The frequency and severity of physician burnout have resulted in an epidemic that is impairing the American health care delivery system. Herbert Freudenberger coined the term burnout in 1977, referring to a syndrome characterized by emotional exhaustion, depersonalization or cynicism, and a lack of personal accomplishment. He noted that burnout reduced health care workers’ ability to provide excellent patient care and adversely affected their well-being.
Physician burnout is rampant in the American health care system. It occurs in over 50 percent of physicians and in significant numbers of trainees. Recent attention to this issue may have improved access to mental health therapies, without, however, a substantial reduction in the adverse effects of burnout.
Nearly all of the 300 to 400 physician suicides seen annually in the U.S. are in some way related to the presence of physician burnout. This statistic amounts to one physician suicide per day. It has been compared to the downing of a Boeing 747 or the destruction of two medical school classes each year. The magnitude of the physician suicide epidemic is demonstrated in a more meaningful way by looking at the calculated annual frequency of physician suicide attempts.
Statistically relevant data concerning the frequency of suicide attempts is traditionally inaccurate and fraught with underreporting errors. However, the calculated physician suicide rate is both meaningful and alarming. The Centers for Disease Control and Prevention (CDC) reported in 2021 that, in general, 35 suicide attempts were seen for every one completed suicide in the U.S. With 400 physician suicides, then 14,000 physician suicide attempts can be expected annually (400 completed suicides x 35 suicide attempts per completed suicide = 14,000 suicide attempts). With nearly 1 million U.S. physicians, then, 1.4 percent of all U.S. physicians are expected to attempt suicide annually (14,000 / 1 million = 1.4 percent).
Studies have suggested that physician suicide attempts are more lethal than those in other professional groups. The number of 1.4 percent of physicians who attempt suicide annually may then be a slight overstatement. Despite the uncertainty in the calculation, these numbers are alarming.
Many health care systems across the country have a stated goal of reducing burnout and its adverse effects. Wendy Awa and associates published a 2016 study that documented the success of burnout prevention in service professions. 80 percent of institutions that addressed burnout prevention reported a reduction in burnout frequency. Reduction of physician burnout and the resulting mental health effects begins with prevention strategies.
Many medical institutions have invested time and resources in strategies to reduce physician burnout. Mayo Clinic, Vanderbilt University, the University of California, Irvine, and many other institutions have programs addressing this issue. In reviewing their mission statements, however, all are programs that make “resources available” for the prevention and treatment of burnout.
To significantly reduce the burden of physician burnout in our health care system, an institutional commitment to burnout prevention is required. This begins with medical school education. I propose that medical schools establish an ongoing educational program to address physician burnout. It is based on the premise that reducing physician burnout begins with medical school education. The theme of that education would state that, to be an excellent clinician, an individual must take excellent care of their own mental health.
I propose that an educational program be structured as an ongoing course throughout the clinical years of medical school. The title of this course would be upbeat, something like “The Successful Medical Practice.” Practicing community physicians should lead this instructional course. The curriculum would define the physician burnout problem, including the factors responsible for physician burnout, the incidence, the risk factors, and the results of burnout, namely the reduction in clinical success and deterioration of mental health and suicidal ideation. Preventing physician burnout would be emphasized, with attention to the prevalence of overwork, personal mental health, substance abuse, the use of mental health resources, and the improvement of the doctor-patient relationship.
Only through intensive medical school-based education, which requires institutional commitment, can the effects of physician burnout on physicians and the health care system be addressed.
William Lynes is a urologist and author of A Surgeon’s Knot.
