The daily demands of practicing medicine can amount to “’an ongoing assault,’” noted a 2022 article published by the American Medical Association.1
Physician burnout and the number of physicians intending to leave their jobs — already at high levels before the COVID-19 pandemic — has increased in the pandemic’s wake. A survey of more than 20,000 US physicians and advanced practice clinicians found that burnout increased from 45% in 2019 to 60% in late 2021, and that intent to leave medicine increased from 24% to more than 40% during the same period.2 Forbes has reported that by 2025, 47% of all health care professionals will have left the profession,3 while the Association of American Medical Colleges predicts a potential shortage of up to 48,000 primary care physicians and 77,100 specialists in the US by 2034.4
Fueling these projected mass retirements and physician shortages is “a broken health care system” that stresses quantity of patients seen over the quality of care provided, which has created “a lack of self-worth” among many physicians, said Robyn Tiger, MD, DipABLM. Dr Tiger, a radiologist who practiced medicine for 15 years before moving into lifestyle medicine, is the founder of StressFreeMD, which offers the CME-accredited course, Rx Inner Peace: A Physician’s Guide for Self-Care.
“With physician stress, anxiety, depression, and burnout on the rise, and having personally lost 3 medical colleagues to suicide, I am deeply passionate about sharing what I have learned with as many physicians as I can,” said Dr Tiger, who began working with physicians and others on stress relief and self-care after overcoming her own stress-related illnesses. She now serves as a subject matter expert in stress management for the American College of Lifestyle Medicine, in addition to serving on the Wellness and Resilience Committee of the North Carolina Medical Society and with the Healthy Healer Program of the Western Carolina Medical Society.
In the following indepth interview, Dr Tiger discusses the impact of burnout and stress on clinicians and what can be done to address this problem.
What kinds of issues do you see among the physicians you work with?
They are exhausted emotionally and physically, they lack self-worth, and they’re not sure what the meaning of their own life is anymore. They are even concerned that they made a wrong choice in going into medicine. Burnout is described as 3 components: emotional exhaustion, cynicism, and lack of self-worth. Physicians are describing all of that and more. They are anxious, reactive, and saying and doing things they wish they could take back. They feel unfulfilled, many report low libido — I hear that a lot. It’s also affecting their family life — their kids don’t want to be around them, and many are on the brink of or getting divorced. It’s disrupting everything, and it’s extremely hard.
There are those who say that physician burnout is a systemic problem that can’t be addressed simply through self-care.5 What are your thoughts about that?
There are 2 important components here: First, the health care system needs to change. I know that some major organizations and even our government is working to do that….[through] a national agenda for physician well-being.6 Beyond that, clinicians, as humans, need to be educated on how to be the healthiest version of themselves, so they don’t get sick from chronic stress, and so they can take care of other people and live the life they deserve to live.
I’m not at the level where I can make changes nationally throughout the health care system, I’m coming from the side of how we can educate the human. I created a CME-accredited program called Rx Inner Peace, [which is supported by] 10 pages of referenced literature. The program is not just telling you to “go do yoga”; it’s teaching you what you need to learn to become the healthiest version of yourself, so that you can prevent or reverse disease.
What led you to transition from practicing medicine to working with burned-out physicians?
Dr Tiger: Several years in[to my medical practice], I found myself developing lots of illnesses and symptoms that I couldn’t really put together. They seemed very disconnected, and they didn’t all happen at one time. I had things like really bad vertigo,… tinnitus, difficulty sleeping, and bleeding gums. I also had really bad reflux, horrible chest pain, and migraine headaches with really violent vomiting.
I developed pain in my body — my joints, muscles, you name it. Every day I just felt like I couldn’t move, like I was like trapped in this tense body. No trauma, just pain. I had paresthesia that would develop at the most inopportune times in my hands, feet, and back. I’d be doing a breast biopsy and couldn’t feel the biopsy gun in my hand.
I went to gastroenterologists, and they put me on pills. I went to a neurologist, and they put me on pills. I went to the periodontist, and they were injecting antibiotics into my gums. I took so much medication and had lots of imaging studies. Being a radiologist, I was getting everything imaged and the results were all negative. All of my blood tests were negative too, and nobody could figure out was the matter with me. Every doctor saw me as a symptom that they gave a pill to. I also went to a physical therapist, and I saw a physiatrist for all the pain. Nobody could figure it out.
The suffering was just so intense that I just didn’t want to feel it anymore, and I had lost 3 physician friends to suicide…2 of them overdosed and 1 jumped off a bridge. I didn’t want that to happen to me. My own family and friends didn’t know completely what was going on with me because I kept it all inside. I did see a mental health care professional, and it really didn’t help.
That’s when I decided I could either go down the path I’m on and end up like those colleagues, or I could try and figure out if I could make myself better. I kept hearing more and more about things like yoga and meditation, and I thought they were weird. Even so, I went to a yoga class after working an entire day, totally exhausted and having all kinds of preconceived notions, and at the end of the first session, I felt calm, grounded, and clear, and I was awake — I wasn’t even tired anymore. That was my first “aha” moment.
