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Join William Lynes, a urologist, as he shares his remarkable journey from a successful medical career to battling mental illness and physician burnout. With over three decades of experience, he delves into the root causes of burnout within the medical profession and unveils his insights on revitalizing the sacred doctor-patient relationship. Tune in as we explore practical solutions, mentorship programs, and the importance of destigmatizing mental health support for physicians. Don’t miss this powerful conversation on reclaiming the nobility of clinical medicine.

William Lynes is a urologist.

He discusses the KevinMD article, “Unmasking physician burnout: a survivor’s story and solutions for a healthy medical profession.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back William Lynes. He’s a urologist, and today’s KevinMD article is titled “Unmasking physician burnout: a survivor’s story and solutions for a healthy medical profession.” William, welcome back to the show.

William Lynes: Hey, thank you. Thank you for having me back, Kevin.

Kevin Pho: So William’s been on many times. Go to KevinMD.com/podcast; in the upper right-hand corner there’s a search icon, and you can search for William’s name to hear his prior episodes and his story. But let’s get straight into your article. It’s titled “Unmasking physician burnout: a survivor’s story and solutions for a healthy medical profession.” So what led you to write this particular article?

William Lynes: Well, as you mentioned, I’m a urologist, and just briefly, I practiced urology from 1987 to 2003. In 1998, I had two catastrophic medical-surgical illnesses, which caused me to lose 40 pounds and have chest tubes, and the diagnosis was septic shock. Then I had a snowboarding accident. When I went back to work after all that, I really was never the same. I looked the same, but I wasn’t the same. I found out that I had bipolar affective mood disorder, I found out that I was suffering from physician burnout, and I began what I call a downward spiral into darkness, which is sort of a code word for suicidal behavior. I ended up attempting suicide on three occasions, the last in 2003, when I retired.

So we have a real problem in the medical profession with physician burnout and related suicides. I think most people are familiar with the statistic that 400 physicians in the United States commit suicide per year, but I look at it a little bit differently. If you try to calculate the number of attempted suicides in physicians in the United States, you come up with something that’s really amazing, which is around 20,000 per year. I come up with that because the general statistic for suicides is that around 50 suicide attempts occur for every successful, that is, completed, suicide, and when you multiply those two numbers, you come to 20,000. Now, there are 800,000 physicians in the United States, and so that amounts to a whopping 2.5 percent of all physicians attempting suicide annually. I think that’s just amazing.

The cause is not really what we’re talking about today, but it’s sort of inherent in the solutions to the problem that I’ve come up with. I divide the solutions into two major groups. The first is what the physician can do to protect themselves and keep themselves healthy, and the second is what the medical profession, which I use as a term for government, for big pharma, for big business and the medical groups and so forth, can do to improve the working conditions and to treat physician burnout.

The things that physicians need to do themselves are, first of all, to realize that we, and I coined this term, practice in the culture of overwork. If you think about it, we overwork to get into medical school, we overwork to get into our residency, we certainly overwork in residency and postgraduate training, and that behavior spills over, in many physicians, into their practices. I think you can sort of think of it as us being evolutionarily predetermined to be overworkers, so I think we should keep that in mind.

I think physicians need to keep track of their own personal needs and be well-rounded people, especially with family, hobbies, exercise and spiritual input. I think it’s also very important that physicians seek mental health care when and if it’s needed. It’s frowned upon, unfortunately, in our medical profession, but it’s really the only thing that has been shown to be effective in the treatment of the burnout physician. I think early on, physicians should be thinking about financial planning, because financial burdens are often some of the root cause of the burnout. They should be aware of early retirement options and sabbaticals. I would actually propose that in medical school there be a class that would run parallel through the clinical science years, which would basically teach the young physician what it’s like to practice medicine and how to be healthy in that environment.

