Strategies for Addressing Physician Burnout and Stress-Related Illness

The everyday duties of practicing medicine can amount to “‘a continuing attack,'” according to an American Medical Association report released in 2022.

Physician burnout and the number of physicians planning to leave their employment, which was already high before the COVID-19 epidemic, have grown in the aftermath of the pandemic. A study of more than 20,000 US doctors and advanced practice clinicians indicated that burnout grew from 45% in 2019 to 60% in late 2021, and that desire to leave medicine increased from 24% to more than 40% during the same period.

According to Forbes, 47% of all healthcare workers will have left the industry by 20253, and the Association of American Medical Colleges expects a possible shortfall of up to 48,000 primary care physicians and 77,100 specialists in the United States by 2034. 4

According to Robyn Tiger, MD, DipABLM, “a flawed health care system” that prioritizes the number of patients treated above the quality of treatment delivered is fueling these expected mass retirements and physician shortages. Dr. Tiger is the founder of StressFreeMD, which provides the CME-accredited course Rx Inner Peace: A Physician’s Guide to Self-Care. He is a radiologist who practiced medicine for 15 years before transitioning into lifestyle medicine.

“With physician stress, anxiety, despair, and burnout on the rise, and having personally lost three medical colleagues to suicide,” said Dr. Tiger, who began working with physicians and others on stress alleviation and self-care after conquering her own stress-related ailments. She is presently a subject matter expert in stress management for the American College of Lifestyle Medicine, as well as a member of the North Carolina Medical Society’s Wellness and Resilience Committee and the Western Carolina Medical Society’s Healthy Healer Program.

Dr. Tiger explores the impact of burnout and stresses on physicians in the following in-depth interview, as well as what may be done to alleviate this issue.

What types of problems do you observe among the doctors you deal with?

They are emotionally and physically drained, they lack self-worth, and they are unsure of the significance of their own existence. They are even concerned that they made the wrong decision by studying medicine. Burnout is defined as having three components: emotional weariness, cynicism, and a lack of self-esteem. All of this and more are described by doctors. They are nervous, and reactive, and say and do things they wish they could undo. They are dissatisfied, and many claims reduced libido – I hear this a lot. It’s also harming their personal life; their children don’t want to be near them, and many are about to or have divorced. It’s causing havoc and is really difficult.

Some argue that physician burnout is a systemic issue that cannot be solved only via self-care.

What are your opinions about it?

There are two critical components here: First, the healthcare system must evolve. I know that several large institutions, including our government, are attempting to accomplish this via a national agenda for physician well-being.

Aside from that, doctors, as humans, need to be taught how to be the best version of themselves, so they don’t get sick from chronic stress and can take care of others while living the life they deserve.

I’m not at the point where I can make national reforms throughout the healthcare system; instead, I’m thinking about how we can educate people. Rx Inner Peace is a CME-accredited program that is supported by 10 pages of cited material. The curriculum does not simply instruct you to “practice yoga”; it teaches you everything you need to know to become the healthiest version of yourself in order to avoid or reverse disease.

What prompted you to go from practicing medicine to dealing with burnt-out doctors?

Tiger, Dr.: Several years into [my medical profession], I began to experience a variety of ailments and symptoms that I couldn’t quite a piece together. They appeared disjointed, and they did not all occur at the same moment. I suffered severe dizziness, tinnitus, difficulties sleeping, and bleeding gums. I also suffered severe reflux, excruciating chest pain, and migraine migraines with violent vomiting.

My joints, muscles, and everything else began to hurt. Every day, I felt as if I couldn’t move, as if I were caught in this rigid body. There was no trauma, only agony. My hands, feet, and back would have paresthesia at the most inconvenient moments. I’d be doing a breast biopsy and wouldn’t be able to feel the biopsy gun in my hand.

