The Worthy Physician

Healing the Healers

• Dr. Sapna Shah-Haque MD

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Dr. Corrigan, co-founder of Physicians Anonymous, shares his mission to provide global peer support for physicians struggling with burnout, mental health issues, and addiction through anonymous, safe spaces where doctors can be vulnerable without fear of judgment or professional consequences.

• Alarming statistics reveal 300-400 physician suicides annually in the US with burnout rates reaching 60-80% depending on specialty
• Female physicians have suicide rates up to four times higher than the general population
• "Microtraumas" accumulate through medical training and practice without adequate processing mechanisms
• Medical culture teaches physicians to compartmentalize emotions and avoid showing vulnerability
• The system, not individual physicians, bears primary responsibility for the burnout crisis
• Financial pressures from medical school debt (often $200,000-$400,000) trap physicians in toxic environments
• Licensing and credentialing questions about mental health create barriers to seeking help
• Physicians Anonymous provides free, confidential peer support where doctors can connect as human beings first
• Recovery from burnout requires multiple approaches including therapy, medication, peer support, and systemic changes
• Physician well-being investments yield returns through reduced errors, malpractice, and turnover costs

Find support through physiciansanonymous.org or connect with Dr. Corrigan on LinkedIn and Twitter.


Though I am a physician, this is not medical advice. This is only a tool that physicians can use to get ideas on how to deal with burnout and/or know they are not alone. If you are in need of medical assistance talk to your physician.


Learn more about female physicians' journey through burnout to thriving!
https://www.theworthyphysician.com/books

Let's connect for speaking opportunities!
https://www.theworthyphysician.com/dr-shahhaque-md-as-a-speaker

Check out the free resources from The Worthy Physician:
https://www.theworthyphysician.com/freebie-downloads

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Speaker 1:

Welcome to another episode of the Worthy Physician. I'm your host, dr Sapna Shah-Hawk, reigniting your humanity and passion for medicine. With each episode, we bring you inspiring stories, actionable insight and expert advice. Get ready for another engaging conversation that could change the way you think and live. On this episode of the Worthy Physician today we are talking with Dr Corrigan, who is the co-founder of Physicians Anonymous in the UK, and his mission is to have it globally. It is available to physicians even here in the United States, and before I go further, I'll let him introduce himself. Dr Corrigan, thanks for coming on and for our listeners. Can you please introduce yourself?

Speaker 2:

Thank you so much, zach. It's a real privilege to be on the Worthy Physician podcast. Yeah, so I'm Dr Corrigan, it is a pseudonym. I'm a physician, actually a qualified psychiatrist, working for about 20 years in mental health, and I had a life crash in midlife, burned out mental illness, addiction and found recovery through a combination of therapy meds and a 12-step group and actually realized that maybe through accessing this incredibly powerful free intervention called peer support, where you're just human beings being human and vulnerable in a safe space, maybe that would have made a difference to me, who's to say? But hopefully it'll make a difference to other doctors, because the problem is we're suffering out there but we are not really good at reaching out for help. But more about that later. And, by the way, we actually started in the US. My first ever is a Tuesday, 6.30pm Eastern Standard, and even though I'm in the UK, my co-founder is in Delaware and so we're kind of US-UK across the pond, but we do have global ambitions, as you mentioned, satya.

Speaker 1:

Thank you for clarifying that, and I am actually signed up to attend one on October 25th just to know what it's about, because medicine is one of the only careers probably where we have a very full day and we have the ability to change and touch many lives and we see people that are in their most vulnerable state. But we also internal a lay person or just say how frustrating your day was. It's very, incredibly difficult for a non-physician or non-health care worker to understand that. So it is incredibly important for that peer support because I think the training is so is so very isolating at times and very special, and if you don't go through it, it is very hard to comprehend.

Speaker 2:

Yeah, there's so much to talk about in terms of medical training, in terms of what I call the micro traumas that doctors go through, small T traumas which, over years, even just four years of med school or five years in the UK. All these traumas sort of add up and unless we have a way of dealing with them that is accessible to every physician, we're going to carry on having the sorts of problems we have. The stats are appalling. Us alone loses 300 to 400 estimated physicians to suicide every year. Our burnout rates, pre-pandemic, were in the 40% of physicians and now it's in the 60s, depending on which study you read. One ER study showed 80% of us are burned out and anyone working in clinical medicine won't be surprised at that.

Speaker 2:

But this is not healthy and we're supposed to be there for people at their most vulnerable. We're supposed to be at peak performance, both physically and emotionally, mentally, and it's really hard. It's not hard to understand why things like medical errors, medical malpractice, people dropping out of medicine, people leaving careers, people you know having mental breakdowns or addiction or even suicide, why that is happening so much in medicine. Some studies suggest we have a suicide rate up to four times that of the general public and it's worse in female physicians. Women usually have a lower rate of suicide compared to men, but in medicine that's turned your head.

Speaker 2:

So the problem is enormous and these are just US stats. It's similar in many countries around the world. I was talking to an Australian doctor not two weeks ago. We're looking to start up a group there and they have huge problems there, similar to the US residents, medical students. It's throughout the whole system very successful specialists. People are taking an enormous amount of strain and medicine is, on the one hand, such a privilege and such a joy to be a doctor, but on the other hand, the personal costs can be too much if we don't look at ways to systematically American Medical Association, even the Surgeon General.

Speaker 1:

They've come with the patient satisfaction with the venture capitalists coming into medicine and buying up the hospital or RVU or even the medical, the electronic health record. All these are factors that have burned out within the system that contain that. I think that could be potential solutions if we could figure out a way to address those. But none of these groups that I have seen and maybe I've missed it none of these groups or outlines have addressed any of that at the system or have even pushed for that. It's always at the individual level. Do you have any thoughts on that?

