What Happens When the Doctor Is Feeling Poorly?

Illustration: Melinda Beck

Tress Goodwin deployed for six months in 2015 as a U.S. Navy emergency medicine physician in an Afghanistan combat zone, caring for critically injured and ill American and allied troops and civilians. “I took care of issues ranging from mass casualties to polytrauma from IEDs to everyday emergencies that occur with a population of 10,000 adults,” says Goodwin, ’02, MA ’02, MD ’08. “The work hours were long and I took care of some of the most horrific injuries I will see in my career, but the sense of purpose in caring for those sent to serve in harm’s way, combined with the immense sense of teamwork, made it the most fulfilling professional experience I have had thus far.”

The hardship, it turned out, was returning to her civilian career. Shortly after settling back into her practice at a Virginia community hospital, Goodwin found she could barely get out of bed in the morning. Her work, she says, was “rinse and repeat.” It felt meaningless compared with the sense of mission and camaraderie she had experienced in the service. “I found myself looking ahead to working 30 more years and wondering how I could even work another five,” she says.

Goodwin was suffering from an increasingly common phenomenon: physician burnout. “I was turned off by the extremely toxic work environment and the corporatization of health care delivery,” she says. She felt like a cog in a machine, she recalls, as if her only value to the hospital was to earn money — and that wasn’t why she went into medicine.

Some 42 percent of American doctors feel burned out, according to a January report by the professional health care website Medscape. Those feelings can impede their ability to relate to patients, leading to poorer quality health care and decreased patient safety.

In a 2016 physician wellness survey, 39 percent of Stanford-affiliated doctors reported experiencing burnout, up from 26 percent in 2013. Stanford Medicine’s WellMD Center, launched in 2015, aims to show how investing in physician health and in the efficiency of medical practice reduces burnout, thereby benefiting the entire health care system — including patients. The center is headed by hematologist Tait Shanafelt, who joined Stanford last year as its inaugural chief wellness officer, making Stanford Medicine the first U.S. academic medical center to create such a position.

An authority on physician wellness and how it impacts health care, Shanafelt was recruited to Stanford from the Mayo Clinic, where he was director of the department of medicine’s Program on Physician Well-Being, as well as an expert on the treatment of chronic lymphocytic leukemia. Shanafelt’s work, including several national surveys of more than 10,000 physicians each, has confirmed dangerous trends in physician exhaustion, disengagement and loss of meaning in their work. When physicians suffer, he has found, so do patients. Shanafelt refers to the trend as a national epidemic that is “eroding the soul of medicine.”

In the field of medicine, “the work hours are dramatically higher than other careers,” he says. “About 45 percent of doctors work more than 60 hours a week, often as much as 75 hours a week.” Moreover, he says, “the culture tends to be a perfectionistic mindset where physicians hold themselves to superhuman standards.”

As doctors spend less time interacting with their colleagues and more time in their own specialized siloes, Shanafelt says, isolation has also grown. A high volume of patients and the demands of digital record keeping have contributed to what he calls “the perfect storm of work overload, loss of meaning and community, and ultimately physicians losing a sense of purpose in what they are doing.”

At Stanford, Shanafelt’s charge is to collaborate with colleagues across medical fields to build the WellMD Center and extend its reach, with a long-term goal of reducing the factors that lead to burnout. They strive to understand the needs of the various subcultures of medicine and present options, since what works for one overwhelmed family practice doctor won’t necessarily help a stressed-out ER physician, or an overworked orthopedic surgeon.

More than 200 doctors have already participated in myriad programs from peer support to training in self-compassion and mindfulness to dinner series that engage them in conversation about both the struggles and the rewards of practicing medicine. Over time, each program will be tracked, evaluated and adjusted, and the physician wellness survey will be repeated every other year to measure progress. Shanafelt hopes the findings about what does and doesn’t help will be broadly applied beyond Stanford.

It is crucial to acknowledge physician burnout and recognize that it is not a personal resilience issue but a system that needs repair, says clinical associate professor of psychiatry and behavioral sciences Mickey Trockel, who directs scholarship and health promotion at the WellMD Center and who led the development of the physician wellness surveys. His psychiatry clients are largely physicians, so he has a first-person window into the problem.

Over the past two years, awareness of physician burnout has grown, Trockel says. Changing the culture is now possible, he believes, but it won’t be quick. Tackling the “shame and blame” he has seen in his physician patients when they admit to feeling imperfect or emotionally exhausted is just one step along the way to a healthier environment.

“We are really trying to look at this from the lens of a societal problem,” he says, “to think about how to prevent this from becoming something that erodes the nation’s health and health care delivery systems.”

It’s easy to see how physicians can feel disempowered, says emergency physician Matthew Wetschler, who took a four-month break halfway through his residency to paint (his other passion) and reevaluate his life, then returned to practice part time.

“Medicine has become managed,” says Wetschler, who completed his Stanford residency in December. “The administrative layer that now measures standardization and metrics adds another layer of work. There is a lot of good there, but the pendulum has swung and now medicine is being reduced to its most skeletal form. We have lost that emotional content.”

Wetschler has given talks about his experience with depression, the growing phenomenon of physician burnout, and the importance of art and creativity in living a more balanced life. In spite of pressure to do otherwise, he has found that if he spends a little extra time with each patient, it makes a huge difference for him and the person for whom he is caring.

“I will go to great pains to be sure someone is heard and they know what is going on,” Wetschler says. “That is the counterculture, but that’s what I need [so I can] show up tomorrow. Otherwise, I will just fry.”

For Goodwin, the eventual solution to burnout was a job change. She now works in the ER at a children’s hospital in Washington, D.C., where, despite a pay cut, she enjoys more flexibility, fewer hours and a work environment in which patient care is paramount. A key factor: Physicians are treated as valued professionals, she says, “not worker bees.”