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DO Well Toolkit

Finding Your Reset Point

Living well

Tips from physicians on building resilience

DOs offer their strategies for addressing physician burnout and share lessons they've learned along the way.

Everyone in medicine, from medical school through retirement, could face depression, burnout or suicidal thoughts at some point in their training or career. In a recent study, more than half of physicians reported experiencing burnout and each year, roughly 300-400 physicians take their own lives.

If you identify with the warning signs of physician burnout or depression, or worry you’re headed down that path, it could be time to reevaluate your approach toward medicine and establish some new habits and boundaries.


5 keys to achieving work-life integration

For today’s physicians, it’s nearly impossible to separate the work of practicing medicine from a fulfilling home life. But that doesn’t mean either area of your life has to suffer. Here are 5 things to keep in mind.

  • Redefine "balance"

    Instead of balance, which puts work and life in competition with one another, think of your goal as work-life integration. As a doctor, work will likely be a major aspect of your life. Try to learn to work around it, or make work and life work together. Talk to your employer about flexible working arrangements or compressing weeks to allow for longer periods of time away from work.

  • Practice mindfulness

    Meditation can help students and physicians create a more thoughtful and less automatic response to stress, notes Ulrick Vieux, DO, MS, the psychiatry residency program director at Orange Regional Medical Center in Middletown, New York. However, mindfulness meditation takes practice, and it may take some time before physicians notice results, so this mental exercise may be more helpful to combat mild symptoms of burnout and depression.

  • Take a break

    Realize when you need a break by identifying common triggers. For many, being easily angered or consumed with stress is a signal that you could use time away. Ask yourself why you're acting differently and try to implement positive coping skills, such as meditation, yoga or anything that reduces your stress in a healthy way.

  • Be more social

    Social media, that is. Physicians must be mindful of the type of information they make public on social networks. It's visible to patients and employers alike. However, when used carefully, social media can be a great way to maintain contact with friends and family. It's a platform to express views about who you are and how you practice. And, it can be a great resource to help connect you with peers who are experiencing similar professional challenges.

  • Talk to your family

    Your spouse and children have responsibilities outside of medicine, which can make balancing family activities and priorities difficult. Talk to your family, especially your spouse, about the difficulties you are facing. This will help alleviate some of the stress when things become rough. With children, communicate early that you will miss some important events, but will schedule time for special family activities.


Recommended for physicians by physicians

Mindfulness guides

Mindfulness is defined as the mental state you achieve when you focus your awareness on the present moment, while calmly acknowledging and accepting your feelings, both mental and physical.

 

 

Meditation apps

  • Calm: This web-based app facilitates meditation through soothing images, audio and instruction. Opt for 2-, 10- or 20-minute sessions.
  • Buddhify: Mobile app providing mindfulness-based meditation through a series of guided lessons.
  • Insight Timer: Home to more than 3.7 million meditators, this free meditation app can be downloaded via Android and iOS stores.
  • Simple Habit: Meditation app for busy individuals looking to reduce stress, improve focus, improve sleep, relax faster and breathe easier. The app provides 5 minute exercises, making it easy to fit mindful moments into busy lifestyles.
  • Headspace: Hundreds of themed sessions of everything from stress to sleep. Bite-sized meditations for busy schedules.

Deep breathing exercises

 

Sensory counting

  • Focus on one stimulus (something you see, hear, smell or feel)
  • Block everything else out
  • Focus on every aspect of that stimulus, then notice your other senses

Therapy worksheets

Worksheets related to:

  • CBT
  • Self-esteem
  • Anger

Learn more

 

Books

  • Wherever You Go, There You Are by Jon Kabat-Zinn (2005)
  • Deep Work by Cal Newport (2016)
  • The Resilience Factor by Karen Reivich and Andrew Shatte (2013)
  • Heal Thy Self: Lessons on Mindfulness in Medicine by Saki Santorelli (2000)
  • The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being by Daniel J. Siegel, MD (2007)
  • The Art and Science of Mindfullness: Integrating Mindfulness into Psychology and the Helping Professions by Shauna L. Shapiro and Linda E. Carlson (2017)
  • Mindfulness: An Eight-Week Plan for Finding Peace in a Frantic World by Mark Williams, Danny Penman, et al. (2012)
  • Resilience: Why Things Bounce Back by Andrew Zolli and Ann Marie Healy (2013)
DO Well Toolkit

Wellness Lifelines

Finding help

Mental health resources for physicians in crisis

Learn where to find help if you're suffering from burnout or depression.

Whether you’re in crisis, or just beginning to struggle with burnout or depression, talking about how you feel is the first step toward recovery. The resources below provide contact information for mental health programs offered by osteopathic medical schools and affiliate organizations.

Note: As a membership organization, the AOA cannot provide medical advice or practitioner referrals.  If you need medical advice, please consult your healthcare provider. Resources on this page are provided for informational purposes only. The list is not comprehensive and does not constitute an endorsement by the AOA.