Speaker 2:

Way too many thoughts. The main problem I have with the term burnout, which is why I'm glad you mentioned moral injury the problem I have with the term burnout, which is why I'm glad you mentioned moral injury the main problem I have is that it could be seen as putting the blame on the worker because it's an occupational hazard or an occupational perdition. It's defined by the World Health Organization as a work-related problem, not a mental health problem, not anything else. So the cause is the work, but especially in medicine, but actually in other high-performing professions as well, the blame can be put back on the professional themselves. You're not balancing your work life, you are not looking after yourself, you are not working efficiently or effectively. The problem is with you and, of course, maybe a small percentage of people. That is true, but it can not be true for everybody, because we work incredibly hard.

Speaker 2:

There are a few other professions that I've seen that work as hard or as long as doctors do, because it's a vocation and, as I say, it's a real privilege to do what we do. But the problem is not with us. The problem is with the system to a much larger extent. Sure, as I said, there are personal issues that we can tweak. You know, we can look at our self-care, we can look at our life-work balance, as I like to call it, rather than work-life balance, because you know, theoretically two-thirds of your day should not be at work, or at least that's for normal people. Normal people work eight-hour days and yet we, from a very young age, get used to just basically devoting your whole life to medicine, except when you're sleeping. It's not long enough, especially during residency. Sleep deprivation is a huge problem and I just I can't believe that with all the evidence we have around sleep deprivation accidents, medical errors, cancer risk, all the stuff that's there I spreadsheet that we haven't worked out a better system to work with people's circadian rhythms and to tackle that sleep deprivation issue.

Speaker 2:

But back to the main systemic causes. At the end of the day, the problem is not with us not working hard enough or smartly enough. The problem is increasing demand. There'll never be enough healthcare workers for the demand of the world, so there's always going to be that tension. But the increasing specialization of medicine, patient expectations, and we can blame to some degree, we can blame Hollywood and science fiction for that that people are expecting perfection in an imperfect system. People are expecting cure for conditions that are currently not curable. And then people get really upset when the doctor who's just done a 36-hour shift makes a mistake. And then they get sued. Medical malpractice is rising every year and it's one of the most stressful things a doctor can go through.

Speaker 2:

And then there's the medical culture which those of us that have been fortunate enough to go through med school there were, some amazing professors just lit up the room and you knew that they cared about you, they knew they cared about their patients. But then there were others. There was just bullying, there was nastiness, training by ritual, humiliation in some places. The horror stories that I've heard and I've had a few myself from many countries around the world is just appalling and effectively bullying, discrimination. All these sorts of things are still going on in our medical training, medical schools and residency. And, yes, we're getting better at calling it out, yes, we're better at standing up for ourselves, but at the same time, if you are a medical student or a resident, you're in a seriously disadvantaged power position and it's really difficult to call out a senior, highly respected you know, multiply published professor on their behavior. So the power dynamic is really skewed in medical school. And then, if we learn by modeling behavior for our seniors, then we're just going to carry on doing the same thing with the people that we are teaching and training. So medical culture needs to change.

Speaker 2:

But more importantly is the sheer amount of trauma that we're exposed to and the fact that from a young age in medical training we're taught to dissociate or separate or build up barriers from our emotions. And we have to, because you've got to be able to cut up a dead body to learn anatomy, you've got to be able to switch that off, to study, to focus, to do your exams. You'll be exposed to birth and death in the wards and the clinical attachments and then you're thrust out into the world as a nearly shiny doctor, and the day before was a med student and the day after they're suddenly a doctor and it's absolutely terrifying. And there's 20 patients waiting to be seen. One has just died and you have to break the news to the grieving family and you then have to switch off and see the next patient who may be even worse off than the previous patient, and then you've just got to do that for hours at a stretch and then somehow still retain your humanity through all of this.

Speaker 2:

And that is the fundamental problem, I think, with the medical system at the moment. I'm not even going to go into things like revenue and how perverse incentives really have screwed up medicine, but the main problem with a caring profession. When you mix that with a profit motive, I find it very hard to square that circle. I find it hard to put profits before patients in any healthcare system.

Speaker 1:

I agree, I agree. I mean I do understand that hospitals and clinics are businesses and they need to keep their doors open, and medical school is expensive and it keeps on getting more expensive. So I understand all of that, but we cannot put a dollar before a patient's health. I think that's unethical. That is part of the reason why I stay employed with a nonprofit, just to align with my values. At least it helps me stay focused and whether the patient has insurance or not, we do not turn them away. That's the reason why I went into medicine and originally wanted to do Doctors Without Borders, but practicing in rural Kansas can sometimes be similar. I love the challenge, but it's crazy how bullying still happens, and I don't know how common it is in the UK or even here in the US compared to other countries, but I'm sure that I know that it does happen. How do we change that culture? Because you're right, the culture starts early in medical school and then throughout residency, and then we're supposed to maintain that as an attending.

Speaker 2:

Yeah, if I need the answer to that, I'd probably be heading to Stockholm Prize. There's so many things that need fixing, but to me, it would start with getting the key people around a table and agreeing a set of values. Once you agree your set of values, from then you can build a new system. And it sounds incredibly simplistic, but actually, if you have the solid foundations based on, for example, things like equity, compassion and compassion includes towards the patients, towards the healers, patients towards the healers, towards the administrators, towards the investors uh, you know various other.

Speaker 2:

There's so many values that we could agree on, but those are just a few. Get those around the tape, get the. You need to get the politicians, the medical industry, the insurance industry, medical education, medical training, representatives of jobbing physicians. And then the key thing here is to have patients patients with a voice, because ultimately, they are who we serve. And if we sit and develop a system without engaging patients in a meaningful way and in an ethical way in which patients are supported, to be able to say what they really feel to this potentially fearsome group of doctors, patient activists and so on, I'd even consider involving people who've suffered because of medicine, who've been victims of theatrogenic harm.

