There’s a lingering and damaging — but largely unspoken — crisis affecting our nation’s physicians and health care workforce. It goes by different names, but an increasing degree of burnout experienced by physicians has dire long-term consequences for how our health system will function in the future.
Every physician I know has a friend or colleague affected by burnout, or has themself confronted symptoms of emotional exhaustion or detachment from their work. A national survey of US physicians published in September showed an alarming 62.8 percent of physicians experienced burnout in 2021, up from 38 percent the previous year. In Massachusetts, and across the country, large numbers of physicians are reducing their hours or contemplating leaving the profession. A statewide survey of the Massachusetts Medical Society this year showed more than 50 percent of physicians had already cut their hours in the wake of the COVID-19 pandemic or planned to do so. One in 4 Massachusetts physicians said they planned to leave medicine in the next two years, mirroring national studies that show the same.
If only a fraction of physicians follow through on this decision, it will create enormous pressure on an already overburdened health care system. In a state and country with an aging population, where far too many people already don’t have access to the care they need, the consequences will be dire.
There is no doubt that the lingering effects of the pandemic are factors in these numbers. However the roots of physician burnout go much deeper and point to systemic issues in our health care system that have long been ignored: ever-growing administrative burdens that take us away from time with our patients; poorly functioning electronic health records; inadequate physician support in practice environments; a pervasive sense of being powerless to fix the problems we encounter; deliberate disinformation campaigns meant to undermine trust in science and medicine; and, more recently, hostile political attacks and third-party interference in the patient-physician relationship.
What’s worse, physicians are often reluctant to seek help for their mental health needs. Many fear that it will jeopardize their license or employment because of outdated and stigmatizing language on medical board and health system application forms that asks about a “past diagnosis.” After finishing my residency at the Massachusetts General Hospital, I — like all physicians — was asked by the state Board of Registration in Medicine if at any point in the previous eight years I had been diagnosed with or treated for any mental or psychological condition. Fortunately, irrelevant and stigmatizing questions about a past psychological diagnosis are no longer asked of physicians seeking licensure from the Commonwealth. But that’s not true for other states.
Four in 10 physicians in a recent Medscape survey said they have not sought mental health treatment because they worry about their medical board or employer finding out and potential repercussions. Seeking therapeutic interventions early helps protect against crisis situations later. Physicians haven’t turned our backs on our patients or lost the will to do our jobs. But we’re human, and we can’t ignore the increasingly bureaucratic and impersonal health care system and the toxic environment that surrounds it.
So, what’s the remedy? As part of our Recovery Plan for America’s Physicians, the American Medical Association is pushing for legislative fixes in state legislatures and Congress to remove the most common burdens physicians encounter, such as the onerous prior authorization process in which insurers commonly require hours of paperwork before patients get approved for the care recommended by their physician.
There is a lot that states and health systems can and must do on their own to help ease the pressure on physicians, actions that are strongly supported by the AMA, Massachusetts Medical Society, Federation of State Medical Boards, and others. States and physician employers can start by auditing their existing medical licensing and credentialing applications and removing any questions that ask about past diagnoses of a mental illness or substance use disorder, or past counseling to help with one. Rather, the AMA encourages medical boards, hospitals, and health systems to focus on whether a current health condition such as depression exists that, if left untreated, would adversely affect patient safety.
The next critical step, after medical licensing and credentialing language is changed, is to communicate these changes to physicians, residents, medical students, and the entire health care workforce. Then these changes need to be supported throughout each state and institution with resources to help physicians and other health care professionals seek care, including efforts to reduce the stigma that is too often attached to seeking care.
Seeking care for burnout, mental illness, or a substance use disorder is a sign of strength — an act that takes courage and deserves our health system’s unconditional support. As physicians, we need to be leaders to deliver and model that message and behavior in our practice every day.
The major factors that drive burnout are complex and not easy to solve. The AMA’s advocacy is addressing it at every level, and we know it is a long-term process. We urge state policy makers, hospitals, and health systems to work with us every step of the way. The health of patients, physicians, and our nation’s health care system depends on it.
Dr. Jesse M. Ehrenfeld is president of the American Medical Association.