Swipe to advance
1 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Physicians have struggled with burnout for some time, but it has become worse during the pandemic, influencing happiness, relationships, career satisfaction, and patient care. Tragically, burnout and depression have led to a number of physician suicides, deeply affecting families and the medical profession.

In this year's report, Medscape explores how physicians are coping with burnout and how it affects their view of their profession. More than 12,000 physicians in over 29 specialties responded to our survey. Data were collected from August 30 through November 5, 2020.

Some totals in this presentation do not equal 100% due to rounding.

2 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Burnout is still at a critical level. This year, 42% of physicians reported that they are burned out, similar to last year. But COVID-19's influence seems to have affected some specialties more than others.

Last year, the five specialties ranked highest on burnout were urology, neurology, nephrology, endocrinology, and family medicine.

The lineup is different this year; the specialties ranked highest include critical care (44% in 2020), rheumatology (46% in 2020), and infectious diseases (45% in last year's report).

3 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Women have consistently reported higher percentages of burnout than men over the years, but this year the disparity was greater than usual. (The smallest difference was seen in our 2013 report, when 37% of men and 45% of women said they were burned out.)

"Many women physicians are in families with children at home," says Carol Bernstein, MD, psychiatrist, Montefiore Medical Center, Bronx, New York. "It's already known that women assume more responsibilities in the home than do men. The pressures have increased during COVID-19: having to be their child's teacher during homeschooling; no childcare; and the grandparents can't babysit. Those all bring enormous pressure and burdens. In addition, all doctors and nurses are worried about bringing the virus home to their families."

4 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

The lack of personal protective equipment (PPE), difficult conditions, long hours, grief over losing patients, and watching patients' families suffer added a layer of extreme stress and exhaustion for many frontline workers.

5 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

One physician summed it up as: "It's all of these causes; it's death by 1000 cuts." The chief causes of burnout remain consistent from past years and are pushing physicians to the bursting point. The top causes of burnout in our 2016 report look familiar: too many bureaucratic tasks; too many hours at work; increasing computerization of practice; and insufficient compensation. (Respondents could choose more than one answer.)

6 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

7 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Over 70% of respondents who reported burnout consider it serious enough to have at least a moderate impact on their lives. One tenth consider it severe enough to consider leaving medicine, an unexpected outcome after having spent so many years in training to become a physician.

8 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Healthcare organizations and outpatient clinics were among the top work locations for burnout in our 2019 survey report as well as this year.

9 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

10 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Happiness among physicians took a huge plunge since the onset of the pandemic, from 69% pre-COVID-19 to 49% now (those responding very happy/happy). Stresses, risks, social distancing, and future uncertainty have contributed to declining happiness.

11 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Exercise continues to be a popular way to cope with burnout (45% chose exercise last year). However, drinking alcohol and overeating junk food have slightly increased since last year (24% and 33%, respectively, in 2020).

"Doctors are inherently very resilient people; maintaining our resilience is important and it's just as vital to keep up good habits and behaviors as it is to avoid getting into bad habits, which unfortunately some people do," says Peter Yellowlees, MD, MBBS, professor, Department of Psychiatry, University of California, Davis, and author of Physician Suicide: Cases and Commentaries.

12 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

"Get rid of insurance company interference with treatment, such as excessive prior authorization processes and denial of standard-of-care practices." –Neurologist

"Less charting/billing tasks, an EHR that actually works right, and time off for exams!" –Gastroenterologist

"Patients' families having reasonable expectations." –Pulmonologist

13 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Work-life balance is clearly the most pressing issue for physicians, followed by the related issue of combining work and parenthood. Compensation is a more frequent issue of concern for men than for women. In Medscape's 2020 report Women Physicians: The Issues They Care About, work-life balance was women's top concern, followed by compensation and then combining parenthood and work.

14 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Work problems don't stay at work: Burnout from work spills over into every aspect of a physician's life.