Speaker 2:

I think it's important to hear all these voices Thrash out for as long as it takes, or maybe just lock people in a room and say we'll let you out when you've come to some agreement. Thrash out what the values are and from then on, try and shift the system. Everyone signs up to those values, a bit like the UN Declaration of Human Rights. Of course, not every country's complying with that, but the vast majority are, and there's things you can do in terms of enforcement and so on. That's where I'd start, but I wanted to just pick up another point which I'm glad you mentioned, which is medical school debt. So I think the figure is around $300,000 to $400,000 now coming out of med school. Do you know of the latest figures?

Speaker 1:

What I've seen is $200,000 plus, and I've talked to some. I think at about a state school it might be, let's say, 50,000. And at a private school, anywhere from 80,000 to 100,000, potentially, so I do the math and then about a 6% interest, assuming that's the interest that you have in loans.

Speaker 2:

Yeah, and then there's the cost of living through all of that and textbooks and all that. Anyway, whatever the number is, it's ridiculous, and what it does is it sets us up. Not only are we the smallest in the hierarchy of medicine or the lowest in the hierarchy of medicine when we start, we also have potentially the biggest debt let's leave mortgages out of this for the minute and so we are in a vulnerable position because we need the job and so it's really hard for us to stand up to ridiculous work hours and bad conditions of work, and because everyone else is in that system, we don't realize it's wrong. And I've worked in four different healthcare systems now so I'm able to compare and contrast and it's apparent to me that the systems where you have the biggest amount of debt and the biggest power differential are the systems where the biggest abuses happen, and I'm sorry to say that this is happening in the US as well, and so this medical school debt is a huge anchor holding us back, and I wish there was a way to solve that, and I've spoken to a number of physicians actually who, for various reasons, burned out, and they found ways to deal with the debt, to get it written off. There are actually mechanisms to reduce and get your student debt written off and just not having that fear and that financial burden is so really.

Speaker 2:

But then you know, let's say we pay off our debt and we're in our 40s and we've got a nice practice going and we buy the nicest house that we can afford with. You know the amount that the bank will lender. We're then locked into that situation and of a few years later kids come along. You want them to go to the best schools, etc. Etc. You deserve a decent holiday. These are all reasonable expectations, but the point is we then find ourselves seriously stuck and not able to flex financially. So if the system is bad for us, bad for our mental health, or new management comes in and the whole culture changes and it becomes really toxic, then it can be incredibly challenging to take a leap for your own health because of the financial obligations.

Speaker 2:

So money and the related fear is a really common thing that I see in the physicians that I work with in our individual coaching so I work as a physician coach but also within our anonymous groups.

Speaker 2:

I have to say the most common thing is fear.

Speaker 2:

The next most common thing is the amazement at sitting in a virtual room and sharing vulnerabilities and feelings with fellow physicians, because part of that wall that we learned to build up is being super competent and always happy in front of the patients and the colleagues, because we can't show weakness.

Speaker 2:

And it's been an eye-opening experience for the members who come to our free, anonymous peer support sessions to actually be vulnerable, for people to talk about how awful the day was that they just had a patient die they don't have anyone else to talk to, you know and how joyful the day they're an obst, obstetrician, they're a bunch of babies into the world and it all went well, you know, beautiful, but just to share that vulnerability, that human experience that we're just exposed to the hard edge of throughout our working days, it has been a great release for people. And so you know if there are people out there listening who are struggling, who are at risk of burnout or burnt out already. I'd encourage you to find different forms of peer support where just one there are lots of statewide or international groups that one can access, where everyone needs to choose the thing that works for them. But I welcome to come on and try a meeting and I'm delighted that you're coming in November, really looking forward to that.

Speaker 1:

Actually, so am I, and you know, it's not that I'm experiencing burnout or moral injury again. It is more I want to establish and I want to hey, you know what it's not a question of, if it's a question of when I hit a spot where it's rough, and even if it's not rough, I would like to connect with other physicians and just have that peer support, because we don't always have to look at that when we're hitting rock bottom. But how about just to stay sane and sail the course? Because, again, medicine can be brutal and also incredibly beautiful, just with the profession and working with various personalities and not only co-workers and patients.

Speaker 1:

Now, one thing that go ahead no, no, go on. One thing that you had mentioned was microtraumas at the beginning. Can you expand on that a little bit? Because I think that we as physicians and even in healthcare, we kind of diminish our negative experience and almost to go coincide with that I'm happy, everything's fantastic, and I'm going to be incredibly stoic or happy to not show any weakness and not ask for help. So I think we minimize a lot of negative experiences. So I wanted to see if you could touch on very briefly about microtrauma.

Speaker 2:

Yeah, thanks, thank you for coming back to that. It really is. It's so important to talk about because I guess you know we think of PTSD. We think of people who've been exposed to, you know, witnessing murder, or were nearly killed, or they were in a combat zone, and that is big PTSD, or sorry, big T PTSD. And then there's medicine.

Speaker 2:

Now, outside of the armed forces, I struggle to think of a profession that, on a daily basis, is exposed to as much blood, guts and death as medicine Obviously depends on your specialty and various bodily fluids. So this is not normal. Human beings were not designed to be exposed to this amount of stuff and then just robot-like, leave the shift and get on with their life. There are a minority of incredibly blessed and lucky and well-balanced individuals who are able to process the stuff. They've got their own mechanisms and you know, sail through medical school, sail through medical career and bless them. I wish I knew what their secret was, was, but I'm not one of those, and pretty much everyone I speak to can recognize that these traumas do build up over time and that we are exposed to unnaturally high levels of small t trauma. And just to add to that, of course, this is trauma. This is vicarious trauma. So it's this, is seeing it in other people and we we are by nature, being physicians, generally empathetic individuals, and we, you know, we feel the pain. And to have a patient die especially thinking of COVID patients dying and they're dozens or hundreds on a ship, you know, I mean it's just insane. And then thinking about them all alone there on a vent and their family can't come to visit them because of lockdown, and then copy and repeat that hundreds of times. This is a huge amount of trauma that's built up and there are studies looking at markers of chronic trauma and even things around epigenetics coming out. These things are not good for us and medical culture doesn't have a built-in way of dealing.

