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Dr. Jeffrey Moody says his generation needs to be more open to discussing the reality of burnout.

Dr. Jeffrey Moody was on call every other night for two years — then he was on call every day for two years after that, sleeping at the hospital during shifts. Finally, he was on call from his home for four years.

A 55-year-old urologist, Moody finished medical school in 1992 and completed his medical training in 1999 during what he calls the “pre-empathy epoch,” where physicians were discouraged from speaking up about work conditions and the personal toll of the job. 

The prevailing sentiment, he said, was that doctors should “suck it up” and keep going, or risk being called “weak” or “lazy.”

“You don’t raise your hand for help; that is not a thing,” Moody said. “You just keep the Superman, Superwoman cape on and you just keep soldiering through and just keep working harder in spite of the fact that that may be the worst thing you can do.”

For Moody, everything boiled over with the introduction of electronic medical records during his first10 years in medicine. Before EMRs, his record-keeping work was simple: He dictated notes into a tape recorder.

“I’d see 20 or 30 patients — ‘Dah dah dah,’ I can talk pretty fast — the transcriptionist would type it up and I would sign my notes and that was the end of it,” Moody said. “When we got the electronic medical record, that added at least an hour and a half to maybe two hours per day to my day. So now, all of a sudden, something that I got used to taking 20 minutes was taking five or six times that.”

The day he snapped his keyboard in half, Moody faced facts. He was burned out. 

“That was kind of my low point there, when I was very frustrated with my electronic medical record and I realized that that was probably not the only issue. That was probably just a symptom of a much larger problem,” he said. “When I talk to my friends and colleagues and clients about burnout, I’m like, ‘If you feel like you’re having a bad day every day for the last year, then it’s probably more than just a bad day. There are probably some things you need to be aware of and learn about.’”

He’s not alone, El Paso County Medical Society CEO Mike Ware says. 

“We’re talking about a very serious issue, something that physicians are trying to hide from their patients,” Ware said, adding that physicians learn to downplay their own needs. 

“Your patient is there to get your help,” he said, “not the other way around.” 

While burnout among health care professionals has been rampant for years, the COVID-19 pandemic has exacerbated existing issues. 

In a survey of 12,000 U.S. physicians across 29 specialities, online medical journal Medscape found “burnout and the stress of the pandemic — including factors such as personal risk, social distancing and financial uncertainty — appeared to diminish physicians’ overall work life happiness, with only 49% reporting they were happy in 2020 versus 69% pre-pandemic. More than one-third (34%) reported feeling unhappy last year, compared with 19% in 2019.”

Medscape’s report, “Death by 1000 Cuts: National Physician Burnout & Suicide Report 2021” found that nearly 80 percent of physicians said they felt burned out before the pandemic, while one in five said their burnout emerged only last year, citing “stress and exhaustion ... due to many factors including lack of PPE, watching their patients die without their families, and chronic stressful conditions due to COVID cases.” 

Critical care (51 percent), rheumatology (50 percent) and infectious disease specialists (49 percent) ranked among the highest in reporting burnout for the first time since Medscape began surveying on the issue in 2013.

The Department of Health and Human Services announced July 16 it will provide $103 million in American Rescue Plan Act money over three years to combat burnout and promote mental health among the health workforce.

“The Biden-Harris Administration is committed to ensuring our frontline health care workers have access to the services they need to limit and prevent burnout, fatigue and stress during the COVID-19 pandemic and beyond,” HHS Secretary Xavier Becerra said in a news release.

In allocating funds, HHS will “take into particular consideration the needs of rural and medically underserved communities.”

HHS’ announcement noted, “Health care providers face many challenges and stresses due to high patient volumes, long work hours and workplace demands. These challenges were amplified by the COVID-19 pandemic, and have had a disproportionate impact on communities of color and in rural communities. The programs announced today will support the implementation of evidence-informed strategies to help organizations and providers respond to stressful situations, endure hardships, avoid burnout and foster healthy workplace environments that promote mental health and resiliency.”