Now, the big problem is that the patient-doctor relationship has deteriorated over the last 20 years, and this brings in the solutions for the medical profession, pharma, big business and so on. I don’t think that big business should be making clinical decisions that are better made in the exam room. For example, I have a pet peeve, which is that I don’t think physicians should be called providers, and I don’t think patients should be called otherwise either. Physicians definitely need more input into their clinical environment. Tort reform is really important. The threat of malpractice is something that is over the head of most physicians on a daily basis, and something really needs to be done about that.

I am fascinated by so-called physician mentor programs. These are programs where a young physician would be paired with a more senior physician, hopefully to establish a friendship during their practicing years. It has pluses and minuses, if the person isn’t your friend, but at least it gives you someone to talk to in the future, down the road, if you start having problems. Anonymous telephone helplines are important, and people are starting to talk about establishing those. Lastly, alternative mental health insurance is really mandatory, and by that I mean a medical group should supply mental health insurance that allows the physician to take his mental health care outside of the medical group and be treated by someone who’s not in their peer group. So those are some of the solutions to physician burnout. I think it’s a complicated thing, and I would just like to reinforce this idea of the deterioration.

Kevin Pho: So I want to start my questions there, with that deterioration. From your perspective, what are some of the reasons why the doctor-patient relationship is deteriorating?

William Lynes: I think big business has gotten involved in medicine, and it’s money. They think that they can control costs without sacrificing quality, and so they’ve taken decision-making out of the exam room. I think examples of that have been going on for the last 30 years. It’s just been a drip, drip of sacrifices that have been made to that relationship. I believe that the United States modern medical system of patient and physician is the best system that there is, but this deterioration has really adversely affected it.

Kevin Pho: And how has that deterioration led to physician burnout, even in your case or in the case of your colleagues? Where do you see that direct connection?

William Lynes: Yes, I think that a physician nowadays doesn’t feel like they’re in control. I think that they see long lists of patients to see, they see requirements for meeting certain time frames, and I think that this is, frankly, just depressing. I think that physicians are a noble group, and in general they really are physicians in order to take care of patients, and they see, over and over again, that there are barriers and blockages in their way.

Just a little example: I had a foot injury that needed physical therapy, and this is at Kaiser Permanente. My primary doctor ordered it, and it took literally three months of review by bureaucratic committees in order to OK that. That’s distressing to a physician, the question of who’s in charge and who’s making the decision. So that’s basically the spiel there.

Kevin Pho: Now, you listed various multifactorial approaches to physician burnout, one of which was financial education. So again, talk about that connection between financial literacy and how it can help with clinician burnout.

William Lynes: I think that medical school education does a very poor job talking about money. Money is going to be huge in medical practice. I don’t think we should consider that physicians get rich, but they should be compensated adequately, and during their practice they’re going to have lots of opportunities to invest money and to do things with their money. I don’t think that the medical profession is really prepared for that. It’s similar to a person who all of a sudden has a decent income, and the question is, what do you do with your money? And there are all kinds of money pressures, in terms of mortgages, in terms of investments and so forth. So I would envision more concentration by the medical profession on education in the financial area.

Kevin Pho: Now, do you hear stories or see cases where these financial pressures, whether it be poor investments or overwhelming educational debt, perpetuate burnout?

William Lynes: No question. Student debt is really a problem. I had very little of that, because I went to medical school and graduated in 1981, so I had a little bit, but my kids have huge loans, and the question is, how do you pay those back? I don’t know what the answer is. I’m really opposed to the government coming in and paying those loans. I think that’s really unfair to the non-physician, non-educated group of people.

So yes, I think that the disasters happen, and they’re one of the major contributors to physician burnout. Physician burnout is a multifactorial problem involving mental health issues, financial issues, family issues and health issues, like in my case. But financial is way up there.

Kevin Pho: I want to touch next on tort reform, because among the many discussions I have about burnout, tort reform actually doesn’t come up that often. So talk about how the threat of medical malpractice shadows physicians today, and how that potentially leads to increased stress and potential burnout.

