By Brittany Schmidt DC, MHS

Physician burnout. You’ve probably heard of it. You’ve probably experienced it firsthand. No, not just if you’re a doctor; if you have a doctor in your family, or even if you’ve seen a doctor as a patient. Yes, patients experience physician burnout—just in a slightly different way. Patients, unfortunately, suffer the effects of physician burnout. Burnt out doctors feel rushed, they become complicit, and they can become apathetic. If a doctor is not in their best state are they able to provide the best care? I think no, if you disagree, I want you to ask yourself, would you want a tired, under-compensated, apathetic, and stressed doctor treating you or your loved one? Clearly, physician burnout impacts not just doctors but families of doctors and patients as well. 

For me, physician burnout started long before I became a chiropractic physician. It started in chiropractic school (or maybe even in undergraduate school while preparing for admittance into a program), and I would venture to say that many of my colleagues can relate. The training and schooling that doctors and health care professionals undergo is rigorous and exhausting. I had heard about self-care but didn’t take it to heart. I pushed aside the notes on self-care and answered the call to perform and achieve. I thought; if I was the best student I could be, then this would make me the best doctor I could be. In some ways, I was right. Doctors need to be experts in their field, they need to take schooling seriously, they need to pass boards, and so on. But what good is any of your knowledge if in one, two, or three years the effects of burnout set in? You can be the smartest doctor, you could have gotten the highest board scores, but again, if you’re tired, under-compensated, apathetic, and stressed, you’re probably not going to provide the best care. Right now, the system doesn’t recognize that. It doesn’t reward self-care, it actually rewards giving it all you got until you have nothing left to give. 

During chiropractic school I became pretty ill. At the time I didn’t make the connection. I was in a profession that talked extensively about the mind-body connection and yet somehow, I had missed the point. One day, while in the library, I found a quote that started to shift my mindset. The proverb read, “Physician, heal thyself.” Maybe you’ve heard this before, maybe it’s your first time seeing it, either way, pause and read it again. Physician, heal thyself. I read it over and over and over again. I whispered it, and as the words passed my lips it started to make more sense. I left the library feeling so in tune, filled up with a new sense of understanding. If I were a video game character, the words “LEVEL UP” would have flashed on the screen. I shared it with another group of students, hoping it would sink in like it did for me. The truth is, it was just the beginning of my understanding of self-care. I didn’t know it, but a journey of healing had begun. I didn’t think that stress was contributing to my illness, I didn’t think that unresolved trauma, mental health issues, and my inability to say no were all having extreme effects on my body. Then it clicked for me, if I ignored it at that time then it would spill over into my future years of clinical practice, something I had worked so hard for. Suddenly, taking care of myself became just as important as studying for boards. I didn’t think it was possible to do both, turns out I was wrong. Unfortunately, this is not the case for all. So many do ignore it, they keep their heads down and just do the work to graduate without realizing that stress follows you. It grows. It intensifies. You don’t realize it until you stumble across the term physician burnout, and have it resonates with you. 

The fact is, these programs are tough, and being in practice is no cake walk. My patients confide in me. They share stories of abuse, rape, financial problems, loss, marital problems, parenting struggles, etc, etc. Hearing these things is a privilege and humbling, I love that my patients feel comfortable enough to trust me with these things, AND at the same time, hearing heavy stuff is difficult. Seeing people get better is the greatest feeling I’ve experienced, and at the same time, not being able to help someone is one of the toughest feelings I’ve experienced; I wasn’t ready for that. Losing patients whether they die of natural causes or tragic accidents, is also something I wasn’t ready to grapple with. Those are a few examples of emotional stressors that can contribute to physician burnout. 

