Maintaining Sustainability and Longevity in our Practice

February 18, 2018 11:43 AM | Deleted user

Lei Lei, MD
WACEP Secretary/Treasurer

I have been out of residency for five years, and it is remarkable that even in my relatively young career, I find myself and my colleagues all over the country burdened with burnout. After having kids and starting my life anew after almost a decade of the “it’ll get better” mentality, I sometimes wonder if I was overly optimistic about the practice of medicine. Though it seems like it is the current “hot topic,” it is becoming increasingly apparent that physician burnout is a persistent and growing issue in our profession which leads to significant downstream effects.  Burnout contributes to poor physician retention, which results in worsening physician shortages, which in turn will self-propagate as the remainder physicians struggle to fill the holes leading to medical errors, bad patient care, and of course more burnout. Physician burnout contributes to depression and one of the highest suicide rates of any profession.  

Our profession is woven into our identities. Work is not just work; it comes home with us; and goes to sleep with us.  Physicians have been trained to project an indomitable image.  In reality the typical emergency physician statically does not sleep well, eat well, and doesn’t seek treatment for mental and physical ailments.  Our irregular schedules working holidays and weekends make it difficult to manage family life; our unwieldy student loans hold us financially captive to the medical field as we are often not in a position to replace our income by alternative means. Third shifters are at particular risk for metabolic syndrome and chronic sleep disturbance correlating with an increase incidence of hypertension, diabetes, and decreased lifespan.1 At the hospital we are charged with caring for our patients, striving to please exacting administrators, and being the stoic leader in the chaos of the ED. Self-care is always a peripheral after-thought. Even at home, we are often primary providers and our family members often view us as an endless resource for medical expertise. We care for others, but our own wellness is not a priority. 

Physicians are leaving medicine or looking for alternative revenue streams for this reason. The Association of American Medical Colleges is projecting a shortage between 40,800-104,900 physicians by 2030. One third of practicing physicians will be of retirement age within the next 10 years. The younger physician cohort are suffering from burnout and cynicism not previously experienced by other generations of physicians.  A Facebook group “Physician Side Gigs” boasts twelve thousand members of practicing docs who looking to decrease clinical work and supplement their income. Our profession is facing some serious issues, but physicians can only affect part of a solution. Hospital administrations, medical educators, and federal and state regulators will have to prioritize physician wellness by addressing physician burnout. Many residency programs are enacting curriculum changes that build new physician resiliency and minimize burnout, but we should also ask ourselves: what can practicing docs do to improve their own resilience and what can hospitals and governments do to promote physician wellness. 

My goal is to convince our collective profession that prioritizing our health and wellness needs to come off of the back burner. It is time to stop viewing self-sacrifice as a necessity in the culture of medicine. Hospital administrators will not do this for us. Hospital staff will not do this for us. Only we can advocate for ourselves.  This can mean telling your colleagues to take a break during a shift that allows for eating, pumping, or just a simple escape from the chaos of the department.  This can mean offering positive reinforcement for our colleagues who are making healthy choices. This can mean standing up for our colleagues who are being singled out. We need normalize these behaviors as the standard and not the exception. Let us be more honest with ourselves and in our daily interactions. The grumbling we hear during shift change and on our day-to-day exchanges with worn-out colleagues is a symptom of a larger problem.  We need to start and sustain these conversations. The more we passively absorb the stresses of this dysfunctional healthcare system, the more devalued we will be as doctors.  

We must also focus on enacting changes across the system that favors sustaining physician wellness and changing the long standing cultural practices within medical communities that reinforce self-sacrifice as a necessity in medical practice. Healthy practices should be reinforced by our community and government. The biggest hurdle is simply making this a conscious priority in our minds as well as those of hospital administrators. This could mean framing the issue in terms of loss in productivity, physician retention, poor patient care, and mistakes in health care. As a member of professional organizations like WACEP and the Wisconsin Medical Society, you are supporting initiatives that benefit physicians and helping these issues to gain visibility and attention in legislation and policy. 

With that I would like to announce that in the following months, WACEP will be starting a social media initiative to promote physician wellness. Please follow us on Twitter @WisconsinACEP or Facebook @WIACEP for updates.

1. Wang, F., Zhang, L., Zhang, Y., Zhang, B., He, Y., Xie, S., Li, M., Miao, X., Chan, E. Y. Y., Tang, J. L., Wong, M. C. S., Li, Z., Yu, I. T. S. and Tse, L. A. (2014), Meta-analysis on night shift work and risk of metabolic syndrome. Obes Rev, 15: 709–720. doi:10.1111/obr.12194