CHICAGO – Physician burnout is common, and occurs across specialties including gastroenterology, according to a discussion held at the annual Digestive Disease Week.

A number of studies and surveys have reported on physician burnout, including a large 2015 report from the Mayo Clinic, which found that 54% of the physicians surveyed had at least one symptom of burnout (Mayo Clin Proc. 2015 Dec;90[12]:1600-13).

Still, physicians often fail to recognize burnout symptoms in themselves. At the meeting, Laurie A. Keefer Levine, PhD, a GI health psychologist and the director of psychobehavioral research at the Icahn School of Medicine at Mount Sinai, New York, recounted the story of a medical student who jumped from her apartment building and killed herself.

“While she is not the first medical student to kill herself, this was an opportunity for the medical students to sit down and talk with the faculty,” said Dr. Keefer, noting that specifically, it focused on how this young woman’s distress had been missed, what was going on with students, and what is missing in medical education.

One of the main questions that came out of this discussion was why burnout isn’t more readily recognized. “It had to do with our strength as medical professionals,” she explained. “One common strength is that the pressure is self generated, and we put a lot of pressure on ourselves to excel.”

Health care providers are passionate about their work and it is difficult to give up opportunities that are important to them. “We can delay gratification a really long time until research results come out, or wait a long time for that promotion,” Dr. Keefer said, “But burnout is a very slow and insidious process. A lot of the time we don’t recognize it, and we think ‘just as long as we publish that paper,’ everything will get better.”

Also as time goes on, and physicians become more secure in their work and take on more responsibility, and that becomes another avenue for burnout. But importantly, she emphasized, burnout can be confused with stress, and many people mistake encroaching burnout for stress.

There are pronounced differences between stress and burnout even though they can be co-occurring. The difference, Dr. Keefer explained, is that stress is a problem of too much – work, pressure, and so on, and it is an “overreaction” of the nervous system in that “we’ve got to get it done.”

There is damage associated with chronic stress, but burnout is very different. Instead, burnout is a problem of “not enough.”

“We do not have enough to mount necessary responses to deal with the stressors that we have,” she said. “We are disengaged, our emotions are blunted. We feel helpless or hopeless and lose our motivation. And don’t care about the things we were once passionate about. We don’t have it in us any longer to contribute.”

Physicians use any number of coping strategies, rather than recognizing the problem. The unhealthiest coping strategy is venting. “We all do it, and it feels great, and it is meant to make us feel better,” said Dr. Keefer. “But if continues to happen over and over again, I would encourage you to think it through – that you are engaging in a coping strategy and may be missing burnout.”

It is imperative that medical providers recognize burnout early on, and not wait until it is too late, when there may be major consequences, she said.

Arthur DeCross, MD, professor of medicine at the University of Rochester (N.Y.), discussed some of the subgroups of gastroenterologists who may be at the highest risk of burnout.

Gender plays a strong role, and female gastroenterologists were more likely to identify themselves as being burned out, compared to their male peers. “They may be at risk in the lower domain for a sense of personal accomplishment,” said Dr. DeCross.

“There are respect issues that may come into play, as the literature shows,” he said. “For example, women are more likely to be addressed by their first name by patients and their peers. Also, even at meetings such as this one, how many times is a female presenter simply introduced by her first name?”

There are implicit respect issues here, said Dr. DeCross. “How many times do we hear something like, ‘and now the lovely Millie will present her findings on …?’ ”

He noted that he didn’t think that this lack of respect is intentional, but that it is happening. In addition, there is an issue of wages, and reported data show that women gastroenterologists earn 15% less than their male peers, he noted.

Women are more likely to have competing elements of family and career that put them on the slower track to promotion, he added.

The duration of one’s career also figured into the equation. Burnout was more noticeable early in the career process, suggesting that physicians with young families may be facing more conflicts and stress, and this is an issue that needs to be further explored, he noted.

“Early in the career, there is also the stress of proving oneself,” said Dr. DeCross.

Another contributor to burnout is when physicians spend an increasing amount of time on weekends and holidays doing work-related activities, along with an increase in internal regulatory burdens in the workplace.

Digestive Disease Week^® is jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE), and the Society for Surgery of the Alimentary Tract (SSAT).

Physician burnout common, not readily recognized