The opioid crisis and physician burnout: A tale of two epidemics

Steven A. Adelman, MD
Steven A. Adelman, MD, Contributor

In April, the U.S. Surgeon General, Dr. Vivek Murthy, attended a meeting of the Association of Health Care Journalists. In an exclusive interview with MedPage Today, he shared his mounting concerns about two matters: the impact of burnout on physicians and our society’s current opioid crisis. Dr. Murthy stated that he views physicians as being an essential part of the solution to the epidemic of drug overdoses, which have exceeded motor vehicle accidents as one of the leading causes of death.

Dr. Murthy correctly linked the well-being of health professionals with that of the general public, stating, “As I think about the emotional well-being for our country, I am particularly interested in how to cultivate emotional well-being for healthcare providers. If healthcare providers aren’t well, it’s hard for them to heal the people for whom they are caring.”

As the director of Physician Health Services (PHS), an independent non-profit dedicated to promoting and supporting the health and well-being of some 45,000 physicians and medical students in Massachusetts, I have witnessed first-hand how stress and burnout among practicing physicians may play a role in the opioid epidemic.

In the past, physician health programs across the country focused on assisting doctors with drinking problems, drug addiction, and mental illness. Although these conditions continue to challenge a subset of practicing physicians, the rising tide in the physician health world is occupational stress, burnout, and an overall failure to thrive, which may be both personal and professional. Indeed, a recent study on physician burnout published in the Mayo Clinic Proceedings demonstrated that more than half of all physicians are experiencing professional burnout. As burnout increases, satisfaction with work-life balance drops. The data indicate that internists and family medicine physicians, those who prescribe the lion’s share of opioids, are particularly beleaguered — and this conforms to my own experience assisting distressed physicians who are failing to thrive.

Many physicians in busy primary care practices feel like they are playing a never-ending game of “Whack-a-Mole.” They answer to a growing cadre of masters: faceless managed-care bureaucrats; managers; IT consultants; quality measurement gurus; and…patients. As time grows scarcer and the rewards leaner, being an excellent physician while managing one’s life outside of the office has become increasingly challenging. Given these pressures and demands coming from so many quarters, some adult primary care physicians may not possess enough time or the requisite emotional fortitude to fully explore non-opioid alternatives when, for example, a patient with chronic lower back pain reports that 80 mg of oxycodone (Oxycontin) per day has allowed him to continue working and providing for his family. Scenarios like this raise the possibility that physician burnout may be playing a role in the opioid epidemic.

Solving the burnout crisis of adult primary care physicians is beyond the scope of this blog post. But until our society and the medical profession begin to address this crisis in a vigorous and meaningful way, our quest to put an end to the opioid epidemic remains daunting.

Comments:

  1. EdriCooper

    I am sick and tired people expounding the evils of opioids in this past year. It’s insane, and, I believe self righteous of the ones touting it. And yes I understand the pros & cons, of its use, clearly! I am a retired nurse…. And in my opinion, it is just plain wrong to deny people pain relief. I saw too much of this in my job, of 30 years. It is WRONG.
    Opioids is almost all there is….. Unless use of cannibus is allowed to help.
    I live Oklahoma & legal use of cannibus will never be voted in for use here. l have psorriatic arthritis, which is rheumatoid. My timed periods of fair to good pain relief is appreciated. But the pain returns, and the disease causes fatigue that is horrid, as it destroys your body joints. I blessed to get to use Tramadol…and now they are trying to hype it up as ” opioids like” ! Totally riduculous.
    But I would love to try some cannibus tea or whatever…just no smoking.
    People a lot worse off than I will ever be, deserve whatever it takes to feel better, even if just for a while.
    People without pain do not need to be governing or swaying opinions on pain relief medications.

    • jackie

      Thank you… I have been a victim of untreated pain.. I shouldnt be punished for the drug addicts actions.. nor.. Dr Burnout!.. I need a nights sleep and a day that i can function.. If they figured out the root cause of my pain.. I wouldnt need pain killers… I’m very angry…

      • doctor

        Unfortunately you are both missing the point and are the reason there is an epidemic. You both believe opiates will fix your problem but they won’t. As you said they are temporary. And after a period of time you will be tolerant, then request more., then more, then more until you get to a level that causes significant side effects or death. The whole point of the article is to show that if the physicians had more time they could explain this even to the patients that don’t want to hear it such as yourselves. And let you know that they can provide you help just not in the form you seek (narcotics).

  2. Clark Gaither

    All true. But posts like this always end with statements like “until our society and the medical profession begin to address” rather than a call to action. Well, here are several. It is time for family physicians to tear up all of their payer contracts and kick insurance companies and federal payers out of our offices. Here is a fact: I don’t need the patient’s insurance. The patient needs the patient’s insurance. Remember all of the hand wringing over undue influence from pharmaceutical companies? Whatever their influence may have been, it pales in comparison to the undue influence from payers, including CMS. Everyday, up until my last day in clinical medicine, I was violating my oath each and every time I let a payer get between me and a patient. Conflicting values is one of the main drivers of physician job related burnout. I see it everyday. Enough talk about how bad it is or will get. Let’s do something!
    Clark Gaither, MD, FAAFP (a.k.a. Dr. Burnout)
    clarkgaither.com