Physician Burnout During the COVID-19 Pandemic

The work of a physician is draining both physically and mentally. In 2018, the rate of suicide and depression amongst physicians was approximately 300-400 physicians per year in the United States. About 19% of resident physicians have been diagnosed with depression, in comparison to 7.1% of the general population. The US is not the only country experiencing this crisis, as there have been reported elevated incidences of depression and suicide in countries such as China, Australia, Norway, and Finland. The main factor contributing to physician suicidality is “burnout”, which essentially means emotional exhaustion, depersonalization, and the inability to feel self-accomplishment. Burnout not only places physicians at an elevated risk of suicide, but it can impair their memory and relationships with their patients. The Agency for Healthcare Research and Quality reports that a chaotic work environment, time pressure, and difficulty in balancing family life have a strong correlation with reported feelings of stress amongst physicians. However, the COVID-19 pandemic has pushed the boundaries for every healthcare worker, bringing a sharp rise in the rate of physician suicide and burnout.

The initial months of the COVID-19 pandemic were characterized by deep fear due to limited knowledge of the SARS-Cov-2 virus. Frontline workers, including paramedics, nurses, and other healthcare professionals were constantly witnessing death, while still needing to care for critically ill patients. Further, physicians had to manage the fear of contaminating their friends, family members, patients, and themselves. With greater work hours, a heavier emotional burden, and a lack of sense of control and emotional support due to self isolation, we will most likely see increased rates of physician burnout, depression, and suicide. 

Dr. Lorna M. Breen, a 49-year old emergency room physician at New York-Presbyterian Allen Hospital, tragically passed away due to self-inflicted injuries on April 26, 2020. Dr. Breen’s father indicated that Dr. Breen did not have a reported history of mental illness, but appeared detached shortly before her death. Prior to her death, Dr. Breen was working extremely long shifts to compensate for the hospital’s severe shortage of staff. Dr. Breen was diagnosed with COVID-19 in March 2020, but returned to work after a week and a half of recovering due to feeling guilty from not being able to help her patients. Unfortunately, Dr. Breen was only one of the many cases of suicide due to COVID-19-related stress that were reported. The physician suicide crisis is worldwide and is rapidly worsening. More recently, Dr. Karine Dion, an emergency room physician in Quebec, passed away due to suicide in January 2021. Dr. Kion’s family indicated that the immense stress related to the COVID-19 pandemic led to her suicide. Dr. Katy Kamkar, a clinical psychologist in Toronto, described the stress that physicians are experiencing during the pandemic as causing an overwhelming sense of powerlessness and helplessness. 

Out of all of the professions in the United States, physicians have the highest rate of suicide. To excel in the field, it is commonly believed that one should be mentally tough, never display any signs of struggle, and to focus on one’s mental health last. Psychologist Steven Cohen, PsyD, indicates that, “sudden, intense feelings of helplessness and hopelessness can provide suicidal thoughts even in people without any underlying mental conditions.” This is why it is crucial to be aware of the early signs of depression and suicide, as the tremendous stress brought on by the COVID-19 pandemic can be instantly overwhelming. 

What is being done to alleviate the crisis? Over the years, programs aimed at improving the mental health of physicians have been implemented, for example, the Missouri Physician Health Program. Such programs increase screening measures and mental health education and provide access to therapeutic resources. A study conducted in 2016 showed that individual-focused and organizational strategies have displayed a significant decrease in physician burnout. While this result may prove to be optimistic, it is still uncertain whether treatment and prevention measures are effective during the COVID-19 pandemic where physicians are working more hours and there is less personnel to conduct screening. 

References:

Andrew, Louise B. “Physician Suicide.” Edited by Barry E Brenner, Medscape, WebMD, 1 Aug. 2018, emedicine.medscape.com/article/806779-overview. 

Ankel, Sophia. “A New York ER Doctor Who Felt Guilty That She Couldn't Help after She Was Diagnosed with the Coronavirus Died by Suicide.” Insider, Insider, 12 July 2020, www.insider.com/new-york-doctor-died-suicide-due-to-coronavirus-stress-work-2020-7. 

Arespacochaga, Elisa. “Shining a Light on Physician Suicide: AHA News.” AHA News, American Hospital Association, 17 Sept. 2020, www.aha.org/news/blog/2020-09-17-shining-light-physician-suicide. 

Bernard, Rebekah. “Coping With Physician Depression in the Era of COVID-19.” Targeted Oncology, Targeted Therapies in Oncology, 19 July 2020, www.targetedonc.com/view/coping-with-physician-depression-in-the-era-of-covid-19. 

Kingston, Amanda M. “Break the Silence: Physician Suicide in the Time of COVID-19.” Missouri medicine vol. 117,5 (2020): 426-429.

Lieberman, Caryn. “Coronavirus: Quebec Doctor's Death by Suicide Sends Shockwaves through Canada's Medical Community.” Global News, Corus Entertainment Inc. Corus News, 12 Jan. 2021, globalnews.ca/news/7569318/coronavirus-doctor-karine-dion/. 

“Physician Burnout.” AHRQ, Agency for Healthcare Research and Quality, July 2017, www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html. 

Watkins, Ali, et al. “Top E.R. Doctor Who Treated Virus Patients Dies by Suicide.” The New York Times, The New York Times Company, 27 Apr. 2020, www.nytimes.com/2020/04/27/nyregion/new-york-city-doctor-suicide-coronavirus.html. 

West, Colin P et al. “Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis.” Lancet (London, England) vol. 388,10057 (2016): 2272-2281. doi:10.1016/S0140-6736(16)31279-X