Speaker 2:

The way we deal with it right now is what we've learned at the knees of our trainers, which is that we smile and move on, or we develop a horrible alcohol problem, or we crash and burn, or we just have such defenses that we leave the shift and we're unable to relate to the outside world or our families. And that was like I was several of those. So I developed a raging addiction which made me feel better short term but caused more problem term and I compartmentalized my feelings completely, helped by the addiction, because it's nice to you know, it's useful to dam things down. I compartmentalized completely so I would be at home with my kids on the rare occasion I was home before they got to bed and emotionally I was not there, my head was somewhat and to me this wasn't healthy.

Speaker 2:

And, yes, anyone listening could say yeah, but, dr Corrigan, you meet a whole bunch of people who are self-selecting because of course they're experiencing burnout, but this is between 40 and 80% of us are experiencing burnout. So I think there's a lot more out there than I've met that are experiencing burnout and we're not taught ways of dealing with it. We're not even taught that there is a problem and certainly it's very difficult to sit down and say I think we have a problem in this department. Can we talk about just what just happened? Because how do you do that? You've got, as I said before, 20 patients waiting to be seen, no-transcript healers, and so I'm very sensitive to trauma because I also would notice it in my psychiatric patients and my addicted patients in my clinical life, and an unprocessed trauma is an unhealthy thing to have in the body and we need to find ways of dealing with it.

Speaker 1:

Now, thank you for touching on that, because I would like to see who actually comes out of medical school or training, or even being an attending, without some form of PTSD. I think we're very resilient individuals, but that does not mean that, like you had mentioned, the mind is not built for that right. We study after study after study shows that, and I don't know what it would take to get the medical profession to really step up and understand that. I can say that, where I currently work, when we lost a colleague over the summer unexpectedly, admin was very supportive and through work associated, we were able to some were able to get I should sorry, I should rephrase that, and I do, I do edit this I should rephrase that the ones that needed counseling grief counseling were able to get it, and they shut down the surgery department in order for those that wanted to attend the memorial service. So that's one of the benefits of being in a small town, but that's not, that's not everywhere.

Speaker 1:

One thing that Kansas has done, though, is to take a step in the right direction and consolidate the questions from three questions, I believe, to one to one when we renew our license at the end of it is do you have mental illness or an addiction that would hinder your ability to practice medicine, versus have you seen or sought help from a mental health provider or do you have depression? Do you have problems with substance? So it's reworded and the Board of Healing Arts, I can tell you, are very pro-physician getting help. It's not going to count against them. So that's a step in the right direction. That's only one state out of 50. And I don't know what other states have changed questions.

Speaker 2:

Yeah, there was a study on it. I think it's about half now have improved, but only one is actually compliant with the full four standards set by the. I'll have to look it up, but there's four standards set to protect physicians. But I'm so glad that your state is doing that because the way it's worded, in some places it actively prevents people from getting proactive help. So in other words, you can see that there's a problem happening, you want to go and see someone about it, you want to go and talk about it before the feces hits the rotating oscillator and because of the wording of that question it's an active disincentive to getting help. And until that is at federal level, it's going to be quite variable by state. But just speaking of states, there's another factor which I didn't realize how varied it was. But in one state if you are a patient unhappy with your doctor and you feel there's been a problem and you want to sue them, you can just go ahead and sue them and the whole process gets triggered and you can potentially, if you have a good enough lawyer and a favorable jury, you can get a payout. And this is not in any way minimizing patients who have genuinely been harmed by patients. There needs to be a mechanism of redress for that, of course. But I was recently privy to a case where there was absolutely no scientific evidence linking the doctor's care to the outcome that the patient was suing for. And yet the patient got a multi million dollar payout in one state and yet the state next door that same claim would have had to go through a vetting process and it would have been three very senior clinicians who would have gone independently of each other. This has clinical merit or this does not have clinical merit? And if it does have clinical merit, then it goes through the judicial process and then whatever happens happens. But so you know we're beholden to federal standards and yet at state level the medical practice variation, the licensing variation, the credentialing variation is so vast that you know it's no wonder where. You know we don't know whether we're coming or going and we really need to look at standardizing and humanizing a lot of these things. You know there needs to be a better balance where the healers are looked after, they're incentivized to proactively get help rather than potentially punished. It's not just state licensing, it's credentialing of hospitals and so on.

Speaker 2:

These questions are also asked. Torture reform is another issue. So in some states if you've ever had mental health treatment and you're being sued, that information can come out in discovery. So all of a sudden you're seeing a psychiatrist for depression in your 20s could become public knowledge in a court and that could be used against you because obviously, having seen a psychiatrist, you must be mentally incompetent, or at least that's what the lawyer will say.

Speaker 2:

So, talking about systemic issues, there's tort reform, there's all sorts of regulatory things that if we went back to the principles of values, compassion, fairness, equity, that these things will all need to shift in those directions, because it feels incredibly unbalanced right now and being sued is one of the most or being investigated by your state licensing board is routinely one of the most stressful things that a physician can go through because it triggers that fear I'm going to lose my job, my career, my reputation, my marriage.

Speaker 2:

That fear gets triggered, linked, of course, to the financial stuff I was talking about earlier, and certainly here in the UK we've had a string of physician suicides amongst doctors being investigated by our equivalent of the state licensing board, the General Medical Council, and a bunch of doctors died sort of mysteriously but they weren't officially labeled suicide, but you can read between the lines.

