If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing \u201c988,\u201d or the Crisis Text Line by texting \u201cHOME\u201d to 741741.<\/em><\/p>\n

CHARLESTON, S.C. \u2014 Melanie Gray Miller, a 30-year-old physician, wiped away tears as she described the isolation she felt after losing a beloved patient.<\/p>\n

\u201cIt was at the end of a night shift, when it seems like bad things always happen,\u201d said Miller, who is training to become a pediatrician.<\/p>\n

The infant had been sick for months in the Medical University of South Carolina\u2019s pediatric intensive care unit and the possibility that he might not improve was obvious, Miller recalled during an April meeting with physicians and hospital administrators. But the suddenness of his death still caught her off guard.<\/p>\n

\u201cI have family and friends that I talk to about things,\u201d she said. \u201cBut no one truly understands.\u201d<\/p>\n

Doctors don\u2019t typically take time to grieve at work. But during that recent meeting, Miller and her colleagues opened up about the insomnia, emotional exhaustion, trauma, and burnout they experienced from their time in the pediatric ICU.<\/p>\n

\u201cThis is not a normal place,\u201d Grant Goodrich, the hospital system\u2019s director of ethics, said to the group, acknowledging an occupational hazard the industry often downplays. \u201cMost people don\u2019t see kids die.\u201d<\/p>\n

The recurring conversation, scheduled for early-career doctors coming off monthlong pediatric ICU rotations, is one way the hospital helps staffers cope with stress, according to Alyssa Rheingold, a licensed clinical psychologist who leads its resiliency program.<\/p>\n

\u201cOften the focus is to teach somebody how to do yoga and take a bath,\u201d she said. \u201cThat\u2019s not at all what well-being is about.\u201d<\/p>\n

