In 2006, EPM conducted a survey about the mental health challenges faced by practicing emergency physicians. The results were shocking. This year we recreated that same survey and reached out to our readers to see how attitudes had shifted in a decade.
In 2006, Emergency Physicians Monthly conducted a reader survey that was incredibly eye opening. Of 106 resondendents, 73% reported having experienced depression, and 41% of them did not seek treatment. 85% of sufferers did not report the illness to regulatory authorities, several noting privately that to do so might jeopardize their ability to continue to practice. 48% considered harming themselves in the course of the condition.
This year marked the 10-year anniversary of that survey, and we decided to re-poll our audience to see how attitudes had shifted. This time around we chose to focus more on burnout, after recent publicity has marked emergency medicine as the “most burned out” specialty.
We had 516 respondents in the survey over 6 weeks in April and May of 2016. Respondents were 99% physicians with approximately a 3:1 male to female ratio. 58% were over 50, 31% 40-50 and 11% 30-40. Not everyone answered all questions.
Over 70% had never taken a burnout inventory, yet 82% feared that they might indeed be burned out. 88 of the 423 who felt burned out were doing nothing to address this condition. Of those who were doing something to combat burnout, the results were rather telling:
One hundred twenty three had cut back on hours or changed practice location or switched to urgent care; 67 had retired, left EM or medicine or had plans to do so imminently or as soon as finances would allow. Alternate clinical practices mentioned include primary care, wellness medicine, regenerative medicine, prison medicine, weight loss, phlebology. Alternative careers included medical administration, teaching, IT, and writing.
Approaches to combating burnout included diet/nutrition, exercise, hobbies, reading, vacations, family days, introspection/positive thinking, talking, sharing, saying “no!”, reducing night shifts, yoga, meditation, relaxation, sleep hygeine, and seeking outside support. Sources of support included families, friends, religion, prayer, and various forms of therapy.
Several respondents had sought life coaching, talk or cognitive behavioral therapy/psychotherapy, counseling, and/or pharmacologic treatment for depression, PTSD and SUD. Some admitted to cursing more, drinking more, gambling, and smoking “weed” as forms of coping.
Several said that they were helped by taking the survey and were studying the situation and trying to find more positives in their work and life balance while looking at sustainable alternatives. While one planned to “move out of a soul sucking system”, another suggested moving into a more “life sustaining specialty” or leaving to practice in another country.
One respondent said “I have given up trying to do anything more to remedy the burnout, including everything the “experts” have recommended, multiple modalities like yoga, medication, etc. They don’t work because they don’t address the underlying issues that lead to burnout. Many of the reasons are beyond my control. The root problems such as the abuse that is rained down upon EPs by hospital administrators, government, and others who control the delivery of emergency care.”
Another had a more positive outlook, “looking for an environment where I am supported, enabled, and protected, that says “Good job!” and “we have your back”…I have talked to a psychiatrist/pediatrician friend who helped me realize that this is not happening at my current location. I recognize that our problems are not unique but the approaches taken to remedy them differ from place to place. I have the right to work somewhere that is supportive and positive about how hard we work in the ED.”
And while many of the responses were negative, few were despairing. Many recommended sharing with colleagues as a positive approach to the problem, actively admitting feelings and working to find ways to like the work.
Over 60% of our respondents had known a physician who had suffered clinical depression. 43% had personally known a physician or medical student who had completed suicide. Nearly 60% had experienced symptoms that might be indicative of depression, and of these 300, 45% had not sought treatment. Of those who did NOT seek treatment, nearly 40% did not do so because of concern about reporting requirements or confdentiality.
Sixty percent of our respondents had been asked by a licensing agency, employer or credentialer such as a hospital whether they had “ever experienced a mental illness” (which questions would almost certainly be deemed impermissible in an ADA challenge). Of these, only 3.4% had responded affirmatively to such questions.
Although this survey sampling was not conducted in a way as to be scientifically valid, it would seem that far fewer would now admit the condition to authorities, as opposed to 15% a decade ago. Explained one respondent, “I see a therapist and pay her cash to keep it “off the record” as I fear any type of paper trail that could impact my career. I would not talk on the record to a (physician) for the same reason.” Approximately 10% of our respondents who did answer such questions affirmatively reported that they then experienced some type of repercussions.
Approximately 19% of those who had experienced depressive symptoms considered harming themselves while experiencing symptoms. (This is considerably less than the 48% we reported a decade ago, though that survey was preceded by an article on physician suicide, which may have influenced those who chose to participate).
Less than 3% of all respondents had ever been evaluated or enrolled in a physician health program. Of that small number who had been in a PHP, responses were split equally on whether they felt that their rights had been observed. The majority of PHP participants had received treatment, and a majority of those felt that the diagnosis and treatment were correct; almost all were able to successfully return to practice. One individual with alcohol dependence and PTSD completed PHP monitoring, is happily sober (though not working for 15 years), and wishes he had accepted help much sooner.
About half of our respondents did not know whether or not their state requires that a physician report/refer a potentially impaired colleague; but half said that they would refer if they were concerned about a condition that could lead to impairment. However, only about 11% said that they would likely refer such a colleague if they were not SURE about impairment, but were only concerned about POTENTIAL impairment. This brings into question the value of required reporting statutes – a consideration that has been confirmed in other studies.
Happily, 76% of our respondents did report having a physician or other source of primary medical care, and a slight majority would consult that physician if they felt they might be developing a depression. About a third did not know whom they might consult in such a situation, while two thirds did.
To see the results of the survey in full – click the image below.