Recent studies show that the pressure of providing high-quality care—coupled with long hours, administrative burdens, and conflicting responsibilities—is taking a toll on the mental and physical health of ocular surgeons and staff.
The Medscape Report on Ophthalmologist Lifestyle, Happiness, and Burnout, a survey of over 9,100 physicians across some 30 specialties, found that 62% of ophthalmologists described themselves as “very happy” or “happy” outside of the workplace, making ophthalmology the seventh-happiest physician specialty overall.1 However, 23% of male respondents and 45% of female respondents confessed to feelings of burnout and/or depression. Bureaucratic tasks such as charting and paperwork emerged as the chief contributor to burnout, reported by 65% of ophthalmologists. Declining pay came in second (42%), followed in third place by electronic health record documentation, at 37%.
The survey also found that the impact of depression and burnout extends to patient care. Nearly a third of respondents said they become “easily exasperated” with patients, and 10% conceded to making uncharacteristic errors. In addition, the report found that 40% of female ophthalmologists reported feeling “very conflicted” or “conflicted” between work and family responsibilities, while just 21% of male ophthalmologists reported such feelings.
Even residents are not immune. A 2020 study found that almost 70% of ophthalmology residents either experienced firsthand or witnessed burnout, depression, or suicidal ideation. The respondents cited no time to attend wellness programs (25%), academic responsibilities (13.1%), administrative duties (10.6%), and shift duration (10.6%) as the top reasons for burnout.2
No Surprises
To many clinicians, these findings are not surprising. “In fact, I feel a bit of sadness that we see such significant impacts on the well-being of physicians, staff, everybody,” says Laura Baldwin, CPC, RN, SHRM‑CP, a senior consultant with BSM Consulting in Phoenix, Arizona. “It’s worrisome, and I definitely think it’s something we need to talk more about.”
“It really doesn’t surprise me that work-related tasks, paperwork, and EMR demands are a leading factor in burnout,” says Mitchell Shultz, MD, the medical director at Shultz Chang Vision in Los Angeles. “As a business owner and independent practitioner, continuing to find new revenue streams under the pressure of increased labor expenses adds a level of stress in an effort to maintain profitability and avoid declining net income.”
Dagny Zhu, MD, a cornea, cataract, and refractive surgeon, and medical director and partner at NVISION Eye Centers in Rowland Heights, California, agrees. Dr. Zhu, who has a three-year-old child and is the sole surgeon at her practice, observed that the Medscape survey results relating to feelings of conflict among female physicians resonated with her.
“For me, the hardest time was that first year, balancing taking care of a newborn when I was [on maternity leave], and then going back to work and balancing doing the same volume of surgery while also doing additional tasks like pumping,” says Dr. Zhu. “All of that was just very, very overwhelming.”
It doesn’t have to be that way. Strategies like vacations, regular exercise, and maintaining a healthy diet can all help protect one’s well-being. Some other ways to reduce feelings of burnout may include learning new skills, pursuing outside interests, maintaining a positive culture in the workplace, and professional counseling.
Getting a Life Outside of the Day-to-Day
In the quest for equilibrium, vacation is crucial. Over half of respondents to the Medscape survey opt for three to four weeks of annual leave, while 27% take less than two weeks. In addition, 62% embrace exercise to relieve stress, followed by 49% who seek the company of loved ones. Other activities mentioned include spending time alone and meditation.
These aren’t the only ways to achieve a good work-life balance, however. Jeffrey Whitman, MD, president and chief surgeon of the Key-Whitman Eye Center in Dallas, finds that adopting new treatment approaches and learning new skills—whether for personal or professional benefit—helps him stay excited about his job.
“We work with a lot of vendors to do clinical research, and to me, that adds another dimension to the job other than the simple day-to-day routine of, for example, going from one cataract surgery to another or a retina surgery to another. It helps to have other projects that can use other parts of your mind,” he says.
Dr. Whitman also strives for a fulfilling life outside of work. He especially prizes family time. “I think in early practice I missed out a lot on my kids’ growth, education, and other activities,” he says. “I’m fortunate in that they got married and had kids here, and I’m trying to spend more time with them and our grandkids.” He and his wife are involved in philanthropy and volunteer work; they also visit museums, attend concerts, and do other activities to “enrich our mind.”