Speaker 2:

You know they did actually investigate them and it's the most stressful thing, almost that a physician can go through and we need to be able to deal with it and support people better. Because my personal experience was, when my stuff came out, my colleagues nine out of 10 of them turned their backs because they were afraid of being associated because of the rotation and, to be honest, with a shoe on the other foot. I'm not sure I would have done different. I might've probably been so afraid and self-protective that I would have turned my back on it as well. But the one out of 10 that didn't have been incredibly supportive and proven themselves to be good friends and good colleagues, but they nevertheless some of them were fearful of kind of publicly supporting doctors in trouble because the reputation risk again. But at least I knew that I was being supported privately. So there's a lot of complexity to this.

Speaker 1:

You're absolutely right. There's nothing that is as isolating as what you've just described, and the sad thing is is that when we're in medical school and residency, we're told it's not a matter of if it's a matter of when, it's just something that we expect and it's an occupational hazard, but yet there's a culture around that that you don't discuss that either, and while I get that, there's no way to process any of these traumas that we whether small T or large T that we have in medicine, and so that's the reason why I'm such a huge fan of Physicians Anonymous and other platforms that allow physicians to be human and allow one to express their vulnerability and just be themselves be a human being and not a title or a white coat, yeah.

Speaker 2:

So when you come to the meeting, we ask that you check your credentials and your white coat and your stethoscope at the door. So within the room, which is obviously a virtual room in zoom, we are human beings first and foremost and what we have in common is our humanity and the fact that we happen to be physician or, in brackets, medic. So that immediately because the first was quite funny the first meetings that we set up, it became a bit like a sort of networking conference. You know, I'm a, I'm a, you know, attending from the Midwest, blah, blah, blah, blah. I've got, you know, x, publication, y, research grants. And we kind of had to reconfigure to actually say, to set some guidelines for our groups, to actually say, yeah, you're welcome to do that. But actually we try and park these things at the door to just focus on our humanity.

Speaker 2:

And the other thing we do in the groups is the facilitators who we train up, rural volunteers, we model certain positive behaviours, so showing vulnerability, cognitive reframing, basically being able to see that there are multiple perspectives to scenarios, active, deep listening process. For if there is a doctor who's particularly distressed or we're worried about their risk, we have a process for dealing with that. But the main thing is that you know, within the groups people are able to show vulnerability. We can leave our diplomas and our weaponry and armour at the door and just connect as human beings. And actually we had one of the participants kind of saying I wish I discovered this 20 years ago. You know, maybe my career path would have been different, maybe I wouldn't have burnt out as much, because I never realized that my colleagues were struggling as well. I always thought it was just me. I always thought I was the only one who had who was burning out, who was struggling with the workload, struggling with the late night, struggling with the deaths of the patients, or the awful bullying professors or whatever it turns out. We all were, or at least the majority of us were, but we couldn't show vulnerability to each other.

Speaker 2:

It's a bizarre system. I compare my training as a doctor to my good friend who's a psychologist, and sure, there's also a degree of competitiveness and they'll get a good job and all that. But they have compulsory therapy, compulsory supervision for every case they see, they have to talk it through with a senior colleague and they also have in many places different forms of groups. For example, there's a format called a Barland group, which is available in the US and the UK, where you actually talk about the feelings that the patients bring out. And it doesn't have to be someone who's died. It can be the so-called heart sink patient, the repeat presenter with the same problem, seeking addictive meds or an alcoholic or whatever they've got. They're causing it themselves but they're unable to stop and it brings out frustration and anger and all sorts of natural feelings to the carers. You've seen the guy five times this week. Why wouldn't you be frustrated? But we never talk about that stuff. We might make inappropriate jokes and I love medical humor. It's so dark, helps us get-.

Speaker 1:

Amen to that.

Speaker 2:

But and that has its place, of course but at the end of the day, if it's not enough, end of the day, if it's not enough, we need to find ways to to talk about feelings and, um, recognize the stuff. I mean, I was a psychiatrist and you know it took me three years in recovery to start to recognize the feelings that were coming out because I just I just blocked myself off of them completely to recognize them and others I just couldn't in myself. And you know I'm not alone there. I've seen so many colleagues who are just so defended and, yeah, across the professions I'm looking. We're particularly bad in psychiatry because we're just dealing with a huge amount of tsunami, really, of toxic emotion that we just have to find, you know, build up defenses against it. Yeah, I've kind of gone off on a tangent now and I can't remember what our original point was no, no, actually, I think you're still within.

Speaker 1:

I think I think you're still within those boundaries. I mean, because you touched on a very important thing is that we're very good at as physicians about saying, oh, you appear to be sad, don't tell me about that. Right, and we can use motivational interviewing and we can really pull things out of patients. But when it comes to ourselves going back to our training and maybe even a bit of personality, as to what draws type A know, type A personalities into medicine, I'm just throwing this all out there.

Speaker 1:

At the age of 40, I am learning how I feel and using putting it into words more eloquently in order to teach my son, who's four. And so it's like why in the world am I doing this at 40? I thought I was better at this and I was like my gosh. We're really taught not to, not to label our feelings or feel them, and we have to compartmentalize or push everything down and I can't do that anymore, just with so it's been interesting. And when at work. Now, if there's a difficult case or what have you, we'll try to do a quick debriefing case, or what have you, we'll try to do a quick debriefing. Or if it's going to be a crazy day, which it can get a bit insane in clinic. Try to do a quick hey, this is what we need to do X, y and Z, just to talk about flow and it seems to help. But yeah, it's difficult learning these things at a later age in life.

