Physician Burnout Simmering Below the Surface

Left alone in a small examining room, I scrolled the Associated Press news app on my cell phone, waiting for my physician to arrive. It was the last day of Black History Month, with little more than 12 hours remaining before it became another chapter in the long history of America recognizing the accomplishments of African-Americans.

My appointment, scheduled at the last minute, would not involve my primary care physician, an engaging and cheerful young woman of Indian descent who is part of the health system’s residency program. Once, when I asked her about experiencing any signs of burnout, she told me that she was not, but that all of her colleagues seem to monitor one another for it. According to media reports, burnout is an epidemic among U.S. physicians, and appears to contribute to between 300 and 400 suicides each year: a doctor a day.

There was knock on the door and in a hurried rustle of papers, my physician arrived. She was black.

She was energetic and animated. We exchanged perfunctory greetings and she mentioned that she was a mother to two teenagers. When she asked me what I did for a living, I told her and also mentioned that the day before, on Talk Ten Tuesdays, we had as a special guest: Crystal Watkins, MD, PhD, director of the Memory Clinic at Sheppard Pratt Health System and assistant professor of psychiatry and behavioral at Johns Hopkins University School of Medicine. During the broadcast, Dr. Watkins related her experiences as a young African-American growing up in Baltimore.

This tribute to the accomplishments of Dr. Watkins, as I told my physician, was in recognition of Black History Month. At that point, she promptly showed me her petite black, red, and green Black History month ribbon, tucked behind her white coat. Her mother was an English teacher, she explained, and her father was a mathematician and worked for IBM.

When I mentioned “ICD10monitor,” she shuddered, and the tenor of the conversation changed dramatically.

“I hate to code,” she told me, pointing to the monitor on her computer. “And then they’ll come and say, ‘this isn’t the right code,’ and I’ll say, ‘OK.‘ I don’t let it bother me.”

When I asked her about burnout, she became even more somber, explaining mounting pressures of the job and then, almost offhandedly, making a passing reference to a recent suicide, assuming I was aware of the incident. I was not. When I mentioned my primary care physician and how the residency program tended to watch for signs of burnout among young physicians, that was not the case, she said, in her situation.

Unprompted, she continued discussing the intricacies of being black in an all-white community, insisting that her teenage son not pull his hoodie over his head under any circumstances, for example. She was also alarmed by the presence of swastikas in her upscale neighborhood. She also referenced post-traumatic stress syndrome (PTSD) and wrote on a paper towel the name of a local African-American physician, Rodney Hood, MD, who evidently has linked PTSD to slavery.

It seemed for a moment that I was the therapist and she the patient.

Moments later, she looked at my chart and dispensed a logical diagnosis and a succinct plan of care.

Our brief engagement ended, far too soon.

Because burnout has been a recurring subject on both ICD10monitor and Talk Ten Tuesdays, I described my experience with H. Steven Moffic, MD, the nationally renowned psychiatrist who shared his perspective on the topic. What follows are highlights of that interview.

1. Buck: Given the historical challenges black Americans face growing up in this country, I would assume that the path to become a physician must be extremely daunting.

Dr. Moffic: It sure has been, and is, Chuck. That can relate to the challenges of successfully navigating our educational systems, which vary in quality, as well as the remaining conscious and unconscious racial bias in our healthcare systems. The percentage of black Americans entering medical school is still less than their percentage of our population.

2. Buck: What are the most recent statistics about physician burnout and the alarming rate of physician suicide?

3. Buck: In describing her experience as a black American, my physician seemed rather resilient and stoic. Can you explain that reaction?

Dr. Moffic: What an excellent observation about her likely being resilient, Chuck! Given the micro- and macro-traumas that so many black Americans go through, they often have to develop even more resilience than the high degree that most all physicians have to obtain. After all, among other challenges, most physicians have to rebound from patients who don’t get better or die, working long hours, and the demands of always learning new information. Seeming stoic can be the external expression of that resilience, appearing that nothing much will faze you, which can be reassuring to patients. Developing such post-traumatic strength has many benefits, but it can also make one less attuned to one’s burning out, at the same time.

4. Buck: When she mentioned the black American physician who suggests a link between PTSD and slavery, is that a causal connection?

5. Buck: Are there early warning or telltale signs of burnout that coders and clinical documentation integrity specialists could detect in their working relationships with physicians? If so, what are they?

Dr. Moffic:  Well, if they could only follow your example, Chuck. However, if they don’t have your experience and curiosity, there are still some usual telltale signs of burnout. Those include increased frustration in their work, especially with the coding demands that your physician conveyed to you. Such burning-out physicians tend to be more brusque, less caring, and make more mistakes, many of which coders need to try to correct. These are actually warning signs that patients can see in their own physicians.

6. Buck: Finally, what is the link between burnout and PTSD?

Thank you, Dr. Moffic.

About H. Steven Moffic, MD

Specifically related to the topics of this interview, Dr. Moffic is a member of the new Workgroup on Psychiatrist and Physician Wellness and Burnout of the American Psychiatric Association, and will be a co-editor of a new book on psychiatrist burnout. He also received the one-time Hero of Public Psychiatry award from the American Psychiatric Association. Just recently, he was told that his name will be added to the Wall of Tolerance as part of the Civil Rights Memorial in Montgomery, Ala. for his career work in addressing intolerance and hate.

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