Physician burnout is a pervasive challenge across medical specialties. Roughly half of physicians report feeling burned out, with higher rates among women and critical care and urology specialties.[1] Overwork, the burden of bureaucratic tasks and the depersonalization of medicine top the list of factors contributing to physician unwellness.[2] The consequences impact provider mental and physical health, patient outcomes, and the overall quality of care in our healthcare system.

The first step toward increasing physician wellness is awareness of the situation and the resources available. We sat down with President Dr. Quinn Pauly and Executive Director Colleen Camenisch of the Nevada Physician Wellness Coalition to discuss the state of physician wellness and the resources they provide to support healthcare providers.

Q: What led you to get involved with physician burnout?

Dr. Quinn Pauly: I’ve certainly not been immune to it myself. There have been times throughout my career, when I felt that I’d met the definition of burnout and even drifted into some depression. That, combined with reading about how much it impacts so many of my colleagues and losing colleagues in our community inspired me to assemble a group of like-minded physicians in Reno and said, “Hey, you know, Plan A’s not working very well.”

It’s not enough to just hope doctors can snap out of it. So, we decided to create this volunteer, physician-led coalition to see if we could address the issue of burnout and physician suicide.

It is problematic both locally, statewide, nationwide, and globally. It’s an ongoing problem and we’re here to do our best to be a resource for our physicians in the state of Nevada.

Colleen Camenisch: When I started in the world of graduate medical education, I did not have much experience in the world of medicine. I had a parent die when I was relatively young at the hospital. I’m not sure of all the circumstances surrounding it, but it certainly impacted our lives to a significant degree, and it made me feel like if there was anything that I could do to help impact patient care, it would be amazing for everybody: the patient, the physicians.

So, when I went to the med school to work, I was really, really struck—having worked in lots of different industries—by the altruistic nature of people that went into the field of medicine, especially understanding how intense the path is. That’s not just for practicing physicians, it’s the whole journey starting in medical school.

It just really seemed to me that the people that go into medicine are called to that work, and super dedicated. There is so much they sacrifice in their life, including, oftentimes, time with their own families.

For me, it felt really like a perfect blend of what was personally important to me and also just a way to honor these people that are doing so much and sacrificing so much to really hold our communities together.

Q: How do you define physician burnout?

A: Dr. Quinn Pauly: It’s a term that is often thrown around without a specific definition. It has more recently been recognized as a definitive term, as a diagnosis, if you will.I think it boils down to physicians being cynical and feeling a low sense of accomplishment, depersonalization, and not recommending the profession for their kids or their friends. It sometimes manifests as physicians retiring earlier than physicians would have in this past or changing careers more than our predecessors.

Q: What are the consequences of physician burnout?

Dr. Quinn Pauly: The results can be devastating on a human level and a business management level.

Burned out physicians are less productive, more likely to make a mistake, more likely to have a malpractice suit filed against them, and more likely to leave their position.

The cost is very high to replace a physician, probably between a half a million and a million dollars when it’s all said and done. Not to mention, the disruption for the practice and the patients having to find a new physician and so forth.

The worst-case scenario is that the burnout, turns into depression. Suicide is a symptom of depression. So, that’s really the magnitude and the seriousness of what we are trying to address.

Over 400 physicians in the United States commit suicide every year. That’s the number of physician suicides we know of. There are likely several more that aren’t diagnosed or coded, if you will, as a suicide, but probably were. This includes four or five right here in our local area just in the last few years, including this year, in 2021.

Q: How many physicians are effected by burnout?

Dr. Quinn Pauly: For the last 5-10 years the number of physicians who report burnout is about 50% of practicing physicians. Unfortunately, during the COVID-19 pandemic, that percentage has increased. There are several million doctors practicing in the United States. So, it is a pretty high number of physicians impacted.

Q: What are the primary factors driving physician burnout?

Dr. Quinn Pauly: I was very interested to learn that it’s not the same for everyone. I mean, even within a hospital system, one group of doctors’ factors that contribute to their burnout might be different than ones that are on a different floor of the hospital, which was new information for me.

There’s never been a group of physicians prior to the last 10 years, that were exposed to the same factors that we are. And I’m not saying, you know, that we’re less resilient or more resilient. Older physicians are getting burned out as well and have been for a long time. But it’s kind of a perfect storm, you know?  

There are more demands to see more patients, pay is less, and there are much fewer private practice physicians. Most of us are employed by a large organization, so there’s this loss of autonomy. There are also rules and regulations requiring us to document things many of us feel aren’t related to actual patient care and detract from our ability to have face-to-face time with our patients.

Also, we don’t see other doctors as often, like in the old days when we’d go to the hospital more often. It all contributes to the loss of the sense of worth and accomplishment of what we all went to medical school and aspired to be, these caring, giving, helpers of the community. There’s definitely been a loss of that, and all those factors accumulate right now to a large number of physicians in the United States getting so despondent that they actually take their own lives. The suicide rate among physicians is significantly higher than that of the general population. It’s also gender related. Female physicians are even more vulnerable to burnout and suicide than their male counterparts. So, it’s not a one or two factors, it is an accumulation of many factors that has led us to where we are today.

Colleen Camenisch: It’s also hard to know how many of these characteristics drive someone into medicine in the first place. For example, the sense of a tremendous responsibility and care for the work,  that’s being done. Physicians often have high expectations for themselves and for the work that they do, that might be contributing.

Dr. Mick Krasner and Dr. Ron Epstein have written a little bit about this mishmash between being called to a certain type of work and then not being able to balance it out with the other aspects of your life. You know? Like work-life balance. If you hold this huge responsibility, how then do you balance out the other responsibilities in your life? We see this in medical education as well.

The other thing we know is that physicians aren’t always good at seeing doctors themselves, like getting routine checks. So, there are sometimes higher rates of cancer among physicians and even doctors coming out of residency programs. That sounds surprising, but people just might not be getting screened appropriately. There’s a lot in the mix that’s contributing to physician unwellness.