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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023
| Contributor Information
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
The impact of persistent burnout and depression continues to build among doctors. Frustration, sadness, and anger are widespread. In this year's survey, over 9100 physicians across more than 29 specialties told poignant stories of how burnout and depression affects them, how it harms personal and patient relationships, and how they are trying to deal with it. While the COVID-19 pandemic is causing fewer deaths in the United States now than it did 2 years ago, the changes it has spawned are still burdening physicians and clinicians.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Fifty-three percent of physicians said they are burned out — a big change from our report 5 years ago, before COVID-19 crashed onto the scene. In Medscape's 2018 report, 42% of physicians said they were burned out. Also, 23% of physicians report depression now compared with 15% of respondents 5 years ago.
Some totals in this presentation do not equal 100% because of rounding.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
The specialties most affected have shifted somewhat. Five years ago, 47% of family physicians said they were burned out (57% now) and 46% of internists said they were burned out (60% now). Emergency medicine (65% now), which tops the list in this year's report, was less impacted in 2018 (45%).
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Burnout consistently afflicts a greater percentage of female physicians than male physicians. But the numbers have risen notably since 2018, when 38% of men and 48% of women reported burnout.
"Studies have shown a clear link between microaggressions — either race- or gender-based — and an increased risk of workplace distress," says Wendy Dean, MD, co-founder of Fixmoralinjury.org. "Whether it's emotional exhaustion (burnout) from constantly having to defend their authority; being overlooked for leadership opportunities; having different expectations of behavior; being interrupted or talked over in meetings; or as betrayal (moral injury) by an organization failing to uphold stated codes of conduct, women's relative disempowerment to men puts them at higher risk of distress."
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
"Pervasive and persistent" are words that respondents used to describe the feelings of burnout. Almost two thirds of respondents said they have been burned out for 13 months or more.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
The top three factors are the same as they were 5 years ago, pre–COVID-19. But this year's report also includes 8% of respondents who said their greatest stress came from taking care of COVID patients.
EHR documentation continued to frustrate physicians. On average, physicians spent 1.84 hours per day beyond work hours completing EHR documentation, according to research published in a JAMA Internal Medicine report. That adds up to 9.2 hours spent each week on work outside of the workday.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Other responses include:
"We're asked to do too many different things — and there's not enough time to do all of it."
"The compensation is not worth the effort and is not increasing appropriately with the cost of living."
"Excessive consults from inexperienced hospitalists."
"Insurance companies telling me how to practice medicine and controlling what the patients can and can't do."
"Fear of lawsuits."
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
"The impact of COVID on physician burnout will remain for years," says John Whyte, MD, WebMD chief medical officer. "The focus has changed. Now it's all about helping patients catch up on all the care, especially preventive, they that missed. This is causing very busy days and long lines, which frustrates everyone. And COVID taught us more about the social determinants of health; now everyone wants us to measure and do more things in a brief office visit."
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Experts say it's important not to place the blame for burnout and depression on physicians; if the work environment is harmful or creates unrealistic pressures, it's not physicians' fault for becoming overwhelmed.
Still, some physicians think their own traits exacerbate the situation:
"My perfectionism leads to way more charting time after office hours, contributing to a worse work-life balance."
"I'm prone to worry and fret about worst-case scenarios."
"I am an empath and 'anal,' for lack of a better word. I feel everything, which drains my energy. I am going to dot every 'I' and cross every 'T' when it comes to my patients."
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
"It's positive that physicians are reporting that they cope with burnout as well as 50% of their colleagues," says Margaret Calvery, PhD, professor of pediatrics at University of Louisville School of Medicine, Louisville, Kentucky. "It shows they are recognizing that their stressors are shared and common. But it's also negative when you feel that half of your cohort is struggling significantly with burnout. At 50%, individuals lose hope and energy for change and may feel defeated."
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
This year's report shows less burnout in office-based solo practices than in other work settings. In Medscape's Self-employed Physicians Report, self-employed respondents reported that what they liked best about being self-employed was having autonomy (64%) and having control over their own productivity (38%). "I can choose my cases, spending adequate time with each patient as clinically indicated, without productivity pressures dictated by an external system," said one respondent.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
The largest share of burned-out physicians say that burnout has a severe impact on their lives. Harvard Business Review noted that there are three types of burnout: (1) Overload, in which you feel forced to work at an unsustainable pace; (2) Underchallenged, where your tasks are boring and monotonous; and (3) Neglect, in which you have no guidance or structure. Overload is mentioned most often by physicians.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
"Physician burnout is a normal response to overwhelm and exhaustion in a doctor," said Dike Drummond, MD, CEO at TheHappyMD.com. "It drives you into survival mode, head down and struggling through the chaos and overwhelm of each day, just praying you will feel better tomorrow.
