The Public Health Risks of Medic Burnout

Physician burnout is a significantly underappreciated public safety issue, and sleep loss is often overlooked as a contributing factor, according to a new position statement published by the American Academy of Sleep Medicine.

Sleep is essential to health, and sleep deprivation due to shift-work schedules, high workload, long hours, sleep interruptions, and insufficient recovery sleep have been implicated in the genesis and perpetuation of physician burnout. The risk for burnout is especially high due to the novel coronavirus (COVID-19) pandemic, which is requiring physicians and other health care personnel to work long hours under stressful conditions.

"Physicians tend to reside in a culture of working hard at the expense of self-care, including adequate sleep. We need a major culture shift to allow physicians to get the sleep they need," said senior author Dr. Indira Gurubhagavatula, associate professor of medicine at the Veteran's Administration Medical Center at the University of Pennsylvania and chair of the AASM Public Safety Committee, which developed the position statement on behalf of the AASM board of directors.

The position statement, published online as an accepted paper in the Journal of Clinical Sleep Medicine, calls for more research exploring sleep disruption, sleep deprivation and circadian misalignment in physician burnout, as well as examining efforts to address sleep problems among doctors. It notes that the physicians most at-risk are at the peak of their careers, and burnout may cause them to seek early retirement, which could negatively impact the physician workforce needed to care for a growing and aging patient population.

While the position statement was developed before the current public health emergency, Gurubhagavatula said it's even more important now for health care workers to address sleep.

"Insomnia related to stress and anxiety about the pandemic may compound the physical, emotional and cognitive demands of working in high-stress environments," she said. "Some coping habits, such as the use of alcohol or excessive caffeine, can worsen sleep quality and quantity, which may in turn impact the ability to function at high levels. Healthy sleep is one of the major restorative activities that will help health care workers cope and perform well."

She noted that heath care employers should consider creating opportunities for rest breaks, including designated nap areas; providing counseling services for those dealing with stress-related insomnia; and distributing education about sleep health and sleep hygiene to help maximize productivity and well-being.

The position statement and a detailed companion paper on the role of sleep in physician burnout are available on the Journal of Clinical Sleep Medicine website.

Reference: Kancherla Binal S., Upender Raghu, Collen Jacob F., Rishi Muhammad Adeel, Sullivan Shannon S., Ahmed Omer, Berneking Michael, Flynn-Evans Erin E., Peters Brandon R., Abbasi-Feinberg Fariha, Aurora R. Nisha, Carden Kelly A., Kirsch Douglas B., Kristo David A., Malhotra Raman K., Martin Jennifer L., Olson Eric J., Ramar Kannan, Rosen Carol L., … Gurubhagavatula Indira. (n.d.). Sleep, Fatigue and Burnout Among Physicians: An American Academy of Sleep Medicine Position Statement. Journal of Clinical Sleep Medicine, 0(0), jcsm.8408. https://doi.org/10.5664/jcsm.8408

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