Additional resources

National Suicide Prevention Lifeline

Get free and confidential 24/7 support, as well as prevention and crisis resources and best practices for professionals.

Call: (800) 273-8255 (TALK)

Visit: https://www.suicidepreventionlifeline.org

National Alliance on Mental Illness (NAMI) Helpline

Contact the Helpline Monday through Friday, 10 a.m. to 6 p.m. ET.

Call: (800) 950-6264 or text “NAMI” to 741741

Visit: https://www.nami.org

 

Veterans Crisis Line

Help is on standby if you’re a Veteran in crisis or a concerned loved one. Call 24 hours a day, 7 days a week.

Call: (800) 273-8255

#BeThe1To

#BeThe1To is the National Suicide Prevention Lifeline’s message for National Suicide Prevention Month and beyond, spreading the word about actions we can all take to prevent suicide.

Visit: http://www.bethe1to.com/

Federation of State Physician Health Programs

Contact a state member Physician Health Program (PHP) near your community.

Visit: https://www.fsphp.org/state-programs

DO Well Toolkit

Physician Depression

Healers in crisis

Recognizing the signs and getting help when you need it

Depression among physicians is growing more common, with 15% reporting feelings of hopelessness and thoughts of suicide.

It’s natural to feel down sometimes. You might struggle to get out of bed or lose interest in things that make you happy. But when these feelings become pervasive, it could be a sign you’re suffering from depression.

As common in the medical profession as in the general population, depression affects an estimated 12% of males and up to 19.5% of females, according to a 2018 Medscape study. It is even more common among medical students and residents, with 15-30% screening positive for depressive symptoms.

Physician depression can lead to increased medical errors, lower patient satisfaction scores and higher rates of turnover. Outside of work, depression can result in broken relationships and substance abuse problems.

The issue becomes further compounded by the fact that physicians are often reluctant to seek treatment for mental health issues, leading to feelings of isolation and hopelessness.


8 symptoms to watch for

Sadness is only a small part of depression. In fact, you may not feel sadness at all. Depression has many other symptoms, both mental and physical. If you experience any of the following for longer than two weeks, you could be suffering from depression:

  • Hopeless outlook

    One of the most common symptoms, often described as a feeling of "emptiness"

  • Persistent irritability

    Feeling misplaced anger or aggression toward coworkers and loved ones

  • Feelings of worthlessness

    Interpreting minor setbacks as personal failures

  • Overwhelming fatigue

    Overwhelming feelings of exhaustion, coupled with insomnia or the need to sleep all the time

  • Appetite & weight changes

    May result in significant weight gain or loss (when not dieting)

  • Loss of interest

    No longer looking forward to hobbies or activities that used to bring you joy

  • Difficulty concentrating

    Problems focusing on the task at hand and difficulty making decisions

  • Thoughts of death or suicide

    Recurrent thoughts of self-harm or suicidal ideation


Physician suicide

One physician per day commits suicide in the U.S., resulting in the highest suicide rate of any profession. According to Medscape, the physician rate is more than double that of the general population (28-40 per 100,000 compared with 12.3 per 100,000).

Often, physicians who commit suicide suffer from untreated or under-treated mental health issues, such as depression or burnout. Just 13% of physicians report seeing a professional to deal with mental health issues, with more than 60% saying they have not sought help or counseling.

Suicide can start with ideation, or the contemplation of ending one’s own life. These thoughts may arise in people who feel completely hopeless or believe they can no longer cope with their life situation. Warning signs include:

Suicide Warning Signs
Thoughts Behavior Mood
Feeling like a burden Increased use of alcohol, drugs Depression
Believing there’s no reason to live Acting recklessly Loss of interest
Feeling trapped Isolation from friends, family Humiliation
Experiencing unbearable pain Sleeping to much or too little Irritability
Feeling empty or hopeless Aggression Anxiety
Thinking about death often Telling loved ones goodbye Rage

 

Need help?

It’s time to find help. Talk to your physician or use a wellness lifeline.

DO Well Toolkit

Retired Physician Wellness

DO Well Toolkit

Physician Wellness

DO Well Toolkit

Resident Wellness

DO Well Toolkit

DO Well Toolkit

You counsel your patients to make lifestyle changes to improve their health. Here's why you should follow your own advice.


Physician Rx


Physician Burnout By The Numbers

Medscape's National Physician Burnout, Depression & Suicide Report for 2019 includes responses from more than 15,000 physicians practicing in more than 29 medial specialties.

of physicians report burnout

44 %
Learn more

of doctors report thoughts of suicide

14 %
Learn more

of physicians have not sought counseling

64 %
Learn more

of med students report depressive symptoms

27 %
Learn more

DO Well Toolkit

Physician Burnout

Road to recovery

Risks, warning signs and how to cope

Identifying the problem is the first step toward preventing and recovering from burnout and exhaustion.

