Doctor morale shaky as practice stressors surge

Doctors are singing the blues. They're down about low reimbursement rates, loss of respect and too many patients.

Many suffer from sagging morale, burnout and depression, according to a new nationwide survey of physicians. Six in 10 doctors have considered leaving medicine because they are discouraged by the health care system.

Some struggle to put a bright smile on what they see as a grim reality.

"It's getting worse. It's almost like a snowball rolling downhill," said Gregg Broffman, MD, medical director of Lifetime Health Medical Group in Buffalo, N.Y., who is familiar with the survey and has practiced for more than 25 years. "No one ever taught us this in medical school. No one ever said, 'Folks, the world is going to change professionally for you, not only technologically, but also in the way that business is done.' "

The American College of Physician Executives queried 1,200 physician executives -- most of whom see patients -- about their morale and published the results, with related articles on stress and burnout, in the November/December 2006 The Physician Executive.

Low reimbursement rates and loss of autonomy were the top two reasons for poor morale.

Bureaucratic red tape, patient overload, loss of respect and the medical liability environment were among the other reasons physicians cited.

Those work problems caused fatigue in 77% of physicians, emotional burnout in 67% and marital/family discord or depression in about one in three physician respondents.

One emergency physician who answered the anonymous survey contemplated suicide and reported to be close to filing bankruptcy. "I am working every day, sometimes double shifts multiple days of the month, just to keep up with the bills. HELP!"

To combat their troubles and stress, more than half of the discouraged doctors talked to colleagues about their morale problems. About one-third searched for a job outside health care. Others received counseling or sought relief by lobbying local, state and federal authorities for changes in the health care system.

"The things we see affecting [morale] are the frequent frustrations with trying to provide the kind of health care you want in the current health care system," said Lynne Kirk, MD, of Dallas, president of the American College of Physicians. "It makes us concerned about how many internists are throwing in the towel."

Making changes can help

In a related article, physician executive coach Manya Arond-Thomas, MD, of Ann Arbor, Mich., writes that stress is an occupational hazard for doctors, and they shrug it off without realizing its impact on their well-being. Physicians should recognize that a successful life is based on more than accomplishments and productivity, she said. She suggests doctors give themselves multiple vacations, both short and long, as a way to rejuvenate.

"Part of it is to help them reconnect to what is it that gives them a sense of passion and purpose about their work life," Dr. Arond-Thomas said. "Managing stress has to be a conscious part of your routine, and you sort of build it into your life."

The University of Virginia School of Medicine offers a stress reduction class to help faculty and community physicians avoid burnout. The course teaches meditation techniques and shows doctors how to relieve stress and deal with their emotions.

John B. Schorling, MD, MPH, who teaches the course, said doctors need to make time for themselves, whether it's meditating, exercising or spending time with family. He said exercise and meditation are part of his routine to alleviate stress.

"I don't go home and ruminate about it anymore. When I'm with my family, I'm really with my family," said Dr. Schorling, director of the physician wellness program and head of the section of general medicine at the university.

Sometimes, doctors don't accept help when it's offered. Physicians and administrators at Lehigh Valley Hospital in Allentown, Pa., created a support group, but few physicians showed, said John E. Castaldo, MD, the hospital's chief of neurology. Many doctors said they didn't have time to attend.

"We're a profession, but we're not a community as we should be. As a physician, there's no one who seems to care for you. Your colleagues never ask you how you are," Dr. Castaldo said. "We have to start looking out for each other."

Medical leaders say support from spouses and other family members is important to prevent low morale and stress among physicians. They said doctors should not neglect their health. And they recommend that physicians reduce work hours to 55 to 60 hours a week to lessen the risk of burnout.

"It's very important to set aside time for things that make you feel happy," said Steven Gabbe, MD, who has studied physician burnout and is dean of the Vanderbilt University School of Medicine in Nashville, Tenn.

Doctors should be open to talking to colleagues and others about dealing with the stress of their profession, physician leaders said.

"There may be something in the psyche of physicians that people rely on us, and we might not be as good at relying on others," said Rick Kellerman, MD, a family physician in Wichita, Kan., and president of the American Academy of Family Physicians. "Somehow we've got to make sure physicians are taken care of."