In the past four months, the Twin Cities physician community has lost several of our own to suicide. Tragically, we are not alone—about 300-400 physicians in the U.S. die each year from suicide, with physicians facing a suicide risk nearly 2-3 times higher than the general population (American Foundation for Suicide Prevention).
Burnout was an epidemic in the health care community prior to the COVID-19 pandemic. In fact, a JAMA Internal Medicine article from 2017 noted that 25% of family physicians self-reported signs of burnout, pointing to several work-related conditions as contributing factors (like stress, work environment and job demands). These conditions have only worsened since March 2020 (Kaiser Family Foundation/Washington Post Frontline Health Care Workers Survey).
Our health care system—its culture and the expectations on our physician workforce—is neither sustainable nor healthy. The system isn’t just broken; it’s inherently flawed by design, and it’s breaking our physicians, our healers.
While there is not a singular cause for burnout, family physicians from across Minnesota have voiced shared concerns, including:
- Primary care physicians are being pushed to see MORE patients in shorter increments (a byproduct of the fee-for-service reimbursement system). This has a profoundly negative impact on both physicians and patients, directly affecting patient care. Family physicians are trained to be relational doctors. They want to spend the necessary time with their patients and families to be able to practice the art of medicine and have the ability to address and acknowledge the social factors impacting their patients’ health.
- The prior authorization process and battle to get patients the treatments that they need creates unnecessary barriers and burdens for both patients and physicians. Ask any primary care doctor about prior authorization, and you will hear about the stress, frustration and lost time spent on a process that does not put patients first, recognize them as individuals or trust their health care team in knowing what is the best path forward.
- Physicians are regularly completing patient documentation during their personal time, after regular work hours, because of increased charting demands and the churn in their days.
- There is growing frustration and disillusionment among our physician workforce due to increasing anti-science rhetoric and all the ways that impacts clinical care, public health and patient outcomes.
In addition to these concerns, our physicians and physicians-in-training who need mental health support are often punished for getting help. Some choose not to seek mental health treatment for fear of discrimination or stigma, specifically as it relates to the credentialing and board licensing processes and the potential for their licensure status (and, thus, ability to practice) to be at risk. Along with other Minnesota physician groups, we have been advocating for change in mental health disclosure on credentialing and licensing applications since before the pandemic, but Minnesota remains one of several states that have not changed the language on their physician licensure application (“Minnesota’s Board of Medical Practice Should Change Licensure Language…”).
The rise in burnout and increase in physician suicide are the direct result of a system wide failure—one that must be addressed, systemically and comprehensively. As family physician Michelle Wenner Chestovich, MD, writes in We Need a Better Solution for the Terrible Disease of Burnout, “It is simply and manifestly insufficient for an organization to say ‘call this number if you need help’ or ‘join the yoga class we provide once a month.’ Real systemic changes must occur: regular support needs to be offered, protocols developed, investments committed. Perhaps as importantly as tangible changes, the very culture of medicine must change.”
Now more than ever, it’s critical for health care clinics/hospitals/systems, payers, physicians and more to come together and have meaningful conversations that lead to actionable steps and changes to truly address burnout and the increase in physician suicide. Not only do we need to normalize physicians seeking help for mental health concerns and remove stigma and punishments, but we also need to recognize that our healers are human too and they need support like everyone else.
MAFP leaders and staff are ready to be part of these important, necessary conversations. Reach out to us at office@mafp.org and/or 952-542-0130 to connect.
Let’s work together to making meaningful change to address physician burnout, depression and suicide.