William Lynes: I think, from my own experience, that when you’re in the exam room with a patient, you always have in the back of your mind, “Can this lead to a lawsuit?” I think that’s a horrible environment for practicing medicine, where you’re trying to do the best, the “do no harm” sort of thing. I know in my own case, I had one malpractice suit that followed me for six years. I was exonerated at the end, but it was one of the most horrible experiences of my life. I think it’s a daily battle in the back of the mind of a practicing physician, what’s going to happen. I think the media plays it up, I think patients play it up as well, and you hear of suits and of people being served with papers quite often.

Kevin Pho: You mentioned that you were undergoing a medical malpractice lawsuit for six years. Give us a little more detail about how that affected your psyche on a daily basis.

William Lynes: Well, first of all, the patient was ill. He had had a renal transplant and diabetes, and I put a penile implant in him, and it got infected, and so he had a horrible hospital course in the intensive care unit, spiraling down and potentially dying of sepsis. During that, it became clear to me that the patient really hated me and never liked me, and I think that predated the procedure. So every single day I was in the hospital with him, trying to take care of him, he would badmouth me to nurses, and they would say, “Mr. So-and-so says he wants another doctor.” Eventually I did transfer care to a colleague of mine, just before he died. But I felt that he deserved me making a yeoman’s effort on his behalf, and I did.

After that, of course, it became quiet for a while. I knew I was going to be sued, but within a year or so, I was served with papers, and then over the next five years there were depositions. At Kaiser we have arbitration, and the arbitration was a week long. I elected to go to the arbitration each day and sit there as everybody on the prosecution side, of course, painted this horrible story of this horrible, negligent physician, and I had to sit there and listen until, at the end, I finally was able to talk and, to some extent, clear up where I was coming from.

But yes, I had migraine headaches, and I really, really hadn’t had a problem before. This predated my health problems, so I was actually doing relatively well as far as burnout. But it sticks in your mind and never goes away, and then there’s always, well, what if it happens again? So that’s sort of my story.

Kevin Pho: One of the last things that you mentioned as a potential solution was mentorship programs. In an ideal world, what would that look like?

William Lynes: Well, you have a medical group, and when the young partners-to-be are brought into the group, they are offered a certain list of individuals who are able to be their friend, basically. The idea is that you would establish an ongoing relationship with that person, and if the person wasn’t adequate, then you would switch. But you would try to establish somebody who you could talk to five years down the road, when you’re having trouble sleeping, trouble with call and surgeries and so forth, because the burnout physician is really out there alone.

I had a psychiatrist, which was very helpful, but I didn’t really have any physicians that I thought I could talk to. I had one who I did, but I was actually very reluctant to even talk to this colleague. So the idea is you would establish this relationship so that if you get in trouble, you have someone to talk to. The talking is very important, because what you find is that you’re not alone, that the people you practice with understand completely what you’re going through, and they have similar problems and ideas, and there’s something about that which is comforting. So that’s the idea of a physician mentor program. The downside of it is, what do you do if you get a guy who you just don’t hit it off with? So I think the literature is a little mixed about the success rate of mentor programs, but they do fascinate me.

Kevin Pho: And my final question, William: Tell us the take-home messages that you want to leave with the KevinMD audience.

William Lynes: Well, I think that physician burnout and related suicide, which is almost always burnout-related in the physician population, is a real problem, as I mentioned with those statistics. I think that the root cause of it, both on the physician side and on the medical group side, is a deterioration of the patient-doctor relationship, which has occurred over maybe the last 30 years. We can blame big business, we can blame pharma, we can blame the government, but a lot of it falls on the medical group. So I think that whenever decisions are made clinically, the number one thing that people should keep in mind is that relationship and building it up. The question is, does this build up the relationship, or does it not? And I think pretty much all the solutions that I talk about flow from that.

Kevin Pho: William, thanks again for sharing your story, time and insight, and thanks again for coming back on the show.

William Lynes: Thank you, Kevin. Have a good day.