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Burnout and Post-Traumatic Stress Has Reached Epidemic Proportions

Posted on Thu, Jun 22, 2017
Burnout and Post-Traumatic Stress Has Reached Epidemic Proportions

By Jane Sullivan, Ph.D.

Epidemic is the term currently used to describe the increased incidence of both burnout and post-traumatic stress disorder (PTSD) in emergency physicians. It’s difficult to know if calls to action to address this epidemic have been responded to with any successful intervention. So perhaps the statistics will continue to be astounding:

  • 300 to 400 physicians commit suicide a year
  • 52 percent of emergency physicians report being burnt out
  • 60 percent of midcareer doctors have been involved in lawsuits
  • 10 to 15 percent of all doctors have issues with substance abuse during their careers
  • 80 percent of physicians state that they believe that the medical profession is on the decline


Post-Traumatic Stress Disorder (PTSD) is a trauma and stress related disorder that may develop after exposure to an event or ordeal in which death, severe physical harm or violence occurred or was threatened, according to Psychology Today. Witnessing the pain and suffering of patients who are impacted by traumatic events such as mass shootings, car accidents, suicides, opiate overdoses and terminal illnesses can erode the barriers that help protect physicians from incapacitating, overwhelming emotions. It is, however, the inability to access emotions and the lack of support to express genuine and understandable grief that may set the foundation for the symptoms of PTSD.

The Symptoms of PTSD

The symptoms of PTSD are usually quite demonstrable — flashbacks, nightmares, startle responses that can last for months and can become debilitating. Treatment options exist for those medical providers suffering from PTSD, and most organizations are sympathetic to and supportive of providing help.


Recognizing burnout may be more elusive. The term “burnout” suggests that one was on fire at some point, but now the fire is gone. Christine Maslach, who has done significant work on burnout, defines it as, “an erosion of the soul caused by a deterioration of ones values, dignity, spirit and will.”

The Symptoms of Burnout

The symptoms of burnout are varied and refer to a change in a person’s behavior and personality. They include:
  • Loss of a sense of personal satisfaction, accomplishment and meaning
  • Isolation from friends and family
  • Increase in cynicism and sarcasm (patients become stereotyped)
  • Appetite changes – weight gain, weight loss
  • Loss of interest in favorite activities
  • Depersonalization
  • Robotic actions
  • Fatigued before the day begins
  • Increased alcohol and/or drug use
  • Change in demeanor
  • Overreaction to minor incidents
  • Angry outbursts
  • Increased rate of divorce
  • Loss of empathy
  • Disengagement from patients, profession and other providers

The factors contributing to burnout are numerous and somewhat predictable. They include:
  • Societal and patient expectations for medical “perfection” (no mistakes)
  • Personal physician expectation of “perfection” (personal cost of mistake)
  • Too much output, not enough input
  • Pressure to see more patients
  • Medical malpractice creates defensive medicine
  • Focus on the negative
  • Repeat narcotic-seeking patients, drunk patients in the ED
  • Emergency physicians becoming “social workers”
  • Loss of autonomy
  • Increased scrutiny, e.g., physicians judged by quality measures, documentation, chart reviews, peer reviews
  • Standardized medicine
  • Repetition of patients who may appear to be willfully self-destructive or neglectful, with expectations that doctors will “fix them” (“Same stuff, different day”)
  • Decreasing public respect for the medical profession
  • Increasing reliance on technology by patients
  • The impact of night shifts on sleep patterns
  • Disillusionment in medicine, whereby idealism becomes disappointment and dissatisfaction
  • “Destination sickness”; You’ve “arrived,” but now what?
  • Decreasing trust between doctor and patient and increased distance
  • Adversarial relationship with administration
  • Years of ongoing litigation, which generates guilt and, worse, profound shame
  • Shame for failing to live up to one’s image
  • Repetitive grief with no space to grieve
  • Constant stress, fear of making a mistake

Given the impact of burnout on physician behavior, higher medical errors, suicide and lower quality of care, it would seem imperative to understand the causes of burnout and generate concrete actions to address the “epidemic.” However, there are barriers and challenges that exist in addressing both PTSD and burnout which impacts mobilizing treatment interventions.

