Is That Me? Dealing with Family Physician Burnout and Depression

Physician after shift treating covid patients

As family physicians, we’re trained to care for a wide range of patient needs. We evaluate and diagnose based on our medical knowledge. We’re adept at noticing our patients’ physical, emotional and behavioral changes and we provide the care and resources they need. Sometimes, though, with how much time we spend caring for others, we can forget to prioritize our own needs, particularly our emotional needs and professional satisfaction.

Not surprisingly, family physicians are no stranger to burnout, defined by the American Academy of Family Physicians (AAFP) as a psychological syndrome in response to chronic interpersonal stressors on the job. We don’t always recognize our eroding well-being and professional satisfaction. But many of us have probably experienced the signs: physical and emotional exhaustion, depersonalization and a general feeling of a lack of efficacy. That’s the short list. Left unresolved, physician burnout can affect our physical and emotional health, relationships and the way in which we care for your patients.

Concern over physician burnout is real. Consider:

Family physicians are among the top five specialties experiencing burnout.
Two-thirds of family physicians report experiencing one element of burnout.
More women (55%) experience burnout than men (45%).
Burnout is more prevalent at the early and mid-career level.

Is this you? If so, it’s important to note that burnout is not a result of our choices. It’s a result of the family physician ecosystem. This five-tier framework provides a holistic view of the factors affecting physician well-being:

The Health Care System: Regulation and documentation burdens
Organization: Professional dissatisfaction of working within the confines of organizational requirements and operational policies.
Practice: Inefficiencies that occur at the practice level, reducing time spent caring for patients and inhibiting work life balance.
Physician: A physician’s own wellness habits and stress management skills.
Physician Culture: The culture that trains us to put our work before our own well-being.

Considering the role each of these tiers plays in our well-being and professional satisfaction, it’s no surprise that we often experience:

Chronic stress. We feel constant pressure to perform, to get more done, to succeed. Over time, this stress not only leads to burnout but will have physical consequences as well.
Exhaustion. No matter how much sleep we get, we still have a hard time getting out of bed in the morning. We feel drained. We have no energy to spend time with friends and family or even do things we used to enjoy.
Feeling like what we do doesn’t matter. We question if we are making a difference.
Feeling like we are not in control of our schedule. When we don’t feel in control in any situation, it can lead to stress. Feeling that our schedule is inflexible can interfere with downtime and our ability to relax and recharge.
Depersonalization. We don’t feel connected to our patients or even the people we care about.
Less compassion. We don’t have the same empathy we once had for patients. We may even find ourselves becoming easily frustrated by them and their families.
Poor performance. We may underperform at work and at home. We may dread tasks and lack creativity.
Physical symptoms. These could include frequent headaches and stomachaches, even increased heartrate.

While burnout should not be left unrecognized and untreated, it also should not be confused with depression. However, the two share several symptoms, including:

Extreme fatigue
Feeling low
Decreased job performance

What’s the difference between burnout and depression?

Because some of the symptoms can be similar, an accurate diagnosis is critical. If you have depression and it’s noted as burnout, you risk not receiving the treatment you need. A prescription for a long vacation, for example, provides no therapeutic impact for clinical depression, while psychological treatment, medication or both align with clinical guidelines for treating depression.

Similarly, many problems that are characteristic of burnout are work-related. Conversely, with depression, negative thoughts and feelings aren’t only about work, but about all areas of life. Other typical symptoms of depression include:

Low self-esteem
Hopelessness
Suicidal tendencies or thoughts about hurting yourself
Feeling sad or anxious
Changes in sleep patterns (insomnia or sleeping too much)
Changes in diet (having no appetite or eating too much)
Feeling irritable or restless

These are symptoms of depression and should be taken seriously. Family physicians who are experiencing burnout don’t always have depression. However, burnout may increase the risk of depression.

The family physician perspective on burnout and depression

If any of the signs or symptoms of depression feel all too familiar, it’s time to act. Reach out to a family member, colleague or mental health professional and start a conversation about how you are feeling. Talk to your primary care physician (PCP). If you don’t have a PCP, find one. Physicians who commit suicide are less likely to have a PCP than physicians who do not have suicidal ideation. In the general population, about 25% of people see their PCP one month before they attempt suicide. More than 75% of depression is treated by a PCP in this country.

The AAFP strongly believes that physician burnout is a health system, organization, practice, and physician culture problem, not just an individual concern. Therefore, the AAFP takes a systems-based approach to identifying and combating root causes of physician burnout at all levels of the family physician ecosystem. As a trusted partner for members interested in developing their personal resilience skills, the AAFP is committed to providing resources to support members’ well-being and professional satisfaction. These resources are available to all AAFP members, including students, residents, active members, and life members. For example, the AAFP created Physician Health First to help family physicians assess their well-being and access additional tools for making a plan for work-life balance and professional satisfaction.

Taking the next step

There are positive steps you can take now to improve your well-being, even when the stigma of depression or the feelings associated with burnout make seeking treatment and solutions feel difficult. The AAFP Physician Support and Suicide Prevention Resources handout can help you access a therapist or support group.

To receive free, confidential peer-to-peer support from a volunteer psychiatrist, call the Physician Support Line at 888-409-0141.

If you are having thoughts about suicide or hurting yourself, reach out for help immediately. Contact the National Suicide Prevention Lifeline at 800-273-8255 (TALK) or the Physician Support Line at 888-409-0141.

Citation

Shanafelt, T.D., Hasan, O., Dyrbye, L.N., et al. “Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014.”