Speaker 2:

I'm so glad you're doing that with your kid. They're going to really flourish on that and with any luck, by the time they study medicine he says tongue and family in cheek that medical school culture will have changed. Learning their feelings will be a useful skill. And naming them Because right now it's yeah, it's a muscle we never exercise in medicine. But if I were a hospital administrator and I was listening to myself going fair enough, who's going to pay? Whereas if you want to have a half an hour meeting where people talk about feeling, who's going to pay for that? And they have a point.

Speaker 2:

But I'm going to say a couple of things in response. Number one if you're a for-profit, what were your profits last year and could you factor that into the well-being of your staff? Number two when you add up the costs of burnout, mental illness and addiction much of your doctors when you add those up, you probably don't know how to account for those. But here's how you do it you look at the prevalence rates of your common mental illnesses and your addictions and you apply those to your medical workforce and, if you like, you can do it to your nursing workforce and all the other healthcare and other professionals in your organization and you go right. So X percentage are going to be having these problems, right? What is our absenteeism rate and what is our locum costs? Treatment costs, turnover sorry, churn people leaving all of that what is our medical malpractice rate? Start to add up all the costs and I'm pretty sure that if you are honest about it as an administrator and you can find an accountant who gets these things, the subtleties of these costs, you could evidence there is significant cost involved. There was a study, I think in I forget now which journal it was, but it was in the billions of burnout US only. That is what it's costing our organization and we need to invest in staff wellbeing.

Speaker 2:

If you're a home depot, you're going to invest in teaching your sales team how to deal with, how to sell, how to deal with difficult customers, how to deal with emergencies, health and safety, all that stuff. You're going to invest in that stuff and you're going to notice if they're going off sick and burning out and you're going to have to do something about it. It's the same in medicine. If you want to corporatize it, you need to invest in your staff well-being and the return on investment will be significant. If you look at, for example, a couple of randomized controlled trials around physician coaching. I think it was a JAMA article. In the last couple of years, female residents were offered a six-month coaching program and all the important measures improved dramatically. Things like burnout, imposter syndrome, emotionally exhaustion reduced, self-confidence improved. Yeah, these are crucial things and the evidence base is growing. Look into actually supporting your staff, investing in them, and you will get better results and that'll actually be better for your bottom line, in my opinion.

Speaker 1:

Thank you for bringing that up, thank you for addressing that, because we've seen in the business world that other companies, corporations, they do that. They have better retention, they have better outcomes just because people are actually happy and they're better equipped to give 100%. And one of the common factors is that we still have humans working in medicine, we still have humans working in other corporations. Those needs don't change, and that's one thing I think that we forget is that, oh, we're physicians, we don't need that, or, yeah, we're some of the most resilient people, but we still need to take care of our needs, which leads to safety. And that's not only safety as far as physical safety, but emotional and psychological safety. And that is where we, I think, really just brush it off. And it's almost like the alcoholic family right, nobody's going to talk about the elephant in the room because it's going to make somebody upset.

Speaker 2:

Yep, yep. But if we make it part of the medical school training and it's part of the culture and it's in the DNA, by the time you're a qualified doctor you'll just be doing that. The problem is we're not starting. I mean, I've seen some amazing programs at some really progressive US medical schools and elsewhere in the world UK and Europe especially where this recognizing feelings, it's basic kind of CBT, fully evidence-based stuff. Wow, what is that feeling? Oh, I'm going to give it a name, okay, and the thoughts that are associated okay, and do they? Is there another way of looking at this? Is the fact that I didn't do well on this exam doesn't mean that I'm going to be a crap doctor and I might as well drop out? Well, not necessarily. There's another way to look at that, for example.

Speaker 2:

So if we're teaching that and it's practice, these self-care skills and I'm not just talking about CBT, I'm talking about life-work balance we're the worst, physicians are the worst we tell people to lose weight, do exercise, eat healthy, meditate 20 minutes a day. What percentage of us actually do that? And I want to get onto psychiatrists and our own mental health, because that's a whole podcast but we're really not helping ourselves in situations. So there are things that we can do and I'm so glad you mentioned we're a resilient bunch, salma, because I think to survive and even sometimes thrive through the things that we go through in medical training and residency and medical career, we're not to quote the happy MD, we're not deficient in grit, we've got grit, we've got resilience. The problem is resilience only works up to a point and when you're in an incredibly toxic system full of little t-traumas and all the other toxicity that goes with it, you could be the most resilient sereneene jedi like doctor in the world. But eventually you're going to get hit and unfortunately the numbers are supporting my argument. You know we've never had such high burnout rates. Then again, we've not had a covid pandemic. But you know the burnout rates were unacceptably high before covid and it.

Speaker 2:

This just showed all the cracks in the system. You know wherever the system had weaknesses they were just amplified by COVID. And was so delighted to see the Lorna Bree Heroes Foundation and the law being passed and the funding coming with that. But you know it feels a little bit like pushing against the tide because the problem is it feels much bigger than that. But it's a great start in the right direction and you know, at the end of the day, there are resources out there. Like Pamela Weibel in Oregon has got a confidential physician suicide line. Like Pamela Weibel in Oregon has got a confidential physician suicide line.

Speaker 2:

Many, if not all, states have got resources for doctors that are confidential. You just need to know how to find them. The AMA, the colleges, employers have confidential support lines, employee assistance programs which Doctors are terrible at engaging with, even though it's confidential, because we fear somehow being discovered or we fear having to write it on our state paperwork. There are resources out there and if we start, if we get past the fear and the paranoia and just actually reach out for help, if we hit the fan, then my situation might have been different. The reason why I didn't reach out was because I feared losing my license and my career. As it turned out, that's what happened anyway, because I didn't reach out for help, and that's one of the reasons why working in Physicians Anonymous is because I want to prevent this entirely preventable train crash from other people's experiences happening to the physicians practicing today. We need to connect with each other, we need to deal with loneliness, we need to be able to show vulnerability in safe spaces that are not going to be on any paperwork. That's why the anonymous element is so important, and we need to then work together and lobby for change at all those levels that we've been speaking about, because we can't carry on losing three to 400 of us every year in the US alone.