"Survival mode blocks your ability to connect with people in any setting — at work and at home," he says. "It becomes difficult to enjoy your patients, your team, your family members, even time alone with yourself. Colleagues and family members can see burnout well before you do. They don't understand our 'never show weakness' programming that refuses to admit struggle and ask for support. Most doctors don't ask for help until they are at the point of collapse. It does not have to be this way."
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Physicians mostly chose positive coping mechanisms, such as exercise and talking with friends, although a smaller percentage ate junk food, drank alcohol, and engaged in binge-eating. Some doctors may use a combination of tactics at different times. (Note: Respondents could choose multiple answers.)
Other coping tactics mentioned:
Read books unrelated to medicine; pray; hunt and fish; take a crafting class; binge on Netflix; play video games; internet shopping and surfing; ride my motorcycle; play with my dog; see a therapist.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
The highest percentage of respondents say that increased compensation and a more manageable work schedule would help alleviate their burnout.
"The comment about increasing salaries probably reflects the changes in the way physicians are being employed," says Peter Yellowlees, MBBS, MD, professor of psychiatry and chief wellness officer at the University of California, Davis. "More physicians are becoming employed by health systems and proportionately fewer are in independent private practice where, if they want to earn a greater salary, they can adjust their work hours or style to do so. These options are less available to employed physicians, who are often working many more hours than they are paid for but with no financial reward. Hence, their only option is to ask for a raise to at least make them feel more respected and valued, and less 'used.' The financial recognition hence becomes a sign of value and respect from their employer, not just their financial worth."
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
In a commentary in the AMA Journal of Ethics, Danielle Howard, MD, wrote, "If other avenues of change have been exhausted, it is morally acceptable for physicians to unionize and employ collective action — including striking — as long as patients' best interests are their reason for doing so." On the other hand, in response to a comment on a JAMA article that he co-authored, Daniel S. Bowling III, JD, MAPP, wrote, "As we mention in the article, unions are not necessarily the best response, and more of a last ditch way to get management/ownership to pay more attention to these issues."
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Physicians are taking various measures to change the environment that's creating burnout.
"It's important that physicians do what they think is best to set limits and manage their work life in trying times," says Dean. "But it's equally critical to recognize that individual solutions to systemic problems will only be temporizing measures. We need to identify the systems challenges that must change in order to create a better work environment for physicians, to improve retention and maintain access to a better care environment for patients."
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Only 13% have sought professional help for burnout. Many commented that they feel that they can deal with it themselves and that professionals have nothing to add.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Overall, 23% of physicians said they are depressed. Of those, 67% said they have colloquial depression (feeling down, blue, sad); 24% said they have clinical depression (severe depression lasting some time, not caused by a normal grief event); 4% answered "other"; and 5% preferred not to answer.
Other ways respondents described their depression: angry depression; anhedonia; dysthymia; fed up; just bummed out; plain sad; sporadic depressive moods associated with sleep deprivation and chronic stress; situational depression.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Respondents named job burnout the number-one factor, but world events played a large role too.
"COVID forced much great global awareness, especially so for doctors who turned to each other in different parts of the world, in different situations, with different resources, for support and medical expertise in order to survive and do their job," says Calvery. "One is constantly made aware of the inequalities in our country and the world, and it can feel hopeless and helpless to create change for such a big problem."
"With all that's going on, I've lost my faith in humanity," said one respondent.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
About half of depressed physicians said they are able to put their depression on the back burner when treating patients. Yet, some admitted that they're functioning at less than 100% and may make errors or show exasperation toward patients.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
"I cry, but nobody cares; other people have problems of their own," said one respondent.
Despite the recent focus on breaking the stigma of mental illness or mental challenges, most respondents feel that depression is a private matter.
According to the National Institute of Mental Health, 52.9 million adults had mental illness in 2020, and 46.2% received mental health services that year. More women with mental illness (51%) received mental health services than did men with mental illness (37.4%)
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Other responses included:
"Our medical board does not help docs and nurses; they only punish and humiliate."
"I am independent and feel I can manage."
"I don't think anyone would understand or be able to help."
"It's difficult to find a good therapist and schedule and keep regular appointments."
"I don't trust doctors to keep it to themselves."
"I don't want to take medication."
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Family and friends, activities, and hobbies seem to be a strong antidote for most physicians, helping them to live a happy life. Getting enough sleep is also an important factor for about half of respondents.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Many workplaces offer such programs and note that they have reduced absenteeism and increased engagement, but the success of these programs has been questioned by others. A study in JAMA concluded that although workplaces with a wellness program had a higher percentage of employees who exercised and watched their weight, there were no significant differences in clinical markers of health, healthcare spending, absenteeism, or tenure or job performance after 18 months.
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
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'I Cry but No One Cares': Physician Burnout & Depression Report 2023
Leslie Kane, MA | January 27, 2023 | Contributor Information
Physicians discuss their personal and professional happiness, how they strive for work-life balance, and successes and failures in looking after their own physical and mental health.Medscape Features Slideshow, Jan 2023
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Leslie Kane, MA
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