First, medical organizations and administrators whose focus is on the financial bottom line may believe that it’s more cost effective to replace a “hurting” physician than invest in supporting that physician. Individual physicians, who view themselves as heroic and strong, may have difficulty admitting to their own pain and need for help. Peers who witness other doctors with the symptoms of PTSD or burnout are reluctant to talk with their fellow providers about what they are witnessing, perhaps because of a concern about what the reaction may be. In addition, there may be fear of acknowledging a potentially debilitating distress because of the medical licensing board’s question: “Have you ever had a medical condition or been treated for a problem that could hinder or impair your ability to provide patient care?”

Identifying and Treating Burnout and PTSD

Although some organizations do attempt to assess how their physicians are doing by surveying clinicians, such surveys typically have only about a 40 percent response rate. It will, therefore, take vigilance on the part of peers, fellow practitioners and medical directors (who may themselves be burning out) to be observant of physician behavior and attitudes. Engaged physicians maybe the ideal, but identifying and supporting those physicians struggling with PTSD and burnout needs to be a more immediate goal.

Treatment of both burnout and PTSD is the responsibility of all involved. There are many support systems available to help individual physicians in their struggles, such as the American Medical Association and The

As Nietzsche said, “Physician, heal thyself: then wilt thou also heal thy patient.”

Peer groups provide safe, non-judgmental environments to address issues of mistakes, guilt, shame, disengagement, anger and all of those emotions that impact physicians’ attitudes and behaviors. Knowing one is not alone can be very helpful. Staff meetings could include some of these topics for general discussion. Hospital administrations can advertise their commitment to not only helping identify those physicians struggling with the cost of their profession, but also their investment in support activities. In fact, several large hospital systems have hired professionals trained in physician health and well-being to provide care, both proactively and reactively.

If burnout and PTSD in healthcare is indeed at epidemic levels, it will take mobilizing all of the resources necessary to respond adequately. The cost is too high to continue to ignore this issue.


Jane M. Sullivan, Ph.D., is an adjunct professor at Albert Einstein College of Medicine, Bronx, N.Y.; Yeshiva University, New York City; and Fairleigh Dickinson University, Teaneck, N.J., teaching courses on conflict resolution and family dynamics. Much of Dr. Sullivan’s recent professional work has been on leadership development, generational transitions and supporting effective and productive interpersonal communication in organizations. Dr. Sullivan has been a guest speaker on topics such as emotional intelligence, burnout, dynamics within family business, conflict resolution, effective communication and gender differences. She has written several articles on topics related to interpersonal dynamics in business.

Danielle Ofri, M.D. What Doctors Feel: How Emotions Affect the Practice of Medicine, Beacon Press, Boston, 2013.
Tom Murphy, M.D. Physician Burnout: A Guide to Recognition and Recovery, Aloha Publishing, 2015.
Joseph S. Bujak, M.D. Inside the Physician Mind: Finding Common Ground with Doctors, ACHE Management Series, Health Administration Press, 2008.
Burnout: Emergency Medicine Hit Hardest, J. Duncan Moore, Jr., Health Leaders Media
Physician Burnout: Why It’s not a Fair Fight (blog article), Dike Drummond, The Happy
Physician Burnout: It Just Keeps Getting Worse, Medscape, Carol Peckham

Whole Health Medicine Institute
Lissa Rankin, M.D. – Self Healing Kit


National Nurses Week: Finding Balance

Posted on Mon, May 08, 2017
National Nurses Week: Finding Balance

By Ginger Wirth, RN

Nurses, like most healthcare professionals, struggle with work/life balance. This stems from the reason that most of us pursued a career in healthcare – an innate desire to care for others.

Your interest in the field may have developed from early exposure to some aspect of healthcare. A family member or personal experience with your own or someone else’s medical issues can ignite the passion for the art of caring for others.

