax.” And another striking comment was, “where's the relationships with patients that used to make this worthwhile? Everyone is in a foul mood.” So I just thought that was interesting. That is the voice of the physician describing in their own words, what the burnout condition is like. I think it was present prior to this COVID pandemic, and it's only been amplified since.
Another striking image was they asked physicians, “how severe is your burnout?” And 24%, so only a quarter said, well, “it has little or no impact on me.” But if you add moderate to strong, and severe impact on my life, you get 75% of those surveys. So three quarters of the physicians quantified their burnout as moderate to strong and severe with the amount of impact on their lives.
The other portion of the survey that allowed physicians to free text, so they could actually put words to the way this burnout and their depression, anger, everything was making them feel. They asked a question, “how does burnout affect your day?” So some of the quotes were, “I have little motivation to reach out to others. My patience decreased and my irritability has increased.” Someone else said, “I'm always tired. I have trouble concentrating and no time for the children. More arguments with the hubby.” Someone else said, “I'm grumpy and unpleasant to be around. I don't care about anyone anymore. And I don't care about my hobbies anymore,” which is a huge red flag. Even with talking to someone who's not in this profession, there are definitely several red flags and just the way they answered this question. As a marker for, you know, impending moderate to severe depression or major depressive disorder. Finally, a quote came, “I get angry that my spouse doesn't have a job that will adequately financially support us if I no longer want to work as a physician.” And this just even more amplifies the fact that we feel stuck as physicians. Stuck. They feel that most of the time, even if it's not a two physician household, even if there's one physician in the household, they feel as if they carry the burden of providing for the family. And there's no way out which even more amplifies the fact that they feel burnt out because they're stuck and there's just no other way.
Yeah. So how do physicians cope with this burnout? There's a lot of different coping strategies. I was surprised and happy to see that about 48% of people use exercise to cope with their burnout. That was, yeah, that was not me. But 45% isolate themselves from others. That was more like what I would do. 41% talk with family members or close friends, 41% sleep. Music, junk food, alcohol, food (taco bell!). And then binge eating round those out. The big coping strategies with binge eating at 21%, a smaller percentage use prescription drugs: 2%. 2% used cigarettes or nicotine products. 2% used cannabis products. And, this may be under-reported as well. Cause we're all always paranoid about who can read what writing, you know, and then other is 12%. Do you remember back when we were training, like every single ER doc was a cigarette machine. I don't know if we switched, if we've reallocated, our buffering from cigarettes to taco bell or whatever, maybe they all started exercising…maybe that's how that shot up so high.
Another question asked in the survey was why have you not sought help for burnout or depression? 49% said, “I can deal with this without help from a professional.” I'm surprised it was just 49%. Yeah. 43% said they didn't want to risk disclosure to medical board.
I feel like a lot of people I know just feel like it's frowned upon and that it carries a stigma, don't you think?
Oh, absolutely. It shouldn't be that way, but I feel like a lot of people feel that's the case. Our medical board has changed the question every year to more specific to actual psychotic disorders. So it doesn't even really ask about depression anymore, which I think is a really, that's a good step.
Yeah. It would be like, have you been shooting up drugs? Have you been arrested? Have you committed a felony? Are you under the care of a psychiatrist? Like, how is that supposed to be taken?
Right. Like, clearly that was not encouraged. That was not in the column that you wanted to be checking.
Right. And yeah, it's no wonder that people don't seek help when they need it. And no wonder why our suicide rates are so much higher than the general population.
So. 32% of people were concerned about it being on their insurance record, 25% about their colleagues finding out 22% were concerned the medical profession would shun them. Now, where does that thought come from? Like you're going to get help for depression and the medical profession is going to shun? That's kind of scary that people actually think that. 11% say they don't trust mental health professionals and ‘other’ is 21%.
Yeah. I think the medical culture definitely reinforces being impenetrable. If you have a problem, don't talk about it and it's definitely not normalized to seek help for sure.
Yeah. Which is just so wrong given how much stress healthcare professionals are under, even in a non pandemic time. But yeah.
Yeah. I liken it to being thrown into a dumpster fire without any sort of protection whatsoever. Like see how it goes!
Yeah. The dumpster fire floating down the river. That's pretty much.
So the last question we're talking about here is have you used the services of companies, individuals, or coaches who offer programs to reduce burnout? 11% of people said that, yes, they already had used such services. 46% said no, but they would consider using them. And 43% said no and would not consider using them. Yeah. So why would they not consider using people who are specializing in trying to reduce burnout?
Well, there may be some lack of education about the latest studies that have shown that it's so beneficial for us. There probably still is a lot of concern about stigma and, I mean, probably that first one that “I can deal with this without the help of a professional-” 49% of people saying that. Don't you think? I also think there's probably not an awareness, which is just why we had the idea for this podcast. Create awareness. Yes. And just to teach we don't have to suffer.
There are things that we can do with simple mind shifts, mindset shifts that can make such a tremendous difference. And that's why I'm excited. And I hope you share this with other doctor friends and check in every week and hopefully get home in better state than when you got in your car. Absolutely.
So as you can see, there is much, much support for the exciting new frontier of physician coaching. Mindset training and using your amazing, brilliant minds to tell your brain that you are amazing and actually believe it. So over the next couple of weeks, we're going to unpack some of these common struggles and the thoughts that are associated with the struggles and help to equip you with some powerful tools.
So you can also see how amazing, brilliant, wonderful you are to medicine, to your family and to you, we love you and we cherish your beautiful soul. So until next time you are whole, you are a gift to medicine and what you do matters. See you next time.