Burnout is common among medical professionals. It’s defined as a state of chronic stress that leads to physical and emotional exhaustion, cynicism and detachment. Overwhelming caseloads, mountains of paperwork and EHR frustrations are all cited as top contributors by physicians who suffer from burnout, though the problem can begin long before a doctor enters active practice. In fact, data shows that burnout often begins to set in before medical students enter residency.

If untreated, physician burnout can deepen into depression, according to experts. “A lot of people try to hide it,” according to Steven Gates, DO, vice president of graduate medical education at Corpus Christi Medical Center-Bay Area in Texas.


By the numbers

Approxminately 44% of physicians surveyed for Medscape's 2019 National Physician Burnout, Depression & Suicide Report identified as burned out, with another 11% reporting "colloquial depression," generally described as feeling "down" or "blue."

Burned out

44 %

Coloquially depressed

11 %

Clinically Depressed

4 %

Risk factors

Nearly half of physicians report feelings of burnout, and those most statistically at-risk include women and individuals age 45-54, according to the 2019 Medscape report based on responses from more than 15,000 physicians practicing in more than 29 specialties.

The report lists urology, neurology, physical medicine and rehabilitation, internal medicine and emergency medicine as the top five specialties with the highest rates of burnout.


Warning signs

You might be experiencing burnout if you:

  • Feel tired all the time and lack energy.
  • Have trouble falling asleep or staying asleep.
  • Experience forgetfulness or struggle to concentrate.
  • Become pessimistic.
  • Have feelings  of incompetence, poor achievement and low motivation.
  • Feel isolated.
  • Experience hopelessness or other signs of depression.


How to cope

Prioritizing self-care and reducing stress are two coping methods recommended by physicians who have found their way back from the brink of burnout. “I noticed that putting myself and my priorities first ultimately made me a better physician to my patients,” shares Vania Manipod, DO, a psychiatrist who blogs about her experience with burnout in an effort to destigmatize depression and help other physicians recognize the symptoms.

Other things that might help:

  • Talking with trusted friends, spending time in nature, listening to music or carving out a little time for a favorite hobby.
  • Finding a meaningful activity outside medicine, such as volunteering, joining a club or training for a marathon.
  • Joining peers for an exercise class or a group run. A JAOA study found those who worked out in a group experienced a reduction in stress levels compared to those who worked out solo.
  • Practicing mindfulness with a meditation app or simply closing your eyes to focus on your breathing.
  • Getting more Zzs. Most of us need seven to nine hours of sleep. To get there, slowly add more time for rest and build up to your goal.
  • Establishing initiatives at work to limit work hours and creating safe havens for discussing challenges with peers.
DO Well Toolkit

Defining Wellness

Wellness check

The osteopathic approach toward physician health

8 Dimensions of Wellness align with the osteopathic approach to mind, body and spirit.

As a physician or medical student, you’ve dedicated your life’s work to helping patients lead healthy lives. But focusing on your own physical and mental well-being is just as important.

According to the National Wellness Institute, wellness is defined as an active process through which people become aware of and make choices toward a more successful existence. Extending beyond physical health, wellness is multidimensional and holistic, encompassing work, lifestyle and environment.

The osteopathic profession’s Physician Wellness Strategy aims to provide DOs and osteopathic medical students with tools to improve their own well-being and educate others about the importance of wellness. Developed by physicians for physicians, the strategy draws from the four Tenets of Osteopathic Medicine by exploring the full spectrum of your physical and mental health.


8 dimensions of wellness

The following descriptions are adapted from SAMHSA’s 8 Dimensions of Wellness.

  • Physical

    As a DO or osteopathic medical student, you understand the importance of preventive medicine. Establishing healthy eating habits and a regular exercise routine can help ward off chronic disease and keep your mind and body strong.

  • Emotional

    Your emotional health is one of the most important components of your well-being. Understanding your feelings, developing a sense of awareness and building resilience will help keep you focused and balanced.

  • Environmental

    Optimal health is best achieved when your mental and physical health are in harmony with your surrounding environment. How you interact with your natural (i.e. climate) and built (i.e. work) environments can have a major impact on your health.

  • Financial

    Financial health is determined by your relationship with money, your ability to live within your means and your approach toward preparing for short-term and long-term needs.

  • Intellectual

    Seeking ways to stimulate your curiosity and creativity will keep your mind sharp and engaged. By becoming active in cultural and scholastic activities, you'll expand your skills and knowledge. And you'll enjoy added benefits by sharing what you learn with others.

  • Occupational 

    Finding true joy and satisfaction in your work can lead to reduced stress and burnout. This can be achieved by finding ways to utilize your talents, establish a healthy work-life balance and manage workplace stress.

  • Social

    A positive mental outlook can result from having a strong support network of friends, family members and colleagues. Fostering nurturing and supportive relationships also helps build communication skills and empathy.

  • Spiritual

    Spiritual wellness focuses on connectedness with self, others, music, nature, art, or a power greater than oneself. Exploring your values, beliefs and purpose can result in greater happiness and satisfaction with your life and career.