Evidence-Based Reviews

How to preserve your own well-being in a challenging medical environment

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Avoid burnout: Use these strategies to establish a healthy work–life balance


 

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Like all physicians, psychiatrists practice in an increasingly complex health care environment, with escalating demands for productivity, rising threats of malpractice, expanding clinical oversight, and growing concerns about income. Additionally, psychiatric practice presents its own challenges, including limited resources and concerns about patient violence and suicide. These concerns can make it difficult to establish a healthy work–life balance.

Physicians, including psychiatrists, are at risk for alcohol or substance abuse/dependency, burnout, and suicide. As psychiatrists, we need to attend to our own personal and professional health so that we can best help our patients. This review focuses on the challenges psychiatrists face that can adversely affect their well-being and offers strategies to reduce the risk of burnout and enhance wellness.

The challenges of medicine and their impact on psychiatrists

The practice of medicine is inherently challenging. It requires hard work, discipline, dedication, and faithfulness to high ethical standards. Additional challenges include declining autonomy and opportunities for social support, increasing accountability, and a growing interest in reducing the cost of care by employing more non-physician health professionals—which in psychiatry typically include psychologists, nurse practitioners, and social workers. The uncertainty of the Affordable Care Act, declining income, and concerns about the nature of future medical practice are also stressors.1,2

Factors that contribute to psychiatrists’ stress include:

  • limited resources
  • concerns about patient violence and suicide
  • crowded inpatient units
  • changing culture in mental health services
  • high work demands
  • poorly defined roles of consultants
  • declining authority
  • frustration with the inability to impact systemic change
  • conflict between responsibility toward employers vs the patient
  • isolation.3

Concern about patient suicide is a significant stressor.4,5 Some evidence suggests that the impact of a patient’s suicide on a physician is more severe when it occurs during training than after graduation and is inversely correlated with the clinician’s perceived social integration into their professional network.5

Impediments to a physician’s well-being

Alcohol abuse/dependence. Approximately 13% of male physicians and 21% of female physicians meet Alcohol Use Disorders Identification Test Version C criteria for alcohol abuse or dependence, according to a study of approximately 7,300 U.S. physicians from all specialties.6 (In this study, prescription drug abuse and use of illicit drugs were rare.) Age, hours worked, male sex, being married or partnered, having children, and being in a specialty other than internal medicine were independently associated with alcohol abuse or dependence.

Fortunately, psychiatrists were among the specialties with below average likelihood to meet diagnostic criteria for alcohol abuse/dependency.6 However, alcohol abuse or dependency was associated with burnout, depression, suicidal ideation, lower quality of life, lower career satisfaction, and medical errors.

Burnout is a long-term stress reaction consisting of:

  • physical and emotional exhaustion (feeling depleted)
  • depersonalization (cynicism, lack of engagement with or negative attitudes toward patients)
  • reduced sense of personal accomplishment (lack of a sense of purpose).7

In a 2017 survey of >14,000 U.S. physicians from 27 specialties, 42% of psychiatrists reported burnout.8 In another survey of approximately 300 resident physicians across all specialties in a tertiary academic hospital, 69% met criteria for burnout.9 This condition affects resident physicians as well as those in practice. Residents and program directors cited a lack of work–life balance and feeling unappreciated as factors contributing to burnout.

Among physicians, factors that contribute to burnout include loss of autonomy, diminished status as physicians, and increased work pressures. Burnout has a negative impact on both patients and health care systems. It is associated with an increased risk of depression and can contribute to:

  • broken relationships
  • alcohol abuse
  • physician suicide
  • decreased quality of care, including patient safety and satisfaction
  • increased risk of malpractice suits
  • reduced patient adherence to medical recommendations.5,10-12

Physicians who embrace medicine as a calling (ie, committing one’s life to personally meaningful work that serves a prosocial purpose) experience less burnout. According to a survey of approximately 900 primary care physicians and 300 psychiatrists, 42% of psychiatrists strongly agreed that medicine is a calling.13 Overall, physicians with a high sense of calling reported less burnout than those with a lower sense of calling (17% vs 31%, respectively).13

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