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  • Now You Know: Clinician Burnout Is a Reality

    The saying, “If you didn’t know, now you know,” is not intended to be either sarcastic or presumptive of what a colleague may or may not understand regarding an observation or a topic.

    On the contrary, its use in this context is intended to inspire curiosity, appeal to those who may wish to explore topics beyond usual choices and address any misunderstandings in the moment. Based on the interest of our editorial board, my goal is to offer brief articles on topics not usually found in either of our blue or yellow journal in our field. At some point in the future, we will explore the origin of the phrase, however given the depth of interest and the importance of clinician burnout, I will save that discussion for another time in the future.

    Over the course of my career, I have expanded my interests beyond ophthalmology. However, given recent events in our field, burnout is a topic that we should more deeply understand that affects our very own discipline as well as others. I will review what we know about ophthalmologist burnout, what is being done about it, and how we may be part of strategies to address burnout, both organizationally and individually.

    Although Perspective has previously covered clinician burnout, it may be helpful to restate the origin of the term and the definition. “Burnout” was initially described by a psychiatrist in the 1970s when he described his patients who were so spiritless that after lighting a cigarette, the unattended cigarette was allowed to simply burn to ashes.


    Dr. Higginbotham pictured with her previous scribe, Ms. Dominique Alexis, who is now in medical school at SUNY Upstate Medical University. She is applying to ophthalmology residency this in 2024 and has been a participant in the Academy’s Minority in Ophthalmology Mentoring program since 2021. The use of scribes can mitigate the pressures of seeing patients and reduce the potential of burnout.

    Ophthalmology, particularly when I was considering my choice of specialties more than 40 years ago, was once considered one the happiest subspecialties. In fact, most of our colleagues are still very satisfied with their choice of specialty and continue to experience the joie de vivre caring for patients. We have all experienced the need to sustain high volumes of patients seeking care to keep up with demand and the toll of seeing enough patients to maintain the financial viability of modern practice. I believe those of us who have practiced for many years remember the days when some colleagues routinely saw 10 to 20 patients in a day, and now those numbers have increased to 50 or 60 patients in a day.

    By the mid ’90s, this reality changed, when it was evident that higher patient throughput was necessary to survive. As a result of the increased pressures, of which patient load may be only one of many contributors, some colleagues may experience symptoms of depression and turn to excessive substance use, negatively impacting productivity in the workplace and relationships. A recent article published in 2022 by Sedhom and co-workers examined the topic of physician burnout in ophthalmology. The authors noted that an online survey conducted in 2020 revealed an overall 37% rate of burnout for our discipline, ranking us towards the bottom of the list of specialties. However, if one examines our resident population, the rate of burnout is higher at 63%. Sedhom and coworkers assessed the severity of burnout among nearly 600 ophthalmologist who responded to a survey. These investigators reported that 37.8% of respondents reported burnout symptoms, ranging from 30.8% among vitreoretinal specialists to 45.4% among ophthalmologists specializing in uveitis. Most individuals revealed mild symptoms at 65.2% and higher rates were noted among women, those employed in academic settings, and hospitals. Lack of alignment with leadership was one of the important factors.

    Ordinarily, Perspective does not take on such difficult topics at clinician burnout. However, I needed to provide a context before transitioning to a point in the article of where we as seasoned ophthalmologists may be helpful to our colleagues. First, we need to acknowledge the pressures that currently exist in modern ophthalmic practice. By assuming there is no problem does not diminish the impact. Considering the importance of awareness of the issue, the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience declared March 18, 2024, as national Health Workforce Well-Being Day. This collaborative, launched in 2017, has three goals:

    • Increase awareness regarding clinician anxiety, burnout, and suicide.
    • Improve our understanding regarding the contributors to challenges to clinician well-being.
    • Advance the rigor of determining the “solutions to improve patient care by caring for the caregiver.”

    The group has also provided a number of resources which can guide organizations and individual practices in finding relevant solutions to address well-being of our colleagues. As an ophthalmic professional community, we can prepare for next year’s Health Workforce Well-Being Day. Acknowledging the issue at the highest levels of leadership is a first step in implementing strategies to more effectively support clinicians in their daily work.

    At AAO 2024 in Chicago in October, the Lifetime Engaged Ophthalmologist Committee will host a networking session in its lounge to provide our members the opportunity to connect with young ophthalmologists (YOs) who are just getting started in their careers. This networking opportunity will hopefully launch a constructive mentor-mentee relationship between professionals from two generations. Whether or not such relationships will mitigate the rates of burnout remains to be seen. However, it is a starting point to create a relationship with an ophthalmologist early in their career. These relationships can not only be helpful to the mentee but also fulfilling for the mentor.

    So, what is a role of an effective mentor? The following are few suggested attributes to consider:

    • Provide candid feedback.
    • Discuss strategies for managing interpersonal politics.
    • Set aside meetings on your calendar for regular mentoring.
    • Advise YOs on executive presence and communications.
    • Guide YOs in development of an intentional and strategic plan for career advancement.
    • Provide an opportunity to shadow you if you still practice.

    I look forward to seeing at AAO 2024 in Chicago this October.