Like Dr. Whitman, Dr. Zhu prioritizes her family. She and her husband, a dentist, both work on Saturdays. As a result, they make Sunday “our golden day that we look forward to every week.” She also plays the piano, paints, and practices her interior design skills. “Picking things out for our home, I enjoy that. Retail therapy is a stress reliever for sure,” she says with a laugh.
Dr. Shultz reminds others not to feel guilty when they decline requests to do things. “I say ‘No’ more often to things that are either not of interest or I just do not have time to commit to,” he says. “I combat the stress by carving out mandatory time for my own physical well-being, which includes working out in the mornings and playing pickleball several evenings and on the weekends as well.”
Before All Else Fails: The Value of Counseling
According to Medscape's burnout survey, more than a third of respondents reported “severe” impacts and 29% reported “moderate” effects on their lives from depression. Still, only 10% reported seeking professional help. To Jeffrey Whitman, MD, that’s a troublesome sign that stigma around mental illness still prevents many from seeking treatment that could help change things for the better.
“We have to destroy that myth that you have to feel sick in the head to see a psychologist,” says Dr. Whitman, who acknowledges past battles with depression in family members. Seeing a professional counselor can “help you feel better about everything. But if you hide it inside, you may burn out. If you feel like you’re getting low, don't be embarrassed to seek out professional help.”
Laura Baldwin, a consultant with BSM Consulting, agrees. Baldwin says a psychologist she once worked alongside compared therapy to regular auto maintenance. “You … see an expert to diagnostically look at your car and make sure it is going to be okay,” Baldwin recalls the counselor told her. “Therapy is the same way. Until we take that stigma away that you only go to a therapist when there’s a problem, we’re going to continue to suffer as individuals when we don’t have to.”
Don’t Underestimate the Role of Practice Culture
Workplace culture plays an important, though often overlooked, role in staving off burnout and depression, says Baldwin. She advises ophthalmic ASCs to establish a clear mission statement, vision, and core values to guide hiring decisions and develop a culture that enables all staff to thrive.
“We need to [stop looking at work] as, ‘It’s a privilege for somebody to get to work in our practice,’” she says. “It is a complete mindset shift into asking, ‘What are the things that are most important to workers? Why would they want to come and join our organization?’ Seek to understand their perspective.”
To foster a healthy working environment, building in “extracurricular” activities can be a good way to show staff they are valued, says Dr. Whitman, whose practice designates an employee to organize lunches, team-building getaways, and other activities. Similarly, Dr. Zhu plans monthly dinners to show her appreciation for colleagues and staff. She also provides annual bonuses and gifts and holds birthday celebrations for team members.
“I think small things like that can really add to the culture. Otherwise, [staff are] just sort of checking in and checking out,” she says, adding that her practice has very low turnover rates. “I have optometrists who have worked at this practice for almost 20 years now. And our patient counselors have been with our practice for almost 20 years now, as well,” says Dr. Zhu.
Focus on the Positive
The patient care and administrative challenges that ophthalmologists face are not likely to go away any time soon. But that doesn’t mean they, their staff, and their families must pay with their mental and physical well-being.
“As bad as the numbers may look, I think it’s honestly way better than it used to be, and I think it’ll continue to improve,” says Dr. Zhu. “We have it pretty good in ophthalmology, so I think we should stay positive and focus on ways to make our training and work environments better for the next generation.” OASC
References
1. Koval ML. Medscape report on ophthalmologist lifestyle, happiness, and burnout 2023: contentment amid stress. February 24, 2023. Accessed March 25, 2024. https://www.medscape.com/slideshow/2023-lifestyle-ophthalmologist-6016086#27
2. Tran EM, Scott IU, Clark MA, Greenberg PB. Resident wellness in US ophthalmic graduate medical education: the resident perspective. JAMA Ophthalmol. 2018;136(6):695-701. doi:10.1001/jamaophthalmol.2018.1383