That passion for making a difference in the lives of patients, families and those we work with takes center stage for most nurses in the industry. There are times when our personal needs are put aside, our schedules changed and, sadly, family milestones are missed to execute our craft to the best of our abilities. This apparent oversight is never intentional, but it often creates conflict in our home lives.

It’s a constant struggle to find that delicate balance. This was brought to my attention by my then-5-year-old son, who asked me at the dinner table one evening several years ago, “Mom, are you going to be a nurse forever?” It was a strange question, to be sure, but our dinner table was usually where I’d recount my day in the emergency department. I answered honestly, “Of course I’ll be a nurse forever.” He then bluntly retorted, “Well, then you will never see your grandkids!” and promptly went back to eating his macaroni and cheese. Out of the mouths of babes … I have thought about that question many times throughout the rest of my almost 30-year career. I use it as a barometer when whatever in my professional career seems to be consuming all of my time, or I have inadvertently missed something important in my “outside life.”

Those close to you – your family and friends – deserve your attention and time. A true balance of both only makes you stronger, and both parts of your life get better. And, I would be remiss if I didn’t mention that it’s also important to take time to care for yourself. We cannot effectively take care of others if we are not taking care of ourselves. I wrote a blog article with some tips you may find useful.

The impact that we are able to make on the world through a career in healthcare, and in nursing in particular, is immeasurable. That is undeniable, and truly makes the world a better place.

Ginger Wirth

Ginger Wirth, RN, joined Envision Physician Services in 2013 as a divisional director of clinical services. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as the ideal opportunity to partner with nursing, physicians and facility leaders to make positive changes to the entire patient care experience. Her nearly 30-year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.


Podcast Provides Tips for Banishing Burnout

Posted on Wed, Mar 15, 2017
Podcast Provides Tips for Banishing Burnout

More and more clinicians are reporting feelings of burnout and a need to find a better work/life balance. In fact, the Medscape Lifestyle Report 2016: Bias and Burnout concluded that burnout among U.S. physicians has reached “a critical level.”

While each physician’s personal and professional pressures vary, most research on the topic suggests that to amp up their resiliency and stave off compassion fatigue, clinicians should reconnect to the people and activities that are a source of joy, and make the most of their “downtime” to provide a sense of control amid the chaos.

Gretchen Rubin has written several books on happiness and forming positive habits, including Better than Before, The Happiness Project and Happier at Home. Rubin shared the following tips during her weekly podcast, Happier with Gretchen Rubin.

Finding Everyday Joy

  • Take photos of everyday life – the foam on your coffee, rain patterns on the window pane, the assortment of pens and sticky pads in your lab coat – for a new perspective.
  • Pick a one word theme or phrase for the rest of the year. For example, “novel” to remind you to try new things or finally get your thoughts in print, or “vision” to frame where you see yourself personally, professionally, spiritually, health wise and/or financially in the near future.
  • Set a timer for writing, painting, baking or any other creative endeavor that you’ve had trouble fitting into your schedule.
  • Be a minor expert, meaning if you have an interest in a topic, commit to learning as much about it as you can.
  • Buy – and read – three magazines that you'd usually never read.
  • Start a passion project. Much like being a minor expert, follow your gut and pursue that project that keeps you awake at night.

Maximizing Your Time

  • If it only take a minute to do it, do it now and cross it off your to-do list.
  • Plan a “power hour” each week to knock out lingering tasks.
  • Turn off your TV to avoid falling into a Netflix binge.
  • Use reminders on your phone for tasks you keep forgetting to complete.

Forming Healthy Habits

  • Use scheduling to build positive habits. Block out time for the gym, meditation, meal prep, etc., on your calendar and don't make excuses when those “appointments” come up.
  • Set an alarm for your bedtime as well as your wake time to reinforce your routine and ensure healthy sleep patterns.
  • Give yourself “gold stars” and “demerits” each week. By reviewing your successes and misses, you’ll be better prepared next time.

For more information about the topics of burnout and resiliency, visit EmCare’s website or the wellness resources on ACEP’s website.


