In 2014, two first-year resident physicians jumped to their deaths within one week of each other in New York City. The unrelated incidents heightened existing concerns about physician well-being as the numbers of physicians who report burnout, depression, or anxiety continue to rise.
Physicians are more likely to commit suicide or have suicidal ideation when compared with other professionals in the U.S.—around 400 take their lives each year—and medical students have rates of depression 15 to 30 percent higher than the general public, according to the American Foundation for Suicide Prevention (AFSP). Tait Shanafelt, MD, director of the Mayo Clinic Department of Medicine Program on Physician Well-being, and colleagues found that more than half of practicing physicians say they are burned out.
“I would assert we have reached a crisis point—in fact, a public health crisis,” said AAMC Chair-elect Marsha Rappley, MD, who is also chief executive officer and vice president for health sciences at Virginia Commonwealth University Health System. “The implications of this are not just personal. [Burnout] leads to increased rates of medical error, impaired professionalism, reduced patient satisfaction, and staff turnover or reduced hours. Our well-being, and the well-being of teams, ultimately affects the health and well-being of our patients and communities.”
Creating a culture of well-being
The academic medicine community is responding to the crisis, supporting wellness activities on campuses, as well as making deliberate efforts to destigmatize seeking help in medical school, residency training, and practice. A new AAMC online resource includes information about depression, resilience, burnout, and suicide rates and ideation among physicians, residents, and students, along with an index of institutional best practices and other wellness-related content.
Rappley hosted this year’s AAMC Leadership Forum, “Creating a Culture of Well-being and Resilience in Academic Medicine,” in Washington, DC, June 13–14. The forum sought to address physician wellness head-on by bringing together leaders for candid conversations about sensitive issues.
“Medical training is known to be inherently stressful, but with changes in the practice environment—the way care is both delivered and paid for—in addition to the use of new technology, including electronic medical records, it has become even more so. That is taking a demonstrable toll on everyone, from students to late-career physicians,” said AAMC President and CEO Darrell G. Kirch, MD. “The good news is the groups representing the profession of medicine are fully turning their attention to this problem in a way never seen before.”
“I would assert we have reached a crisis point—in fact, a public health crisis.”
Marsha Rappley, MD, Virginia Commonwealth University Health System
On the first night of the Leadership Forum, a panel of three young physicians shared personal struggles that included fierce competition and student debt. One of the speakers, Sean Simmons, MD, a lieutenant in the U.S. Navy and intern at the National Capital Consortium’s (NCC) Family Medicine Residency program in Ft. Belvoir, Va., revealed that he was more resilient on the battlefield in Afghanistan than when practicing medicine at home, mainly, he said, because of the kinship he found in the military. Simmons and fellow panelist Will Bynum, MD, a major in the U.S. Air Force and fourth-year faculty member at the NCC Family Residency program have worked together to build closer communities in their program.
“It is very clear that the things that underpin resilience are a sense of meaning and shared purpose, as well as strong collegial mutual support,” said Kirch. “Those are the elements we are trying to strengthen in the learning environment today by creating a culture that is even more supportive at all levels of the educational continuum.”
The importance of connection was a point that resonated throughout the forum. “We heard how valuable it is to know that others, especially individuals whom we respect, may be experiencing the same frustrations and emotions,” Rappley said, noting that 57 percent of forum attendees surveyed on-site reported they were exhausted, anxious, panicked, and/or angry.
Breaking the silence
Christine Moutier, MD, AFSP chief medical officer, spoke about well-being and what it means to be resilient. She also discussed a “culture of silence” when it comes to mental health.
“We normalize and rationalize significant distress as part of our identity as physicians,” wrote Moutier. “While a certain amount of bucking up and forging through is adaptive, like many coping strategies, it can go too far with serious deterioration in our own mental health often being ignored until it is too late.”
Kirch stressed that more openness is crucial. “Simply acknowledging the distress in the profession has been powerful,” he said. “The most important thing now is to have leaders at all levels work together on taking specific actions to address the causes of burnout, depression, and suicide and to rebuild the resilience of the physician workforce.”
Forum attendees were encouraged to challenge traditional notions of work-life balance. “Is trying to achieve balance simply one more pressure we impose on ourselves?” Rappley asked. “And does this label imply that life (or home) is inherently good while work is inherently bad? Might we change our frame and not strive for work-life balance, per se, but rather strive to be fully present and whole wherever we are needed at that point in our lives?”
Roundtable discussions produced action steps that attendees could take back to their institutions. The list—which included strategies centered on personal development, team development, leadership development, safe and anonymous screening, and enacting organizational values—is posted on the AAMC’s website. The AAMC will continue the conversation with several sessions related to resilience at Learn Serve Lead 2016 in Seattle, Wash. The meeting will also have 7:45 a.m. running and yoga “wellness events” each morning.
As Rappley summed up, “If we aren’t improving our health, we are not available to improve the health of others.”