"I find my conversations with my family to be very negative, and it leads to friction and arguments with them." –Anesthesiologist

"I have no energy when I get home and I feel like I'm ignoring my family, but I need time to decompress and process what I dealt with during the day." –Oncologist

"I'm more withdrawn, and I'm taking the stress out on my wife and kids." –Family medicine

15 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

"Physicians certainly try to improve their situations," says Wendy K. Dean, MD, psychiatrist and president and co-founder, Moral Injury of Healthcare. "Most physicians are as efficient as possible, limited primarily by the inefficiencies of the systems in which they work. We should exhaust every other strategy for making the environment more sustainable — better tools, better processes, better workflows, better administrative support at every level — allowing doctors to work smarter instead of harder."

16 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Of the 20% of physicians overall who said that they were depressed, more than two thirds consider it colloquial depression (feeling down, blue, sad). Many have noted that burnout is a major contributor to their depression.

17 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

18 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Almost half of depressed physicians say their depression has no impact on patients, but more than half reported some notable effect on their interactions with patients.

Bernstein notes that these results are possibly less alarming than one might think. "In my experience, physicians are very hard on themselves. While no one should become careless with patient care, it's likely that they are doing a better job than they think," said Bernstein. "It's pretty important to acknowledge that we are human. We are all incredibly stressed; doctors try to have compassion and forgive patients, but we need to have compassion for ourselves, too. Doctors don't give themselves enough of a break."

19 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

It's been estimated that about 300 physicians commit suicide each year. In 2018, suicide was the tenth leading cause of death among the general population in the United States.

Our survey showed that 1% of physicians have attempted suicide, a frightening and sad statistic. "Anyone who has made suicide attempts is at greater risk at some point of completing the act," says Bernstein.

One internist who admitted to having had suicidal thoughts, said, "I yell all the time. I am angry and frustrated all the time. I think about quitting all the time. No one in my organization cares about doing the right things for patients as much as I do."

20 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Thirteen percent of physicians have had thoughts of suicide. Our chart shows those specialty groups with among the highest rates (specialties with over 10% responding "yes"). Some specialties may be prone to more stress, greater danger from caring for COVID patients, and higher levels of burnout and depression, all of which could be factors in having suicidal thoughts.

21 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

One of the dangers of the depression spiral is that the person suffering doesn't share their thoughts and therefore doesn't have anyone to encourage them to get help. (Respondents could choose more than one answer to the survey question.)

"Unfortunately, many physicians don't seek help, even when they know they should," said Yellowlees. "There are many reasons for this, but the most important is that many physicians probably perceive an inherent stigma and shame of seeking mental health treatment. There's also a level of internal denial; they are ashamed and see themselves as failures if they seek help, and they believe that if they keep working hard, all obstacles should eventually be overcome."

22 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

A variety of privacy concerns keep physicians from getting mental health assistance. Risk of being reported to the medical board, fears of one's colleagues finding out, and other potential repercussions are factors that perpetuate the climate of burnout and depression.

23 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Smaller groups and practices are less likely to have programs designed to help with physician burnout and stress. A research study published by the Mayo Clinic noted: "The most efficacious strategy to alleviate physician burnout will target organization-directed changes rather than the level of the individual."

24 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Employer programs tend to have a fairly low level of participation, for a variety of reasons. "Anti-stress/burnout programs focus on individual approaches to much larger problems," says Dean. "The programs offer temporary symptomatic relief rather than lasting systemic change. Many physicians are frustrated by these approaches."

25 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

Physicians named some activities that help them remain in better spirits: playing ice hockey, spirituality and religion, revisioning their career, meditating, taking antidepressants, getting a puppy, focusing more on self-care, daily Bible study, spending time with their spouse, listening to New Age music, drinking alcohol, and writing.

26 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

27 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

28 of 29

Scroll

'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021

Leslie Kane, MA | January 22, 2021 | Contributor Information

29 of 29

Related Content on Medscape

Start
 

Medscape Physician Lifestyle & Happiness Report 2021

More than 12,000 physicians in various specialties told Medscape about their lives before and during the global pandemic.Medscape Features Slideshow, Jan 2021
All Slideshows
1 26 Next