Then there are the mental stressors. The things like figuring out the best treatment plans, making clinical decisions, charting, and billing and coding. You’re either dealing with a boss, a for-profit health care company, or trying learn how to manage and operate a business on your own. There are financial stressors, graduating with possibly hundreds of thousands of dollars in student loans. Paired with poor wages, some doctors are left unable start a family, buy a house, or do things like travel because of it. There are family stressors. How are you supposed to balance clinical practice and spending quality time with your family? This can especially difficult for female providers who have to take into consideration pregnancy, maternity leave, and the ever-looming societal pressure to be there for their children and raise the family. There is dealing with a corrupt and faulty health care system—system that, ironically, is not rooted in health. A system where insurance companies, pharmaceuticals, and for-profit industries run the show. A system riddled with racial disparity and inequality.  Finally, if you are a chiropractor, there is the added stress of trying to constantly prove that you are a real doctor—not a quack—that you deserve a seat at the healthcare table. There is the stress of trying to prove that evidence based care in chiropractic medicine does exist and can be a game changer for the health care industry. There is the stress of having to find a voice in a profession that is also filled with individuals who trade science based care for chiropractic philosophy. If you’re a medical doctor you have the stress trying to figure out how all of these other professions (chiropractors, acupuncturists, PTs, and naturopaths) fit into the puzzle. 

You probably already know all of this and don’t need me to reiterate how challenging it is. The section above is only scratching the surface of the challenges that exist for doctors today. One of the biggest tragedies is the rate of physician suicide. One doctor commits suicide every day. There are more suicides amongst doctors than any other profession. Why? Maybe some of the reasons I listed above. Burnout; is very real. While burnout is an issue, another huge problem (that no one is talking about) is that physicians fear reporting or getting help for mental health concerns. Many don’t know that disclosing mental health issues could jeopardize licenses. A survey that was conducted found that 1 in 15 surgeons said they’d recently had suicidal thoughts, however, more than 60% were reluctant to seek help for it because they feared it affecting their license. This fear is not unwarranted, many states ask questions about mental health on licensure applications. Many insurance companies also do the same when credentialing physicians. Many states ask broad questions like, “Have you ever been treated for mental illness.” Personally, I feel that the questions asked should instead focus on ability to perform job duties safely. Because many people, physicians included, can have a mental illness and still function well. If that mental illness goes untreated however, that may not always be the case, clearly the suicide rate signals that. I’ve read stories of doctors; who are renowned in their field, who have never had any issues or complaints before, being investigated, having their medical records and psychotherapist records invasively looked through, and suffering discrimination after disclosing a mental illness. Not only can this deter doctors from seeking help, it is borderline illegal under the Americans with Disabilities Act. Typically, mental illnesses are covered under this act and should protect physicians, but it doesn’t. Licensing boards get away with this discrimination because of State Legislature and also their responsibility to protect the public from doctors who may not be able to perform job duties because of mental illness. It’s a tough position to be in, I recognize that. Of course we need to protect the public, and we also need to realize that many people (doctors included) can function competently with mental illness and in those cases, they should not be prevented from practicing. I find the question that boards ask a bit ironic because it may defeat the purpose. By asking, doctors become fearful of disclosing any issues and are then discouraged from seeking help, this puts both them and patients at risk. We need to help doctors feel comfortable getting the treatment we need so we can have safe and fulfilling lives and medical careers. 

So, what can you do? 

• Find a self-care regimen that works for you and *actually* do it

• Meditate

• Yoga or exercise

• Eat nutritious foods

• Stay hydrated 

• Practice good sleep hygiene

• Spend time in nature

• Learn to say no 

• Limit screen time

• Leave work at work 

• Have friends in different professions (I find this helps me not talk or always think about work when I am with my friends) 

• Journal 

• Practice gratitude 

• Ask for what you need

• Advocate for ending mental health discrimination

• Call your medical board and ask for change

• Call your legislature and ask for change

• Talk to students about this

Physician burnout is real and it affects everyone. Physicians are real people who have real stories and lives with illnesses, joys, and hardships, just like everyone else. We can all help end mental health stigma and promote growth and change. We are complex beings with emotional, mental, and physical needs, as doctors it is our responsibility (to ourselves and to our patients) to nurture those needs. 

National Suicide Prevention Lifeline

1-800-273-8255

**For simplicity, terms like doctor/physician were used, however this can apply to many different professions in the health care field including but not limited to Physician Assistants, Nurse Practitioners, Paramedics and EMTs, Nurses, Physical therapists, acupuncturists, etc.**