I saw gastroenterologists, who placed me on medicines. I saw a neurologist, and they placed me on medication. I saw the periodontist, who was injecting antibiotics into my gums. I was on a lot of medicine and had a lot of imaging tests. I was getting everything scanned as a radiologist, and the findings were all negative. All of my blood tests came back negative, and no one could tell what was wrong with me. Every doctor regarded me as a symptom to be treated with a drug. I also consulted a physical therapist and a physiatrist for the discomfort. Nobody was able to figure it out.

The pain was so great that I didn’t want to endure it any longer, and I had lost three medical friends to suicide…

Two of them overdosed, and one leaped from a bridge. That was something I didn’t want to happen to me. My own family and friends had no idea what was going on with me since I kept everything to myself. I did see a mental health professional, but it didn’t help.

That’s when I realized I could either continue on my current road and wind up like those coworkers, or I could strive to figure out how to improve myself. I kept hearing about things like yoga and meditation and felt they were strange. Nonetheless, after working a whole day and being really spent, I went to a yoga class, and by the conclusion of the first session, I felt peaceful, grounded, and clear, and I was alert — I wasn’t even tired. That was my first “aha” moment.

My left brain wanted to understand what caused this 180-degree shift so swiftly, so I continued to attend workshops to learn more. To learn more, I chose to enroll in yoga teacher training. As I proceeded with my lessons and teacher training, the symptoms I described improved.

Then I learned about the profession of yoga therapy, where I could apply the ideas I learned in yoga to treat patients with a variety of symptoms, ailments, and disorders. All of my ailments vanished completely as a result of that training and continued yoga therapy. I later earned certifications in meditation and life counseling.

I’m also certified by iRest, a sort of meditation developed for Walter Reed Army Hospital to treat our service members suffering from post-traumatic stress disorder.

I recognized that the diagnosis that no one made was that I had chronic stress. When I discovered how to reduce stress and deal with my own body and mind, I was able to alleviate the symptoms I was feeling, which are today classified as burnout.

How long have you been working on stress and burnout alleviation with other providers, and what type of benefits have you seen?

I retired from medicine in 2012 and have been working in this field for over a decade. I had been working with a variety of communities, including cancer patients, first responders, war veterans, health care professionals, and anybody else who needed assistance. When the epidemic struck in 2020, I realized I wanted to assist my colleagues [and] shifted my emphasis to physicians exclusively. I’m not sure how many people I’ve worked with, but it’s in the thousands.

The outcomes have been astounding. “I’m sleeping comfortably for the first time in decades,” doctors remark, and “my body no longer feels like the tin man.” “Because of you, my marriage was saved,” they’ve said, “I discovered joy in medicine again,” and “my kids want to spend time with me again.”

I essentially teach what we were never taught in medical school: how to manage your nervous system and work with your ideas; it’s a two-part, mind-body approach for me. My role is to assist [physicians] in assisting themselves. I provide education, but they are the ones who are transformed.

Is there any data to support the efficacy of this method to stress and burnout management?

There is plenty of books available. That’s how I got into yoga therapy in the first place because when I started feeling better, I looked into the medical literature to figure out why. I was amazed to see so many publications in our own medical literature regarding the advantages and improvements that disciplines like yoga therapy and meditation can bring about for a wide range of symptoms, ailments, and diseases.

There have also been randomized clinical trials on coaching, as well as a large amount of literature on the subject. For example, the Cleveland Clinic recently announced that they saved $133 million in retention [using a peer-based coaching and mentoring program boosting clinician well-being], because every physician who quits costs the medical system up to a million dollars. 10,11

Is there anything else doctors should know about dealing with stress and burnout?

I’d like physicians to know that they’re not alone if they’re experiencing any or all of the symptoms I’ve mentioned. It is not acceptable, yet it is usual.

Resources

• 988 Suicide & Crisis Lifeline | SAMHSA
• Preventing physician suicide | American Medical Association
• Suicide Prevention and Emergency Help | AAFP
• Physician Support Line and their resource list: Physicians Who Need Help
• AMA Steps Forward: Transform your Practice