Miller says working in the hospital\u2019s pediatric intensive care unit can be tough. \u201cIn medicine, we\u2019re just expected to be resilient 24\/7,\u201d she says. The trauma and stress from patients dying can be particularly hard to process.<\/figcaption><\/figure>\n
Burnout in the health care industry is a widespread problem that long predates the covid-19 pandemic, though the chaos introduced by the coronavirus\u2019s spread made things worse, physicians and psychologists said. Health systems across the country are trying to boost morale and keep clinicians from quitting or retiring early, but the stakes are higher than workforce shortages.<\/p>\n
Rates of physician suicide, partly fueled by burnout, have been a concern for decades<\/a>. And while burnout occurs across medical specialties, some studies<\/a> have shown that primary care doctors, such as pediatricians<\/a> and family physicians, may run a higher risk.<\/p>\n
\u201cWhy go into primary care when you can make twice the money doing something with half the stress?\u201d said Daniel Crummett, a retired primary care doctor who lives in North Carolina. \u201cI don\u2019t know why anyone would go into primary care.\u201d<\/p>\n
Doctors say they are fed up with demands imposed by hospital administrators and health insurance companies, and they\u2019re concerned about the notoriously grueling shifts<\/a> assigned to medical residents during the early years of their careers. A long-standing stigma keeps physicians from prioritizing their own mental health, while their jobs require them to routinely grapple with death, grief, and trauma. The culture of medicine encourages them to simply bear it.<\/p>\n
\u201cResiliency is a cringe word for me,\u201d Miller said. \u201cIn medicine, we\u2019re just expected to be resilient 24\/7. I don\u2019t love that culture.\u201d<\/p>\n
And though the pipeline of physicians entering the profession is strong, the ranks of doctors in the U.S. aren\u2019t growing fast enough<\/a> to meet future demand, according to the American Medical Association. That\u2019s why burnout exacerbates workforce shortages and, if it continues, may limit the ability of some patients to access even basic care. A 2021 report published by the Association of American Medical Colleges projects the U.S. will be short as many as 48,000<\/a> primary care physicians by 2034, a higher number than any other single medical specialty.<\/p>\n
A survey published last year<\/a> by The Physicians Foundation, a nonprofit focused on improving health care, found more than half of the 1,501 responding doctors didn\u2019t have positive feelings about the current or future state of the medical profession. More than 20% said they wanted to retire within a year.<\/p>\n
Similarly, in a 2022 AMA survey<\/a> of 11,000 doctors and other medical professionals, more than half reported feeling burned out and indicated they were experiencing a great deal of stress.<\/p>\n
Those numbers appear to be even higher in primary care<\/a>. Even before the pandemic, 70% of primary care providers and 89% of primary care residents reported feelings of burnout<\/a>.<\/p>\n
\u201cEveryone in health care feels overworked,\u201d said Gregg Coodley<\/a>, a primary care physician in Portland, Oregon, and author of the 2022 book \u201cPatients in Peril: The Demise of Primary Care in America.\u201d<\/p>\n
\u201cI\u2019m not saying there aren\u2019t issues for other specialists, too, but in primary care, it\u2019s the worst problem,\u201d he said.<\/p>\n
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The high level of student debt most medical school graduates carry, combined with salaries more than four times as high<\/a> as the average, deter many physicians from quitting medicine midcareer. Even primary care doctors, whose salaries are among the lowest<\/a> of all medical specialties, are paid significantly more than the average American worker. That\u2019s why, instead of leaving the profession in their 30s or 40s, doctors often stay in their jobs but retire early<\/a>.<\/p>\n
\u201cWe go into medicine to help people, to take care of people, to do good in the world,\u201d said Crummett, who retired from the Duke University hospital system in 2020 when he turned 65.<\/p>\n
Crummett said he would have enjoyed working until he was 70, if not for the bureaucratic burdens of practicing medicine, including needing to get prior authorization from insurance companies before providing care, navigating cumbersome electronic health record platforms, and logging hours of administrative work outside the exam room.<\/p>\n
\u201cI enjoyed seeing patients. I really enjoyed my co-workers,\u201d he said. \u201cThe administration was certainly a major factor in burnout.\u201d<\/p>\n
Jean Antonucci, a primary care doctor in rural Maine who retired from full-time work at 66, said she, too, would have kept working if not for the hassle of dealing with hospital administrators and insurance companies.<\/p>\n
Once, Antonucci said, she had to call an insurance company \u2014 by landline and cellphone simultaneously, with one phone on each ear \u2014 to get prior authorization to conduct a CT scan, while her patient in need of an appendectomy waited in pain. The hospital wouldn\u2019t conduct the scan without insurance approval.<\/p>\n
\u201cIt was just infuriating,\u201d said Antonucci, who now practices medicine only one day a week. \u201cI could have kept working. I just got tired.\u201d<\/p>\n
Providers\u2019 collective exhaustion is a crisis kept hidden by design, said Whitney Marvin, a pediatrician who works in the pediatric ICU at the Medical University of South Carolina. She said hospital culture implicitly teaches doctors to tamp down their emotions and to \u201ckeep moving.\u201d<\/p>\n
\u201cI\u2019m not supposed to be weak, and I\u2019m not supposed to cry, and I\u2019m not supposed to have all these emotions, because then maybe I\u2019m not good enough at my job,\u201d said Marvin, describing the way doctors have historically thought about their mental health.<\/p>\n
This mentality prevents many doctors from seeking the help they need, which can lead to burnout \u2014 and much worse. An estimated 300 physicians<\/a> die by suicide every year, according to the American Foundation for Suicide Prevention. The problem is particularly pronounced among female physicians<\/a>, who die by suicide at a significantly higher rate than women in other professions.<\/p>\n
A March report from Medscape found, of more than 9,000 doctors surveyed, 9% of male physicians and 11% of female physicians said they have had suicidal thoughts<\/a>. But the problem isn\u2019t new, the report noted. Elevated rates of suicide among physicians have been documented for 150 years.<\/p>\n
\u201cIronically, it\u2019s happening to a group of people who should have the easiest access to mental health care,\u201d said Gary Price, a Connecticut surgeon and president of The Physicians Foundation.<\/p>\n
But the reluctance to seek help isn\u2019t unfounded, said Corey Feist, president of the Dr. Lorna Breen Heroes\u2019 Foundation<\/a>.<\/p>\n
\u201cThere\u2019s something known in residency as the \u2018silent curriculum,\u2019\u201d Feist said in describing an often-unspoken understanding among doctors that seeking mental health treatment could jeopardize their livelihood.<\/p>\n
Feist\u2019s sister-in-law, emergency room physician Lorna Breen, died by suicide during the early months of the pandemic. Breen sought inpatient treatment for mental health once, Feist said, but feared that her medical license could be revoked for doing so.<\/p>\n
The foundation works to change laws<\/a> across the country to prohibit medical boards and hospitals from asking doctors invasive mental health questions on employment or license applications.<\/p>\n
\u201cThese people need to be taken care of by us, because really, no one\u2019s looking out for them,\u201d Feist said.<\/p>\n
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Miller says the first year of a medical residency is the hardest: \u201cBurnout starts very early.\u201d(Gavin McIntyre for KFF Health News)<\/span><\/figcaption><\/figure>\n
In Charleston, psychologists are made available to physicians during group meetings like the one Miller attended, as part of the resiliency program.<\/p>\n
But fixing the burnout problem also requires a cultural change, especially among older physicians.<\/p>\n
\u201cThey had it worse and we know that. But it\u2019s still not good,\u201d Miller said. \u201cUntil that changes, we\u2019re just going to continue burning out physicians within the first three years of their career.\u201d<\/p>\n
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