Changes in the climate of healthcare have had an impact on the relationship doctors have with their profession and the communities they work in. Bureaucracy, finances, work hours, and increasing disengagement from the patients they care for have all been cited as reasons behind an eroded belief in the practice of medicine as a calling. As a result, rates of physician burnout have been on the rise. A 2017 Medscape Lifestyle Report detailed that rates of burnout amongst ER physicians tops the list at nearly 60%. In no medical specialty has there been any decrease in rates of burnout when compared to 2013 numbers. In an effort to combat this, the American Medical Association offers a program called Steps Forward that provides learning modules on preventing physician burnout.
Physician burnout is also associated with rates of physician substance use disorders (SUD). Depression, stress and burnout can act as drivers of disruptive behaviors that can resemble those seen in substance use disorders or as triggers for SUD itself. The U.K.’s National Health Service has seen increases in the number of physicians seeking treatment for SUD as a consequence of turning to alcohol and drugs as a way of managing work pressures. It is estimated that 10-15% of physicians will develop SUD at some point in their careers. While this rate is similar to that of the general public, stigma surrounding SUD, stereotypes, expectations that physicians should be able to provide self-care, and a lack of empathy from colleagues are all barriers to physicians seeking treatment. It is not surprising therefore, that physician SUD often presents at a more advanced stage by the time it is identified and treatment is initiated.
Following identification of SUD, treatment engagement remains a challenge. In a profession where the ability to put aside one’s own problems and focus on the job is considered fundamental to career success, seeking treatment from peers can be embarrassing or stigmatizing. Likewise, physicians in the position of having to diagnose or treat a colleague may lack the comfort, objectivity or necessary skill set to best care for the individual.
Specialized treatment programs such as the Sunspire Health High-Performance Professionals Program located outside of Dallas, Texas have been developed to provide physicians with SUD a focused treatment program that takes into account the individuals professional responsibilities. Dr. James Montgomery, Director of the Sunspire program, observes that physicians and other professionals with SUD have “unique treatment needs based on their safety sensitive positions.” Dr. Montgomery adds that, despite a physician’s need to have “healthy narcissistic defenses for the tasks of saving lives, caring for health and protecting the public, a vital step in developing sustainable recovery is to abandon the terminal uniqueness inherent in this role.”
Physician burnout and SUD are expected to remain significant issues as the healthcare system continues to evolve. Despite this, physicians can be encouraged that help is available in the form of evidence-based treatment that allows recovery to take place in non-stigmatized, non-punitive, peer-supported environments.
Dr. Michael Frost is the Corporate Medical Advisor to Sunspire Health.