Battling Burnout and Its Consequences

How can we tackle the increasing incidence of physician stress, anxiety, and depression?Battling Burnout

Stress, anxiety, and depression. As a radiologist, you may have suffered one of these conditions, or watched a colleague suffer — perhaps silently.

Overall physician burnout has climbed a whopping 10 percent in three years, with 50 percent of radiologists surveyed in the 2016 Medscape Physician Lifestyle Report reporting feelings of burnout. Why are burnout and related concerns increasing rather than decreasing in the specialty? What can we do to address these troubling issues, both individually and on a broader scale?

How Did We Get Here?

According to Peter S. Moskowitz, MD, executive director of the Center for Professional and Personal Renewal in Palo Alto, Calif., problems like stress and burnout have become embedded in the culture of medicine. "It's been a significant and increasing problem for several decades," he says. Moskowitz, who is now both a certified career transition and life coach and a radiologist and clinical professor emeritus at Stanford University, has coached over 400 physicians individually since 1998, including more than 40 diagnostic radiologists.

Stress, and its more dire counterpart, burnout, can lead to a variety of larger problems, including depression, anxiety, and chronic fatigue. The need to halt this trend is clear based on a recent article in Stat News, linking the crisis to physician suicide: "Suicide among medical students and doctors has been a largely unacknowledged phenomenon for decades, obscured by secrecy and shame."

Likewise, Claire E. Bender, MD, from the Mayo Clinic in Rochester, Minn., says that mental health issues like depression are considered taboo in the workplace, acknowledging that some physicians will be afraid to bring the topic up to their leadership or colleagues. Moskowitz agrees that few physicians will speak up, thinking it may jeopardize their careers: "Many won't even admit in a survey when they're depressed because it may come back to haunt them by limiting career advancement."

Why are so many medical students, physicians, and (in particular) radiologists suffering in silence? Moskowitz blames increased clinical service demands and pressure to perform, rising student debt from medical school, and poorly developed self-care habits. An article from RSNA News also notes administrative duties, long work hours, and increased computer data entry as contributing factors. But there are tangible steps we can take to improve individual mental health in imagers.

What Can You Do?

Here are a couple of ways you can take action to manage your own stress and its consequences, like burnout and depression:

Practice Self-Care: Take care of yourself by eating well, sleeping, and exercising, says Moskowitz. Plus, avoid using negative habits to cope, such as over-eating, using alcohol, or gambling. "Take work-life balance seriously," Moskowitz recommends, "and find someone to hold you accountable. Balance is hard to reach in isolation."

Reach Out: Bender emphasizes the importance of being on the lookout for symptoms among your colleagues, too. "Keep an eye out for changes in their appearance or signs of fatigue. Often, people wear their depression and anxiety on their sleeve," she says. If you notice something is not right with one of your colleagues, speak up and offer to sit down and talk one-on-one. Bender recommends, "People want to talk and you have to give them that opportunity to do so." She also notes that it's important to get HR or an expert involved if need be.

Seek Professional Help: If you feel like you're spinning out of control, seek professional help. Talk to a therapist if you feel uncomfortable bringing it up with colleagues or your boss. With the incidence of physician suicide tragically increasing, Moskowitz says it's essential for leaders and administration to provide confidential mental health resources to physicians seeking help — however, not all hospitals or practices do. That's why he also believes there institutional changes that need to occur as well to fully tackle the root causes of these problems.

What Can We Do Together?

What institutional changes should we be thinking about implementing as a community? Here are a few ideas for where we might start:

Create Physician Wellness Communities: Moskowitz suggests that we form programming on a local level. This might include getting physicians together in small groups to talk in confidence about the problems they're facing within the department or hospital. Bender says that at the Mayo Clinic, these small group discussions are already occurring. The radiology department funds lunches where Bender and her colleagues discuss the culture of stress and how to resolve it. "People need to understand the need for this and find resources to start these local discussions," Bender explains.

Start a Steering Committee: Moskowitz also suggests the creation of a steering community of leaders from the ACR, RSNA, academic radiology, and other stakeholders to talk about how they can begin to think about a broader culture change to ease workforce challenges and support the health and wellness of all radiologists. In his Radiology op-ed, Moskowitz writes that this steering committee should hold a national symposium, create official policy statements, and evaluate and recommend methods for improvement.

Provide Grants for Research: In the end, Moskowitz believes we need to fund academic grants to research burnout and depression in radiology so we can address them in a strategic, evidence-based way. "The fact that we’ve published about how the incidence is rising isn't enough," Moskowitz says. "We need to be more proactive and more engaged in finding solutions."

By Alyssa Martino, freelance writer for the ACR Bulletin

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