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Letter to the Wellness Section and ACEP: A psychiatrist gives thanks to emergency physicians

Steven Moffic, MD

No, this isn’t a thank you note for saving my life, though many years back you did successfully address the fear that I was dying when it turned out that I had kidney stones. Perhaps my field has reciprocated in kind at times, and helped prevent a suicide in an emergency physician. But this newer story is about something else.

Several years ago, I was getting more and more frustrated in my work as a clinical psychiatrist. In my main system of care, administrators were decreasing the time allowed to see patients. A new electronic health record requirement took up half of that limited time and seemed to add little of value. For the first time in my career, some patients complained that I didn’t spend enough time with them. When I complained to administration, they replied: “you eat what you kill”!

What a demoralizing change from the years when I won awards for my clinical care. I knew it wasn’t from a deterioration in my clinical skills as I got much positive feedback from a bit of work in smaller systems that were more supportive of clinical needs.

I felt emotionally exhausted. It took longer to recoup outside of work. I didn’t want to start over in another system or establish a solo practice. So I retired almost 5 years ago.

I was 66 and could get Medicare, as could my wife. Though I always looked forward to retiring to spending more time with her, this was years earlier than I expected. I hoped the money we saved would last the necessary years.

Within weeks, even days, I felt so much better. I slept better, felt emotionally lighter, and started to increase my professional writing and speaking.

I had enough emotional energy and time to devote to other people. One of them was your own Randall Levin, MD, FACEP-Life, who had retired some years before me. As we became new best friends, I learned from him what happened to me. I had burned out.

Burned out? I never had heard of that while working. I learned, though, that over the past decade, the rate of burn-out of physicians had reached epidemic proportions. Emergency physicians had among the highest percentage. Psychiatrists were on the low side, but that could reflect that more of us were in solo practice, rather than in a system. Even so, our percentage of burnout had approached 40%.

I learned how much other specialties, especially yours, were addressing this challenge. The American College of Emergency Physicians (ACEP) had established a Well-Being Committee, a Wellness Section, had a Wellness Section newsletter edited by Dr. Levin, and a Wellness Week. By contrast, we in organized psychiatry were doing nothing.

Unfortunately, despite other specialties trying to prevent and reduce burnout, surveys like those of Medscape indicate that the rates are still increasing. The major causative factor seems to be the systems that seem to thwart what clinicians know they can do to help in their calling to be healers. That saps our spirit. Though paying more attention to personal well-being could help a bit, it wasn’t nearly enough and could have the paradoxical affect of blaming the victims.

That made me wonder whether psychiatry could add some special expertise. As experts in the classification and understanding of psychological problems, couldn’t we clarify the nature of burnout? Was it a process of varying intensity, listed as a health care problem in ICD 10? Or, was it a full-blown disorder that should be listed in our next revision of DSM 5, psychiatry’s manual of disorders? Or something different? Were there certain psychological processes like denial, counter-phobic responses, and learned helplessness that needed to be understood better and countered?

Even if I was no longer seeing patients, I felt I still had an ethical obligation to help my colleagues, and now the energy and time in retirement to do so. So I reached out and advocated to other psychiatrists and our major organizations over the last four years. I gradually found other psychiatrists who felt the same and wanted to do something about it.

Recently, our American Psychiatric Association decided to formally become involved. We have set up a Wellness/Burnout Ad Hoc Workgroup to work on this challenge. It is related to our Council on Medical Education and Lifelong Learning. We are setting up conference calls and a live meeting at our annual meeting in May, where I will also continue to give presentations on physician burnout.

So, on behalf of all psychiatrists:

I give thanks to Dr. Levin.

And I give thanks to the American College of Emergency Physicians.

I hope our specialties and spirits will work together in the future to stem this epidemic. In the meanwhile, be well.

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