President's Message: Doris Gundersen, MD, August 2014

Friday, August 1, 2014

Why Focus on Physician Wellness?

“In no relationship is the physician more derelict than in his duty to himself.” —Sir William Osler

Most physicians who enter medicine are intellectually curious, enthusiastic, and industrious workers. We choose to lead a life of service with all the attendant rewards. We are afforded the privilege of taking care of patients, making a meaningful difference in the lives of others by curing illnesses or, at the very least, diminishing pain and suffering. We are members of a respected profession and, despite shrinking reimbursements, receive comfortable remuneration for the work we love to do.

Becoming a physician requires innumerable hours of training and studying to master the art. Individuals who choose medicine as a career are by definition high achievers, given the competitive nature of the entrance requirements. We put pressure on ourselves with little tolerance for error. The practice of medicine requires intense dedication and self-sacrifice. Patients are struck by serious illnesses every day, including holidays. Babies are born at unpredictable times. Suicidal patients call any and all hours of the night. Physical trauma is commonplace and infectious diseases can quickly become widespread, creating a community if not global crisis. We prepare ourselves for these scenarios and accept the fact that life will not always be easy.

However, nothing has prepared us for the challenges accompanying our evolving health care delivery system. Prior to the 1960s, medicine was primarily viewed as “a calling.” There was something sacred about being a doctor. It was an honor to serve patients in an intimate way. Over the last several decades, the profession of medicine has collided with a corporate philosophy in which maximizing profits has become a high priority. There is the expectation for physicians to see “the sicker quicker.” With evolving health care structures, physician autonomy has decreased. Physicians who encounter excessive restrictions on their decision making often report increased stress and job dissatisfaction, particularly in the absence of malpractice reform. Other sources of stress include unsettled issues regarding health care reform, arguments with insurance companies about coverage for appropriate treatment, the introduction of electronic medical records, and third party intrusions. The list goes on and on.

It is not surprising that physicians are experiencing high rates of burnout, addiction, depression, and suicide. In a 2001 Kaiser Family Foundation survey of 2,608 physicians, 87% agreed that physician morale had declined in the preceding five years ( In a recent study of more than 4,000 medical students surveyed from seven U.S. medical schools, 50% endorsed symptoms of burnout within the preceding year. Burnout characterized by emotional exhaustion, depersonalization, and a sense of inefficacy can lead to depression. The lifetime prevalence of depression in physicians is approximately 13% for males and 19.5% for females. Of significant concern, male physicians have a suicide rate 40% higher than the general population. Female physicians have a suicide rate 130% higher than the general population. In this country, approximately 250 physicians commit suicide annually.

Historically, the house of medicine has given low priority to the health needs of its own. Implicit in traditional medical culture was the tacit assumption that professional demands would always trump a physician’s personal needs. Consequently, we tend to self-diagnose and selfprescribe. We are less likely to have a relationship with a primary care physician, resulting in a fundamental risk factor for poor health. While counterintuitive, physicians tend to receive poor health care.

There is growing awareness that physician wellness is vital to patient safety and the delivery of high-quality health care. Personal well-being may actually enhance professionalism including empathy and compassion. Physicians in good health are more likely to counsel patients about healthy habits. Modeling healthy lifestyles to our patients is critical, especially considering that chronic and costly diseases such as diabetes, obesity, heart disease, and depression are at an all-time high.

When physicians are unwell, the overall performance of a health care system suffers. Sleep deprivation can be more incapacitating than a high blood alcohol concentration. Call-associated fatigue is related to increased error rates in the cognitive skill domain for surgeons. Fatigue and sleep deprivation increase the risk of percutaneous needle sticks, near-miss incidents, medical errors, and physician motor vehicle accidents. Fatigue and sleep deprivation can lead to burnout that is associated with reduced productivity and inefficiency. Physicians who are highly unsatisfied with their work have an increased probability of changing jobs within the medical field or leaving medicine altogether, leading to increased costs for physician recruitment and retention. The cost of replacing a physician is estimated to be between $150,000 and $300,000. With an aging population, the cost of physician shortages is immeasurable.

Aside from the practical implications of a healthy workforce, physicians are deserving of the same sensitivity and caring they provide to their patients. A medical culture that acknowledges the human frailty of its physicians and does not punish or ostracize them for seeking help is worthy of our efforts to create. Fortunately in Colorado, the Department of Regulatory Agencies (DORA) and the Colorado Medical Board (CMB) recognize that punishing ill physicians does not make them well. Physicians who seek assistance from the Colorado Physician Health Program do not need to disclose their health condition when applying for or renewing medical licensure. This strict confidentiality has led to fewer complaint-driven referrals and more proactive self-referrals.

In contemporary quality improvement campaigns, the phrase “every patient matters” is often employed. I believe that every physician matters! We need one another; we are responsible for one another and our work affords us the privilege to attend to that truth every day. I would like to take this opportunity to express my enthusiasm as I embark on the presidential path of the FSPHP. I am grateful to have the support of talented members of the board of directors and hardworking committee chairs and committee members. In future publications, I plan to share more about the activities of the FSPHP and our progress in advancing the health of physicians. Stay tuned!

--Doris Gunderson, MD
President, Federation of State Physician Health Programs
Medical Director, Colorado Physician Health Program

Frank, E. “Physician Health and Patient Care.” JAMA, 2004; 29(5)637. 
“Physician Depression and Suicide.” Physicians Insurance, March 2008. Wallace, J, et al. 
“Physician Wellness: A Missing Quality Indicator.” Lancet Vol 374, Nov 2009. West, C. et al. 
“Physician Wellbeing and Professionalism.” Minnesota Medicine, August 2007. Morrow, C., et al. 
“Practitioner Wellbeing.” Behavioral Medicine in Primary Care, Chapter 9.