In a paper published by the Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Massachusetts Medical Society, and Massachusetts Health and Hospital Association, the group outlines both the concerns and proposed directives for addressing the problem.
According to the paper, nearly half of physicians in one survey experienced symptoms of burnout including emotional exhaustion, depersonalization, and reduced feelings of professional accomplishment.
The paper also pointed to research that burnout may be the cause of increased medical safety incidents, unprofessional behavior, lower patient satisfaction, and a reduction in the number of physicians nation-wide.
“It starts in medical school when graduates are overburdened with student debt,” said Alain Chaoui, MD, FAAFP, a practicing family physician and president of the Massachusetts Medical Society. Because of the culture of the profession “it is hard for a physician to admit he is having problems because he risks losing his license to practice.”
A study published in JAMA Network in September showed that 45.2 percent of second-year residents reported symptoms of burnout and 14.1 percent already regretted their choice of profession. Chaoui pointed to the increase in paperwork required by health insurance as a major factor.
“You have to be a data entry clerk instead of spending time looking at and talking to the patient,” Chaoui said. “It’s a multifactorial problem. Doctors are not able to practice the way they envisioned.”
Proposed directives for addressing the problem include reducing stigma of mental health concerns within the field; reducing the burden of paperwork involved in electronic health records; and appointing chief wellness officers within health systems and hospitals.
The problem, Chaoui added, is not limited to physicians but extends to others in health care and in mental health care as well. The problem of burnout, however, may not be at crisis levels for those in psychology.
“Everyone is working harder and there are multiple sources of stress,” said Celia Oliver, Ph.D, Psy.D, president of the New Hampshire Psychological Association, “But the report on physicians points to increases in medical errors and I don’t think we are there in terms of psychology.”
According to the APA’s annual Stress in America Survey released in October, stress levels are rising across the country, a problem which Oliver explains will affect mental health issues with clients, increasing demand and putting more pressure on a system already pushed to its limits.
“If a client is more stressed it is going to exacerbate depression, anxiety, anger management, etc., and it is going to deplete resiliency so it is a double whammy,” she said. “And as providers, we have fewer resources in the system.”
In-patient care, when it is available, is often just a bed and medication oversight without the added treatment often needed, she added.
In addition, lower reimbursement rates, increased pressure to reduce session time and frequency and the additional paperwork all add to the stress levels with psychologists working longer hours for less money and dealing with the more acute needs of patients.
Emily Mohr, Ph.D, a regional director of integrated care for Child and Family Psychological Services in Massachusetts has a slightly different view. The level of stress she is witnessing does not seem alarming at this point. The fact that she does not handle billing herself directly and she can see the contrast with the physicians around her, in part, shapes her perspective.
“There are definitely stressors,” she said. “Dealing with managed care and the limitations put in place but I would say from my own experience working in a primary care setting we are not at the crisis level that physicians are experiencing.”
Psychologists also have the advantage because of their ability to choose or change their workplace setting without needing to undergo extensive re-training and because there is more support within the profession for positive self-care.
“We have more options for how we can practice according to our own working style or tastes,” she said. “Also, because of the nature of what we are doing, there is more cultural support around finding work/life balance and self-care. That is what we teach, after all.”
Catherine Robertson Souter is a freelance writer and social media agent based in New Hampshire. A contributor to New England Psychologist since its inception, she previously wrote for Massachusetts Psychologist among other media outlets.