Battling Holiday Burnout: Follow Your Own Advice

Posted on Wed, Dec 14, 2016
Battling Holiday Burnout: Follow Your Own Advice

By Sabrina Griffin, RN, BSN

As we prepare for the holiday season followed by a New Year and New Administration, how do we embrace this festive time of year that will most certainly be followed by massive change, when we are already too exhausted to just take a breath?

Lead from your values. No matter what changes in leadership, we as healthcare providers are going to think, plan and do what is best for our biggest priority, our patients. I know what you're thinking: "I'm exhausted and feel like I'm reaching the burnout zone." Well, remember your oath to "Do No Harm." That statement applies to our patients and to ourselves.

This season of new beginnings and resolutions is a great time for a quick self assessment:

  • How are you doing physically? Emotionally?
  • Share your findings with someone you love and trust.
  • Prescribe yourself treatment as if you are the patient:
    • Allow time for rest and recreation.
    • Balance your life: spend time with the people that you love.
    • Have fun.
    • Explore your creative side.
    • Unplug daily.
    • Sleep at least eight hours.
    • Eat healthfully.
    • Exercise at least 30 minutes a day.
    • Spend time alone each day to slow your mind and calm your body.

I love lists. I've been making lists my entire life - on napkins, sticky notes, in digital organizers. I want to leave you with one of my favorite "to do" lists:
  •     Plan purposefully
  •     Prepare prayerfully
  •     Proceed positively
  •     Pursue persistently

I appreciate everything you do for our patients and the communities we serve. I hope you enjoy some quiet time with family and friends during the holiday season. Remember to take time for yourself and follow your own care plan this season.

Sabrina Griffin, RN

Sabrina Griffin, RN, BSN, is a Divisional Director of Clinical Services for EmCare.


How I Get My Mind Ready for the Night Shift

Posted on Wed, Nov 30, 2016
How I Get My Mind Ready for the Night Shift

By Shilpa Amin, MD
I have been out of residency for seven years. For the duration of my career I have worked the late shift, either 4 p.m. to 2 a.m. or 5 p.m. to 3 a.m. In the past four years, I transitioned solely to nights. Why, you ask. How? I usually get looks of bafflement when I tell people that I work overnight in a very busy urban emergency department with single coverage, while juggling a family with three young children.
I transitioned to nights because it was easier for my family life. My children are in school. I typically leave when they are sleeping and can get home just before they wake. I sleep when they are at school and wake up to pick them up after school. They hardly notice that I’ve gone to work. This works well until they have a day off from school and don’t understand why I’m sleeping all day! Luckily because I work nights, I have a fairly set schedule and can work around their school calendar.
People ask me how I stay up all night. After all, it’s not natural. The key is having a routine that I go through each time I leave for work. My shift starts at 9 p.m. I start my routine at 7 p.m. My ritual is to read books to my children, put my scrubs on, brew and drink Mauritius tea at the kitchen table and decompress. l leave at 8:30 p.m. and pick up treats for the night staff from the same café. I call my husband or my sister on the drive, and park my car in the same spot.
I take a look at the waiting room on my way in. It’s been busier than normal the past few weeks. When I walk inside, I greet everyone and mentally get my plan together with my advanced practice provider about which patients to see. Throughout the night I drink a few cups of green tea for a boost of energy. The 4 a.m. hour is especially tough for me.
On my 20-minute drive home, I listen to my favorite station on Pandora and that’s usually enough time for me to decompress from the events of the night. When I get home, I send the kids off to school and fall back to sleep!
I look forward to my evening and morning routines because it gives me a sense of control, and that is rare during an ED shift.

Shilpa Amin, MD, FACEP, is a full-time attending emergency physician. She received a bachelor’s degree from Rosemont College in Rosemont, Pa., and her medical degree from SUNY Downstate, Brooklyn, N.Y. She completed the Jacobi/Montefiore Emergency Medicine Residency Program at Albert Einstein College of Medicine and served as chief resident. She enjoys spending her free time cooking, traveling and trying new cuisines with her husband and three young children.

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