Caring for Ourselves, Caring for Each Other

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Darrell G. Kirch, MD, AAMC President and CEO
Like many of my colleagues, I have seen firsthand how burnout and depression can interrupt a career in medicine. As a psychiatrist, I have personally experienced the tragedy of suicide. Two years ago, following the 2014 deaths by suicide of two residents in New York City, I spoke about the importance of resilience at the AAMC annual meeting in Chicago. At that time, many in our profession were waking up to the crisis of burnout, depression, and suicide among physicians and scientists, when a study by Tait Shanafelt, MD, and colleagues at the Mayo Clinic showed that an alarming 46 percent of physicians reported experiencing at least one symptom of burnout. Unfortunately, in the two years since I gave that speech, the trend toward depression and burnout has worsened significantly. An update to the Shanafelt study published in 2015 found that the number of physicians reporting symptoms of burnout increased to 54 percent, rising by nearly 10 percent in just a few years. 

In light of this evidence, the AAMC convened our annual Leadership Forum in June to gather leaders of AAMC affinity groups for a wide-ranging conversation about creating a culture of well-being and resilience in academic medicine. This is an issue that affects our entire community. Although there is a growing body of research focused on physicians, we know that our scientists and researchers, as well as our students and trainees, also face issues relating to burnout and depression. Though the data on them may not be as extensive, other health professionals on our campuses also appear to be struggling to maintain their own resilience and well-being. Even for those of us familiar with the issue of burnout in academic medicine, the information presented at our June forum was deeply troubling. Christine Moutier, MD, chief medical officer of the American Foundation for Suicide Prevention, cited a 2013 study that found that physicians who die by suicide are three times more likely to have a job problem than non-physicians who die by suicide. Our other keynote speaker, Colin West, MD, PhD, of the Mayo Clinic, presented evidence that medical students show higher rates of burnout and depression by the end of medical school than their peers in other professions, despite a lower prevalence of burnout and depression before beginning medical school. While our profession attracts people with inherent resilience, I fear that cumulative stress too often wins out.

The consequences of this problem go beyond deeply personal ones—they also affect patient care. Burnout has been shown to lead to impaired professionalism, high staff turnover, a decrease in patient satisfaction, and an increase in medical errors. It is accompanied by a rise in cynicism and a decline in empathy. Dr. West shared the alarming finding that the depersonalization rate among U.S. physicians has grown from 30 percent to 35 percent in just four years. In other words, more than one-third of physicians have lost the sense of humanism that is at the heart of our profession.

Finding solutions

These facts are deeply troubling. But in our June forum discussions, we also talked about solutions. The long-term health of our profession depends on developing a better understanding of the factors that lead to distress and burnout, as well as valid metrics to measure the problem and the effectiveness of our interventions. We know that excessive workload, loss of autonomy, and poor work-life balance contribute to burnout. These are issues that we can begin to tackle at an institutional level.

At the Leadership Forum, participants shared possible strategies to address this problem: We can help new physicians and scientists bolster their resilience by incorporating training in stress management, communication, and self-care into the medical school curriculum. We can ease the transition from medical school to residency and find ways to reduce the stress associated with assessment across the continuum of medical education. We can improve mental health assessment and support services for students, residents, practicing physicians, and researchers. And every one of us who serves in leadership positions, whether as deans, department chairs, or faculty, student, or staff leaders, must learn to recognize the risk factors associated with burnout and suicide. 

Our issues are not merely structural—they go to the heart of our culture. For generations, health care has been a field characterized by hierarchy, autonomy, competition, and individualism, a culture where giving care is lauded, while asking for care may be stigmatized. It is not easy to seek help in that type of environment. We must create a professional culture that promotes wellness, social support, and group connectedness. We must foster environments where we feel safe admitting when we are overwhelmed, depressed, or burned out. We need to promote a culture that bolsters our connection with each other and, crucially, our connection to the meaning in our work. We all became physicians and scientists for a reason—we are driven by our missions to care for patients, teach the next generation, discover new cures, and improve the health of our communities. But too often, the reason we chose this career gets lost amid the stress of our everyday work.

The long-term health of our profession depends on developing a better understanding of the factors that lead to distress and burnout, as well as valid metrics to measure the problem and the effectiveness of our interventions.

 Fortunately, there is a growing awareness of the threat to well-being not only in academic medicine, but across the entire health care community. In early July, the National Academy of Medicine gathered more than 35 leaders from 28 organizations—including academic societies, government agencies, and associations focused on medicine and health care—for a meeting on resilience and well-being. The group expressed a strong desire to work with the Academy to develop comprehensive, solutions-based approaches to wellness that should help inform the conversation taking place not only at medical schools and teaching hospitals, but in hospitals and clinics across the country.

In academic medicine, we know how to lead in times of crisis. When we face an external threat, whether it is a new infectious disease or a large-scale emergency, we are at our best: caring for patients, inspiring our learners, developing new treatments and vaccines, and promoting health in our communities. We now face a crisis in our professional community, and we must dedicate that same passion to keeping ourselves and our colleagues healthy. If we are to provide the best possible care for our patients and support for our communities, we must begin to take better care of ourselves and each other.