A Modest Reform Proposal 

May 3, 2010

Thomas J. Lynch, Jr., MD

The past few decades have been difficult for many doctors in the United States. Physician anxiety is increasing in many ways, attributable to workplace violence, pressure to provide healthcare to a sicker population with fewer resources, and/or grueling work hours with little opportunity for a satisfying work-life balance. As a result, many physicians are unhappy and stressed out. This has important implications for U.S. physicians as well as for patients, their families, and society as a whole.

Concerns Continue to Grow

Extreme stresses, such as violence against physicians—particularly psychiatrists—are a growing concern, but more mundane pressures are also taking their toll. Surveys have shown that constraints on time spent with patients are the leading source of dissatisfaction among physicians. Other sources of dissatisfaction include:

• Loss of autonomy and control due to increased cost pressures.
• Fear of medical errors and litigation.
• The psychological burden of dealing with daily illness and death.

Studies estimate that as many as 40% of surgeons report feeling burned out; for oncologists, that number jumps to as high as 60%. Career dissatisfaction is not just the province of middle-aged physicians—nearly half of all third-year medical students report burnout, and some studies have linked medical student burnout with suicidal tendencies. Dissatisfied doctors are more likely to leave clinical practice or relocate, disrupting continuity of care and adding to physician shortages. Existing physician shortages are expected to worsen, with huge implications for costs and access to care, especially in rural and poor areas.

Healing the Profession

An important step toward overcoming these issues is to help doctors reconnect with the human dimension of medicine, a reason many physicians were attracted to medicine in the first place. Medical schools are beginning to offer more opportunities for students to explore the humanistic side of doctoring, but practicing physicians have few mechanisms in place to nurture this aspect of their work. Hospitals and other healthcare institutions need to provide more opportunities for this type of nourishment. Educational programs that teach communication skills can help. So too can training in mindfulness and meditation or discussion groups aimed at rekindling the passion for healing.

Additionally, organizations must provide more venues for physicians to process difficult psychosocial issues that arise daily and lead to burnout. Efforts are needed to assist physicians when delivering bad news, addressing spiritual crises in patients, and switching from curative to palliative treatment. Other solutions include encouraging mentorships that pair seasoned clinicians with younger colleagues or regular group sessions where clinicians explore the emotional side of caregiving. One such educational program, the Schwartz Center Rounds, now takes place at 182 hospitals nationwide. It supports and trains 50,000 multidisciplinary clinicians a year in dealing with the tough psychosocial issues physicians face each day when caring for patients and their families. Doctors should be encouraged to participate in these programs, perhaps via continuing medical education credits or mandatory time off to participate.

Patients benefit immeasurably when doctors are less stressed and can take time to engage and communicate. Patients who feel supported by their doctors are more satisfied, have better healthcare outcomes, better adhere to treatment plans, and are less likely to sue their doctors. This reform proposal can cost next to nothing, yet yield profound benefits.

Additional Resources:

For information on the Schwartz Center Rounds, go to http://www.theschwartzcenter.org/programs/rounds.html.

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Balch C, Copeland E. Stress and burnout among surgical oncologists: a call for personal wellness and a supportive workplace environment. Ann Surg Oncol. 2007;14:3029-3033. Accessed September 21, 2009.
  Dyrbye L, Thomas M, Massie FS, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149:334-341.