August 8, 2017

The American Psychiatric Association Follows Emergency Physicians Into Burn-out

As I wrote in the last issue of this Newsletter, all the work the ACEP has been doing on wellness and burn-out has inspired me and my American Psychiatric Association (APA). At last, that has led to the establishment of an official Workgroup on psychiatrist and physician Wellbeing And Burnout. To greatly simplify our differences, you are physicians of action, we of thinking, and sometimes we think too long before we take action. Nevertheless, despite your actions on this challenge, your rate of being burned out continues to climb at the top of the specialties, whereas ours, while on the low end at 42% (according to Medscape) is still almost half of us.

I have to wonder. Just think what we physicians of action and thinking can do together! We can be unbeatable.

Here’s what happened at our first live meeting at our major annual meeting of the APA, this year May 20-24. These are some of our plans in process. 

1. A Task Group on Assessment Scales

This group is working on the identification of the best burn-out and depression measures that can be used in an online portal. We should be able to make a good decision on that, since various mental health professionals designed all of these scales. We do need a commonly accepted scale in order to be able to benchmark how we are doing over time and different settings.

Please note that burn-out and depression should be considered as two separate challenges, with only occasional overlap. Actually, the available research studies, as limited as they are, suggests that burn-out is more related to trauma and PTSD than to depression.

2. Task Group on Feedback Resources and Research

This group is working on the “decision tree” for the portal to guide usage of educational content that should be helpful to members. Some might provide CME’s. We think that links to a potential Ted Talk and short videos would be an important contribution in our visually-oriented age.

3. Task Group on APA Members and Other Specialties

Here’s where you come in. 

This group is first of all to put together an overall concept map and framework. This group should also tease out potential differences in burn-out and mental disorders in regards to gender, ethnicity, and age of the physician, as well as different kinds of systems. We need to know what protects certain physicians, both in their make-up and/or the nature of the system.

We need to also connect with administrators who not only are the key bridge between clinicians and system ownership, but are also burning out in similar rates. Administrators should not overly rely on so-call wellness programs, as they will only have limited impacts and can distract from improving the systems as regards their responsibility for burn-out. Moreover, wellness programs will do virtually nothing to help clinical depression and other mental disorders, tragically including that physicians have the highest rate of suicide of any profession.

When ready, we psychiatrists need to connect with other medical specialties, especially if we can contribute our special knowledge and skills, including remedies like Balint groups. I thank you for allowing me to test out such a relationship.

Finally, we think the public needs to be educated as to what is happening to their physicians, as their own quality of care is getting compromised. We need the public’s support, concern, and power to make the political changes necessary to improve our healthcare systems. Firing your physician if you think he or she is burned out, as the CEO of Mayo’s Clinic has suggested, is not what we need from the public or our CEOs.

4. Special Additional Recommendation: Town Hall Meetings

At the recent APA meeting, our Workgroup held a Town Hall meeting asking for the reactions of members to these challenges. Without much publicity at all, this session had an overflow attendance and a never-ending lineup to speak. All felt this opportunity to ventilate, hear from colleagues, and share potential solutions was invaluable and needed to be repeated.

Of all that we psychiatrists did at the meeting, this is the one that I would most recommend to ACEP. Do it at your upcoming annual meeting. It is a parallel example of what a clinical system needs to do to engage its clinicians. In other words, specialty professional organizations like ours also need to find ways to engage and empower their members regarding wellness, burn-out, and/or mental illness.

Have a summer that can help restore your spirit as much as possible!

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