U.S. physicians report feeling down in the dumps

Burned out and discouraged, physicians in significant numbers have considered chucking their medical careers, according to the American College of Physician Executives' first Physician Morale Survey.

The Tampa-based ACPE represents about 10,000 physicians in the field of medical management. The organization's survey of 1205 physicians found work-related stress is causing physical and emotional burnout, marital discord, and depression. More than half of the survey participants are so close to the end of their rope that they are seriously considering leaving medicine.

The ACPE published survey findings in the November/December issue of The Physician Executive Journal of Medical Management.

Top survey findings show:

• Nearly 60% of participants have considered leaving the practice of medicine because they are discouraged over the state of U.S. healthcare today.

• Almost 70% said they knew at least one physician who stopped practicing medicine due to low morale.

• Low reimbursement, loss of autonomy, red tape, patient overload, loss of respect, and the medical malpractice environment represent the leading factors contributing to low morale.

Fatigue accounts for the leading morale buster at 77.4% followed by emotional burnout (66.7%), marital/family discord (34.2%), and depression (32.2%). The survey found that stress can bring some physicians to the brink. More than 4% entertained suicidal thoughts, and more than 2% resorted to substance abuse.

The survey was conducted across the country between July and August this year and included written statements by more than 300 participants. According to some of the commentaries published:

• "One thing that rarely gets mentioned is that, unlike other industries that are cyclical, the practice of medicine continually gets worse and worse, more intolerable, more onerous, with absolutely no hope or reason for any optimism either in the near or remote future."

• "Dealing with new faculty in an academic department is difficult because of unmet expectations, which is partly a generational issue. The red tape is huge, and lack of appreciation of physician expertise or value by administrators is the biggest key in morale. Little things go a long way, but when the docs don't see any leadership in the halls, the wards, near the OR, or in the lounges, they feel like a widget. Medical management or managers generally don't get it when it comes to dealing with docs, especially in an academic setting."

• "Med-malpractice always hangs over physicians. Having to order tests just to cover all bases (makes) medicine less enjoyable as (there is) no tolerance for misses in this society."

Some survey respondents say physicians themselves, and not the healthcare system, are to blame for low morale. An investigative report in the same issue of the PEJMM by David Ollier Weber notes that physicians generally do not take good care of themselves.

Weber cites a 2003 statement by the American Medical Association that says physicians' use of mental health services appears low. He found a report performed in 2002 showing that only about one in five medical students diagnosed with depression sought help. He also found a survey of Johns Hopkins School of Medicine graduates (mean age 61) showing that more than a third of them admitted to having no regular source of personal healthcare.

"That's twice the percentage of the public at large. Other studies have found that up to 56% of doctors don't have their own doctor." Weber said.

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