From Winter to Spring: Burnout and Depression in Medicine

It’s incredible how much can change in a week.  Last week, it was pitch black during my morning commute.  By the time I got out to drive home?  Pitch black again.  It was cold, especially by Southern standards.  The joy of the holidays was long gone, the motivation of a new year had disappeared, and the world was dark, cold, monotonous, and frankly loathsome.  A few days ago, though, I started seeing sunrises on my way to work.  The beginning evening commute was done by the light of dusk, not streetlights.  It’s warmer here in Nashville - you still need a coat, but not layers and layers of warmth-giving bulk.  A sign of things to come?  Spring is on its way, no matter what Punxsutawney Phil says?  I’m hopeful.  Unfortunately, the “loathsome” never ends abruptly.  Punctuating the dark, cold monotony?  Medscape’s Physician Burnout & Depression Report 2024. 

Let’s start with the good news.  We’re less burned out and depressed than we were last year:

And that’s about it for the “good,” unfortunately.

As in previous years, you incredible emergency medicine docs (who see unpredictable chaos and step forward when everybody else is stepping back) are more burned out than the rest of us.

I’m constantly surprised by how many pediatricians are burned out year after year: it’s not because I don’t feel burned out from time to time or see burnout in my colleagues.  It just seems so antithetical to the conception of somebody who hangs out with kids all day (unquestionably a patient cohort where chances of good outcomes are way more likely than not).  I’ve never cared much for sad clowns, but maybe there’s a psychology there that I need to examine.

The reasons cited for burnout are no surprise.  I honestly think these have been the same since the research on burnout in medicine began:

Before we talk about solutions, we need to take a moment to talk about something more serious than burnout: far too many of us are depressed.

Just because a third of us are clinically depressed does not mean it’s “normal” or an “occupational hazard.”  Please just take a second and use MedCalc’s PHQ-9 to see where your risk for depression falls.  It’s amazing how resilient we are, how we just “get used to” feeling a certain way (even when it doesn’t feel great).  If you find your mood meets the criteria for clinical depression, please find a psychiatrist, psychologist, therapist, or counselor as fast as possible.  Don’t just try to fix it yourself.  Do two things simultaneously: do what you can to fix it WHILE getting the help of a mental health professional.  If you are thinking of harming yourself, please call or text 988 the 988 Lifeline.  This world is better with you in it; I know it.

Okay, the situation isn’t great.  However, physicians are really great at fixing problems that do not seem fixable.  The usual suspects are named when participants relayed how they mitigated their burnout and/or depression: exercise, time with family and friends, resting, introverting out, and making time for hobbies all make the list.  The things physicians identify as workplace interventions that would be most helpful in reducing burnout can seem pie-in-the-sky at first, but they offer essential insight into what next steps we can take to help Medscape’s numbers continue their fledgling downward trend.

The key to this exercise is identifying what’s in your control from the above list.  Unless you’re in the C-suite-iest of the C-suite positions, you probably don’t have much say regarding compensation or adding support staff.  But how could you make your work schedule more flexible?  It might take some trial and error, but you could find a win for you and all of your partners.  Or how could you use the autonomy you have regarding how your practice is run?  The last low-hanging fruit may taste bitter but also intensely, profoundly productive, and satisfying when enjoyed: when I want more respect from others, I must practice showing more respect to others.

This survey has a lot to unpack; mine is not the only commentary out there.  I wonder, though, what if your winter of burnout or depression is coming to an end?  What if you’re starting to see a sunrise and are toying around with embracing the agency you’ve earned, having worked tirelessly to be a member of this still-exalted profession?  There may be frost on the ground, but warmer weather is coming.  You may be burned out or depressed, but an entire community of us is pulling for you.  Shed some layers.  Breathe in some new air.  Move forward for yourself and with all of us.