Speaker 2:

It's probably much bigger figures globally, but you can't get them. This is not acceptable. We need to do something and spreading the word through your podcast. We really are worthy to have got as far as we have. We are worthy physicians, but, my God, the system can make us feel so unworthy because it feels like it punishes us the minute something goes wrong, or even if something doesn't. You can get sued for nothing. It can be a matter of opinion. You can be investigated because of a spurious allegation by a malicious patient. You know, all these things can happen Even if you're perfectly innocent. Things still can go wrong and it's incredibly stressful, but at the end of the day, we are worthy. And yeah, I'm just. I'm so glad that you've got this podcast and, you know, I hope that people benefit from listening to it. I'm sure they will.

Speaker 1:

Thank you for that and the inspiration for this podcast. As I've mentioned occasionally and maybe I don't mention it as much as I should but I lost my best friend from residency in medical school to suicide back in 2019. So to me it's a very big deal. It is a very big topic and, with the amount of physician suicide per year, I am shocked that it is not talked about more publicly and that more is not being done faster. It is, unfortunately.

Speaker 1:

We stigmatize mental health and that more is not being done faster. It is unfortunately. We stigmatize mental health and mental health is health. If we look at a lot of the, let's look at Buddhism right, meditation is meditation, living in intention. If we look at Taoism, a lot of the principles of the oldest religions really do, I think, focus on mental and physical health together, because they are the yin and the yang. And, as physicians, as we wake up, as we look at, hey, the system has to change, because if my kids do want to do medicine, I definitely want to make it a little bit better, and if this helps one person, then my work is worth it.

Speaker 2:

Exactly what we felt when we found out that if this prevents one person, one physician, work is worth it. Exactly what we felt when we found out that if this prevents one person, one physician, from taking their own life, then this is it is worth worth every penny. Because, yeah, because we are worth it. And can I just talk about suicide a bit more? I know we should probably have a trigger warning, but we have to talk about it, and talking about it does not increase the risk of people doing it. Asking people, are you feeling suicidal? Are you thinking you might do something to harm yourself? I used to do this day in and day out with psych patients and, yeah, that was fine. But if you're worried about someone, you can ask anybody. There's strong evidence that asking about it does not increase their risk of doing it. In fact, it probably reduces the risk, if nothing else.

Speaker 2:

You've spoken about the worst case scenario and if they're not suicidal, they are really in pain. You know, you've opened up a bridge with them and so it's a good thing to do. And if you look at, like, the family members of people who seemed okay and then unexpectedly took their own life, the number of stories I mean. It's just it brings a tear to my eye. You know, with the parents said I wish I'd asked them if there was suicide, but I didn't even think of it or I was too afraid, or whatever. You can do that you can ask, you can just say are you okay? And they say yeah, I'm fine and you smell BS, or they're not fine. You can call them on it, you know you, you can show them you care and you can only do so much. At the end of the day, if someone doesn't want your help, then also recognize your limitations.

Speaker 2:

But another point about suicide is did you ever see the activist, kevin, who jumped from the Golden Gate Bridge and survived? Oh, wow, okay, kevin Hines is his name, h-i-n-e-s. Just Google him. He's an amazing advocate for mental health and well-being and suicide prevention, so he's got an amazing TED talk. Basically, he was incredibly ill and was walking on the bridge and tourists would stop him and ask him to take photographs of them, but no one asked him are you OK? And eventually he jumped.

Speaker 2:

And then he talks about the study of the less than, I think, one percent of people that survive these kind of serious suicide attempts, and something like 80 percent of them, their first thought as they were doing whatever they were doing, was oh god, give me another chance. Oh god, I wish I hadn't done that. Um, and for many of them, their lives were transformed because finally it's like okay, this is what's really important in my life. You know, I have survived this for a reason. When you face, you know, literally seeing your life flashing before your eyes, you go, okay, he wish I hadn't done that.

Speaker 2:

And this is a really common theme amongst, you know, suicide survivors and I was. I'm just really taken away by that because I think of the patients I've lost, and I have lost colleagues like you, one in medical school, one just after residency. I share your pain with that and I wish I'd done more, I wish I'd asked them, I wish I'd made that phone call. You know, all these things we wish you could change. But the important thing is that you know at that point the sheer amount of emotional pain has to overwhelm the fight to live, and so I can only imagine I mean, I have been suicidal myself during my darkest times. I can relate to that but it never got to the point where the emotional pain was bigger than my love for my kids and my wife. I had no love for my own life but my love for them was bigger. And that's basically what stopped me was a friend in the 12-step program basically helping me to see what was truly important.

Speaker 2:

And I just think our colleagues who complete suicide and often they'll take toxic doses of meds because we know our pharmacology and stuff Often physicians who die do it in on-call rooms and in or near the hospitals. It's what is that message that they're saying hospitals? It's what is that message that they're they're saying there was that awful case of a nurse in I think it was california recently who kind of shot themselves in an er in the workplace. You know it's. These are serious cries for help and I think of all those people that if they've been given a second chance would they do it again and I I strongly believe that most of them wouldn't.

Speaker 2:

But the problem is that's your one line and there is no reboot, um, there is no save game and reload the game. You know it's your one life and so I'm personally so glad that I'm here and I'm able to see my kids grow up and yeah, you know, I thank my higher power for that on a daily basis and I feel desperate for those that that didn't have that option or see, see that that light, or have that reframing, and so so I want us to be there, both as physicians anonymous, but also just as human beings for anyone who's in distress, but particularly focused on colleagues, because we're at higher risk than the average population. Despite all the advantages of being a doctor, we're still ending our lives in droids, and something's got to change.

