Last year, the death of Lorna Breen, a medical director of the emergency department at New York Presbyterian Allen Hospital, garnered headlines across the United States. She had taken her own life. Her story highlighted a disturbing trend in the medical field, namely — the underlying struggle of physicians with mental health and suicide.
But the plight of physicians is not unique in this country. Physicians are the canaries in the coalmine. They simply provide an early and exaggerated look at the problems that are plaguing workers across all industries today. And understanding what is driving physicians to such extremes will help us understand what needs to change across other industries as well.
The Perfect Storm
People often say that suicide is an occupational hazard of the medical profession. Perhaps this is true. Because if we look at students entering the medical field, they are no more likely than their peers to commit suicide. In fact, their mental health is usually on par with or better than their peers.
But once they start practicing medicine, they become up to 2.3X more likely to die by suicide.
This is largely due to the confluence of stress, a lack of sleep and the inability to get the necessary mental health support needed. Covid-19 has only exacerbated this issue. Taken together, these factors have given rise to the perfect storm.
It’s no surprise that doctors face an exorbitant amount of on-the-job pressure. This is likely why burnout symptoms are commonplace and over 40% of residents in general surgery suffer from depression.
But the major causes of workplace stress may surprise you. Physician’s stress arises not from dealing with illness, death and demanding patients. Instead, it is has more to do with dealing with bureaucracy, long work hours, a lack of respect from other colleagues and electronic medical record requirements.
In the United States, most primary care physicians spend twice as long interacting with electronic medical records as they do with patients. Even when physicians are in the room with patients, they tend to spend almost 40% of their time on an EMR.
Physicians also tend to work ridiculously long hours. A whopping 57% of physicians spend more than 71 hours or more a week working. And their chances of burnout go up by 3% for each additional hour worked.
What’s more, in medicine junior doctors tend to bear the brunt of the workload, as they are at the bottom of the pecking order. Because they are paid less, it is natural for hospitals to assign them more hours, not less.
Clearly, stress is a career hazard for doctors. But unfortunately, this hazard is fast becoming prevalent across all industries.
Today, 83% of all Americans say they are experiencing workplace stress. And 25% of these workers reported that they were at risk of burning out within a year. That’s one in four people who are hurtling towards their breaking point.
What’s more, remote work post-Covid-19, has increased the average workday for employees by close to 50 minutes.
Research shows remote employees are working longer, spending time in more meetings and having to keep up with more communication channels.
Nearly 70 percent of professionals who transitioned to remote work because of the pandemic say they now work on the weekends, and 45 percent say they regularly work more hours during the week than they did before.
— Survey of 2,800 workers by Los Angeles-based staffing firm Robert Half.
And regardless of the profession, we know that stress kills. It can exacerbate mental health problems, place strain on your heart and brain and lead to a whole host of back, vision and carpal tunnel-related health issues.
Today, people are sleeping less. In fact, sleep deprivation has been a growing concern for Americans since the mid-80s. Researchers found that the number of people not getting enough sleep increased from 30.9% in 2010 to 35.6% of the population in 2018.But perhaps no one has been more affected than healthcare professionals. Today, 40% of healthcare professionals attest to getting less than 7 hours of sleep a night.
Many resident physicians are forced to work 28-hour shifts, or longer.
Getting less than the recommended 7 to 9 hours of sleep per night can lead to severe health problems, including obesity, Alzheimer’s, heart disease, diabetes and a host of mental health issues including anxiety, depression and suicidal tendencies.
According to researchers, working 17 hours in a row can lead to a decline in motor skills and cognitive abilities. In fact, working this much is like having a blood alcohol content of 0.05%. Working 24 hours or more consecutively is like having a blood alcohol content of 1.0%. So, while doctors are tasked to work for 28 hours at a time, most would not legally be able to drive in their condition.
But this lack of sleep not only poses a health risk to the physicians themselves, it also poses a risk to the patients they are treating. Because apparently sleep deprivation can raise the risk of patient harm by as much as 53%.
For non-physicians, a lack of sleep can similarly lead to slower reaction times, more errors and a decrease in productivity.
Access to mental health
Currently, 19% of the US population is suffering from depression, addiction, or a mental health related issue. That’s roughly one in five people. But 60% of those people are not receiving any mental health treatment.
Most physicians fail to get treated for two reasons. One, they cannot find the time, given the constraints of their job. And two, there is a strong stigma attached to asking and seeking out help.
According to one general surgeon,
“Physicians are treated as criminals and tracked more closely than Level III sex offenders. Answering all these questions on applications, the subtle, unspoken lesson is ‘you had better be squeaky clean, mentally, morally and physically! If you step off the shining path, bad things will occur.’ I have known 7 male physicians who died by suicide. Most with a ‘happy’ exterior. Why? They cannot confide in colleagues for fear that their colleagues will turn them in to hospitals and boards — and there goes their privileges and livelihood. They cannot confide in their spouses because during rough patches mentally, their marriages are already in trouble. If they share psychological problems, they probably fear that the wife may use this as ammunition in any future divorce. So, they keep on smiling — right up to the hour they die.”
Medical boards do undermine the mental health of their doctors by regularly breaching physician confidentiality and privacy. They are punished by being put on probation or having their licenses revoked, even though this is a violation of the Americans with Disabilities Act. Sadly, because of this, most physicians opt to suffer in silence.
Not surprisingly, a study found that more than 6% of surgeons felt suicidal in the past year but that only 26% had sought help.
Similarly, people across other industries are steering clear of drawing attention to mental health issues for fear of retribution. And while under the American Medical Act, employers with less than 15 employees are not allowed to fire or dismiss workers on the basis of mental health, many employees feel uncertain these laws will be upheld.
Physicians are struggling. And we need to take note. Because physicians provide a window into many of the difficult challenges facing the broader workforce today.
We all are experiencing more stress, longer work hours, and a lack of sleep. We have all been affected by Covid-19, both mentally and physically. For many employees, there is a stigma attached to mental health. And because of this stigma, many are not getting the help they so desperately need.
This situation is only likely to get worse unless we do something.
The onus is on us. We all have a role to play.
We need to make sure we are acknowledging and managing stress. We need to keep our work hours in check. And we need to make it okay to discuss and seek out mental health across industries. Employees should have the ability to get the support they need without fear of punishment.
Physicians need help now. We all do. It’s time to put our health and welfare first in this country. It’s time to recognize what we all know to be true. That mental health is a real and growing concern. And it is one that we need to tackle with compassion and care.
If we do this well, not only will also increase the productivity and contributions of employees everywhere, we will also help save lives.
Wikipedia, Suicide Amongst Doctors
American Journal of Medicine, Physician Stress and Burnout
Health Leaders, Corona Virus Increases Risk of Physician Suicide
American Medical Association, As Workhours Rise, So Does Physician Burnout
WebMD, Doctor Suicide the Highest of Any Profession
Ideal Medical Care, Why Physicians Commit Suicide
Ideal Medical Care, Physician-Friendly States for Mental Health
MedScape, National Physician Burnout, Depression & Suicide Report 2019
Dawson Reid Report
Mental Health America, The State of Mental Health in America 2019
Compare Camp, 61 Stress Statistics in 2020
ACEP Now: After Dr. Lorna Breen Died By Suicide in April, Her Family Took Up a Cause They Never Wanted
© Courtney Burry 2021, All Rights Reserved