There's an epidemic in the medical field... and no, it's not that nurses are playing cards

“[Nurses] probably play cards a considerable amount of the day” remarked Washington State Senator Maureen Walsh on Monday while arguing against a bill that would require uninterrupted meal and rest breaks for nurses and would protect them from mandatory overtime.

Her comment has garnered significant backlash, including a petition to make her shadow a nurse for a 12 hour shift, now with over 600,000 signatures. Sen. Walsh has since apologized for her statement, but the flow of frustration and anger on social media hasn’t relented. She smacked her hammer against an already cracked dam and is experiencing the repercussions full force.

But, the frustration about medical working conditions didn’t begin with her; they have been steeping for many years. Poor working conditions in the medical field is so common that its effects have their own diagnosis: Physician burnout.

Physician burnout is as rampant as it is taboo. Increasing pressures placed on physicians, coupled with the perceived consequences for speaking up, has created a dangerous situation where medical professionals are suffering from the effects of poor working conditions and don’t have a safe place to get help. And, worse still, often the help they do receive isn’t effective. Many hospitals attempt to address the issue with resilience training classes, but these classes may be causing more harm than good. The issue isn’t that health care professionals aren’t tough enough; and taking more time out of their already busy schedules only compounds the problem.

The facts reveal the poor effectiveness of these measures:  Male physicians are 40% more likely to commit suicide and female physicians are at a 130% increased risk; resulting in over 400 physician suicides per year. With such a grim statistic it leads you to wonder: Is burnout the correct diagnosis? Many mental health professionals would argue that it is not. Suicide is the symptom of one condition; depression.

Labeling the issue of declining physician mental health as burnout sidesteps the bigger issue: Many medical professionals are suffering from undiagnosed depression. Some balk at that statement, but the facts are clear: Suicide is a symptom of the final stage of depression. Either physicians are suffering from depression or, if they aren’t and are simply burned out, then burnout needs to be treated with the same seriousness that depression is. Regardless of how the issue is labeled the outcome is still the same: Something needs to be done about declining physician mental health.  By labeling depression as something that sounds more benign and less dangerous we handicap our ability to solve the issue; it would be in the best interest of medical professionals to just call it what it is and move on with fixing the issue, rather than getting hung up on the particulars. 

The unfortunate truth is that mental health diagnoses are, unfortunately, still highly stigmatized and carry a lot of unwarranted baggage, particularly when assigned to people in medicine. Many physicians fear that if they were diagnosed with a mental health issue that they may lose their license or their credibility, perpetuating the problem. Medical professionals are highly trained and well-educated; they are aware of the causes, symptoms and results of depression. The issue isn’t a lack of information but a lack of a solution.

What causes burnout in the medical field?

 Stress, when managed in a healthy way, is a good and normal part of life. The bodies natural response to stress helps us perform at our best when it matters most. You know the feeling: Increased heart rate, butterflies in the stomach, muscles tensing ready to act; perhaps you’ve felt it at the start line of a race or when asking someone on a date. This physiological response to fear is a good thing, it helps keep us safe during dangerous circumstances. But stress in unhealthy amounts or when handled improperly can result in lasting damage to the way that the body handles adverse circumstances in the future.

 One of the most well-known behavioral studies on stress was performed by Seligman & Maier. They discovered that dogs given shocks without a way to avoid them would, in the future, not attempt to avoid getting shocked, even if the solution was available to them. This research was the foundation for what later has become known as learned helplessness. Learned helplessness is strongly correlated with depression, which intuitively makes sense: When we are upset but feel that we can’t do anything about it we become sad and, when the feelings are chronic, we become depressed.

 It’s important to note that learned helplessness has nothing to do with mental strength or fortitude. Physicians are far from weak; to succeed in medical school, complete a residency, and become licensed to practice is no small feat. It’s not the person, it’s the circumstance, that is taking its toll on physician mental health; it’s the repeated exposure to negative stimulus with no agency over the outcome. And it’s this lack of agency that is pushing more and more physicians to a burned-out state; a place where they don’t feel able to help others because they can’t help themselves.

 A quarter of US physicians are expected to retire of the next decade and, as the baby boomer generation ages, the amount of people expected to require healthcare is going to rise. The Association of American Medical Colleges projects that we will be short 100,000 physicians by 2030. This imbalance of supply and demand is requiring that healthcare professionals work longer hours and attend to more patients, limiting their ability to provide the best possible care. This in conjunction with an increasing burden of non-critical bureaucratic tasks, declining pay, increasing risk of patient lawsuits, and inefficiencies in medical technology software is wearing medical professionals thin.

What needs to be done?

 Resolving the issue of physician burnout is not a simple task, and there are no obvious answers. But, for the safety of healthcare professionals and for the safety of those that they administer care to, we need to find a way to regain what has been lost. We need to recognize that work-induced depression in physicians is a serious issue and that agency over their work environments needs to be restored to them. And, the first steps in restoring this agency to them is by passing laws that protect them and their rights to a safe and healthy work environment.