The ARPA funding covers three major areas:

• Promoting Resilience and Mental Health Among Health Professional Workforce: About 10 awards will be made totaling approximately $29 million over three years to health care organizations to support members of their workforce via evidence-informed programs or protocols for a culture of wellness.

• Health and Public Safety Workforce Resiliency Training Program: About 30 awards will be made totaling approximately $68 million over three years for educational institutions and other appropriate state, local, Tribal, public or private nonprofit entities training those early in their health careers, to reduce burnout, suicide and promote resiliency among the workforce.

• Health and Public Safety Workforce Resiliency Technical Assistance Center: One award will be made for about $6 million over three years to provide tailored training and technical assistance to the Health Resources and Services Administration’s workforce resiliency programs.

DEATH BY 1,000 CUTS

Ware said physicians are averaging one suicide a day in the U.S., and Medscape’s report showed 13 percent of physicians consider suicide, while 1 percent attempt suicide. In 2018, Medscape found, 300 physicians died by suicide — double the rate in any other profession.   

“Too many bureaucratic tasks” ranked first among the causes of burnout, according to Medscape, as physicians nationwide face skyrocketing demands in digital documentation. 

“Imagine that you love carpentry,” Ware said. “You love building houses and you love working with wood. Imagine you go through many, many years of training to perfect that craft and that skill, make a lot of sacrifices to do that. Then once you get out and you can actually start building houses on your own, instead of building houses and doing what you love, you’re stuck doing paperwork; you’re stuck doing all kinds of administrative work that really don’t go into what really feeds your soul. And that’s a lot of what’s driving [burnout] within the physician population. 

“Treating patients is very energizing for them. It recharges them no matter how tired, how burned out they are. But any time you take them away from doing that and put them on administrative work, it just runs them into the ground.”

The other leading causes: spending too many hours at work (37 percent); lack of respect from administrators/employers, colleagues and staff (37 percent); insufficient compensation (32 percent); lack of autonomy (28 percent); and increasing computerization of practice (28 percent). As one physician told Medscape researchers: “It’s all of these causes; it’s death by 1,000 cuts.”

CHANGING ROLES

Dr. Jim Steigerwald is a 59-year-old obstetrics and gynecology specialist in Colorado Springs. In more than 20 years in a private practice, he was constantly on call. Working more than 24 hours at a time became the norm rather than the exception.

Today, Steigerwald is finding burnout is recognized more by health care organizations, and they are adapting.

For instance, services once provided by an individual are becoming more team-driven. An example: Physicians are now leaned on less as patients are admitted into the hospital. Frequently, special transition teams provide that care, so physicians are not always on call.

“The care is actually better and sometimes safer for the patients because people are specialized in taking care of situations that occur where they are, and so they are more used to it,” Steigerwald said. “And so initially there might be a little bit of resistance, but in general, I think everybody accepts it and appreciates the level of care that they’re getting.”

Steigerwald turns to travel to combat burnout; Moody exercises daily and makes sure he gets 7-8 hours of sleep each night. He said there are institutional issues that impact burnout and there are personal factors — and he advises medical professionals to focus on addressing those personal factors. If EMR takes up a lot of time, hire a scribe or purchase voice recognition software, he said, adding the peace of mind is worth the money. 

“You have to look at your reaction to [workplace issues],” Moody said. “I tend to be a hot reactor, so I had to learn different strategies to react to things when I got frustrated.”

Moody said his generation needs to get comfortable discussing mental health and burnout. Younger generations, he said, are more likely to share their experiences.

“I think Millennials and younger physicians are much more willing to raise their hand,” he said. They’ve already made the mental leap that they are definitely willing to trade lifestyle for money. They’ll prefer to have a better working environment and make less money than the other way around, making more money and then working harder. That seems to be kind of a general trend for younger physicians, which I can’t say that is at all bad. 

“I think also, now, that it’s more socially acceptable for physicians to admit that they might need help. I think in general, that’s been a good thing across the board for all physicians.”

Moody said the $103 million in grant money bodes well for the future and highlights an issue that has never been properly addressed. 

“Will $100 million magically make burnout go away in the U.S.?” Moody said. “Not even close, but it’s another step in moving toward physician wellness.”