My left brain wanted to unpack the physiology as to what led to this 180-degree shift so quickly, so I kept going to the classes to learn more. I decided to go into yoga teacher training to learn more. As I continued with classes and teacher training, the symptoms I described started to get better. Then I learned about the field of yoga therapy, [where] I could take the principles I learned in yoga and study them more deeply to help people with many types of symptoms and illnesses and diseases. Through that training and continuing with yoga therapy, all my symptoms went away 100%. I went on to become certified in meditation and life coaching. I’m also certified through iRest, a specific type of meditation that was originally created for Walter Reed Army Hospital to help our military relieve their suffering from post-traumatic stress disorder.
I realized that the diagnosis that nobody made was that I was suffering from chronic stress. When I learned how to relieve that stress and work with my own physiology and mind, I was able to relieve what I was experiencing, which is in the spectrum of what we may call burnout now.
How long have you been working with other physicians on stress and burnout relief, and what kind of results have you seen?
I stopped practicing medicine in 2012 and have been in this space for a decade now. I had been working with several populations — people with cancer, first responders, military veterans, health care professionals, and anyone else who wanted help. Then, in 2020 when the pandemic hit, I decided that I needed to help my colleagues [and] pivoted to focus my attention specifically on physicians. I don’t know exactly how many I’ve worked with, but it’s in the thousands.
The results have been pretty amazing. Physicians say things like, “I’m sleeping well for the first time in decades,” and “My body no longer feels like the tin man.” I’ve had them say to me, “Because of you, my marriage was saved,” and “I found joy in medicine again because of you,” and “My kids want to spend time with me again.”
I basically teach what we were never taught in medical school, which is how to regulate your nervous system and how to work with your thoughts; for me, it’s a 2-part, mind-body approach. My job really is to help [physicians] help themselves. I give them the education and they’re the ones experiencing the transformation.
Is there any evidence to support the efficacy of this approach to dealing with stress and burnout?
There’s lots of literature out there. That’s actually how I got into yoga therapy to begin with, because when I started to feel better, I dove into the medical literature to find out why. I was surprised to find so many articles published in our own medical literature about the benefits and changes that disciplines such as yoga therapy and meditation can create for many types of symptoms and illnesses and diseases.7-9
There also have been randomized clinical trials on coaching and lots of literature on the topic. For example, Cleveland Clinic recently reported they saved $133 million dollars in retention [through a peer-based coaching and mentoring program promoting clinician well-being], because with every physician that leaves, it costs the medical system as much as a million dollars.10,11
Is there anything else physicians should be aware of in dealing with stress and burnout?
I would like physicians to know that they’re not alone if they’re feeling anything or everything that I described. It’s not okay, but it’s normal.
Also, if someone is having any type of suicidal thoughts, please seek help. To reach the 988 Suicide & Crisis Lifeline, they can call or text 988 or chat 988lifeline.org. [This was formerly the National Suicide Prevention Lifeline.] There is also a phone number (1-888-409-0141), a hotline for physician-to-physician mental health help that doctors and medical students can call and speak to another doctor. There are no notes and nothing is kept where they have to be concerned that their mental health issues could be recorded and held against them.
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org
- Robeznieks A. Doctor shortages are here—and they’ll get worse if we don’t act fast. American Medical Association. Published April 13, 2022. Accessed January 16, 2023.
- Linzer M, Jin JO, Shah P, et al. Trends in clinician burnout with associated mitigating and aggravating factors during the COVID-19 pandemic. JAMA Health Forum. 2022;3(11):e224163. doi:10.1001/jamahealthforum.2022.4163
- Kelly J. New survey shows that up to 47% of U.S. healthcare workers plan to leave their positions by 2025. Forbes. Published April 10, 2022. Accessed January 16, 2023.
- IHS Markit Ltd. The complexities of physician supply and demand: projections from 2019 to 2034. Association of American Medical Colleges. Published June 2021. Accessed February 1, 2023.
- Critical Care Societies Collaborative (CCSC). Burnout: National Summit on Prevention and Management of Burnout in the ICU. Accessed February 2, 2023.
- US Department of Health and Human Services. New Surgeon General Advisory sounds alarm on health worker burnout and resignation. Published May 23, 2022. Accessed February 2, 2023.
- Park CL, Slattery JM. Yoga as an integrative therapy for mental health concerns: an overview of current research evidence. Psychiatry International. 2021;2(4):386-401. doi:10.3390/psychiatryint2040030
- American Psychological Association. Mindfulness meditation: a research-proven way to reduce stress. Published October 30, 2019. Accessed January 16, 2023.
- Ganesan S, Beyer E, Moffat B, Van Dam NT, Lorenzetti V, Zalesky A. Focused attention meditation in healthy adults: a systematic review and meta-analysis of cross-sectional functional MRI studies. Neurosci Biobehav Rev. 2022;141:104846. doi:10.1016/j.neubiorev.2022.104846
- Gleeson C. How Cleveland Clinic has saved $133M in physician retention. Becker’s Hospital Review. Published November 23, 2021. Accessed January 16, 2023.
- Berg S. How much physician burnout is costing your organization. American Medical Association. Published October 11, 2018. Accessed January 16, 2023.