Speaker 1:

We've really touched on the dark side of being a physician, haven't we?

Speaker 2:

Oh yeah.

Speaker 1:

But I mean, this is reality and the truth is that everybody is at risk, I would believe, because we're all human and we all. Everybody's wall to hit of I can't take this anymore or I have nothing left to give is different, and so thank you, number one. First thing, thank you for being vulnerable and telling your story. I think that's incredibly powerful and I definitely hope that the listeners are learning and taking notes For our listeners. What advice would you have in addition to seek help? Definitely be aware of where you are. What are your triggers? Well, definitely be aware of where you are. What are your triggers, things like that. What would Dr Corrigan now tell Dr Corrigan 20 years ago, yeah, oh, come on, there's so much.

Speaker 2:

Stop being a dick number one, listen to your wife. Number two. Those are both very much tongue in cheek, but also true. But the main one is recognize your own humanity. You are not a superhero. I love Scrubs. I mean, if you watch the series Scrubs with Zach Braff back in the noughties, like love Scrubs could relate to so much of it and you know the theme song. I'm no Superman. It is entirely true.

Speaker 2:

The public Hollywood pedestals that were put on the money we're paid profile we get the respect we get, you know it can make us feel invulnerable and sure. In some ways we have superpowers. We, we do have the powers over life and death. Yeah, when, when the right condition comes along and we have the right equipment and meds for it, of course, um, and we can make a vast difference to lots of people's lives and we're so privileged for that. But at the same time we are just human. We were just born, like everyone else, naked. We arrive naked, we shall leave dust to dust and all that, and we have this particular role in life. But at the same time we don't have to necessarily be vulnerable and crying in front of our patients. That's not what I'm advocating, but I am advocating finding a safe space to do that.

Speaker 2:

I wish that I had found 12 steps earlier, because 12 steps is not just about addiction. 12 steps only mention alcohol or whatever the substance is or behavior wants. I'm talking about powerlessness. They don't mention stopping drinking or taking drugs ever again. The 12 steps is about connection with others, reducing loneliness, working out true values of understanding yourself, working out who you've hurt in your life, trying to make amends for that and then living a good life, going forward, trusting in a power greater than oneself. It's like plugging 12 steps for anyone that's struggling primarily with addictions, but it works for life. I mean, I need to write a book on 12 steps to life because really it's a deeply philosophical, deeply wise program that anyone really adopts.

Speaker 2:

In fact, I know someone who's not an addict that worked the 12 steps. They were the, the child of an alcoholic, and they they grew up around hey, I mean, they worked the 12 steps because they felt it would be good for their lives and they they live a life of poise and equanimity and serenity like no one I've ever met before. And when you meet recovered addicts who are in this space, there's a light and energy coming which is so beautiful compared to where they were before they found it. So, yeah, I wish I'd found a support group. I wish I hadn't turned my back on my spirituality and my values. So yeah, these are all things I write in it. But mainly, don't be a dick and listen to your wife.

Speaker 1:

It's really important to listen to that external board and it's always nah, you don't know what you're talking about. I know me better than yeah, we're all guilty of it.

Speaker 2:

Oh man, when my stuff came out, she was like ah, so that's what's been going on. I have been pestering you about this for many years, but I was so good at hiding it. You know if I'm an addict and all that. If only I'd listened to her, things might have been different. But we are where we are and I just need to make the most of it, going forward and learn those lessons and not mess up again.

Speaker 1:

It's a beautiful story. It's an unfortunate way of how you arrive, but I am happy that you're here. I am happy that we're on this podcast together and I hope that the listeners really really take notes and listen and learn and my gosh, the 12 steps can just.

Speaker 2:

It's almost like Buddhism in a 12-step program, if you will. Yeah, there's a huge amount of overlap with all the major spiritual philosophies and religions religions, you know. As far as I can tell, it's kind of compatible with you know, like I've met people from every single religious background and non-atheists and agnostics as well, in 12-step programs and they can all get their heart or their heads around a higher power. The higher power, if you're an atheist, can be the group itself or it can be a chair. Basically, the point is your life, with you managing it. You're the director of your life.

Speaker 2:

And look at what's happened. You have repeatedly crashed the bus, so you're not up to it at the moment. And then there's the whole bit around you're an addict and you have an illness, and not your fault, but you've been blessed with it and there is someone who will, and that'll be the group, or it'll be the program, or it'll be god or jesus or buddha, and it really, really. So, yeah, a little bit of extra 12-step plugging, if you will, highly recommended. But it wasn't the only thing. I got therapy, I got meds and yeah, and I got coaching. That's the other thing One-to-one coaching to help me rebuild and work out what I wanted to do with my life Once I was through the worst of it. I'm going okay, coming out of medicine. What do I really really want to do? What can I use my skillset for if I'm not going to practice clinically for now?

Speaker 2:

And this is one of the avenues which really fulfills the need to kind of give back and help others through Physicians Anonymous that is our hope is that physician coming out of an ER shift at two in the morning where something awful has happened, that there will be a meeting available for them happening in some time zone somewhere and they can just log into that free of charge and just listen or tell their story and laugh or cry.

Speaker 2:

But you know, we want to enable, just to be this platform that physicians can support each other from anywhere around the world, and certainly that's what's happening on a small scale. But we really want to grow to have as many meetings as possible to meet that demand. So I'm going to, if you don't mind, just sort of say people are interested in finding out more. Just check out physiciansanonymousorg or drop me a line through the website, or if you look up Dr Corrigan on LinkedIn I'm on there as well and Twitter, and yeah, just connect with us so we can tell you more. If you're interested in coming to groups or even becoming a facilitator, it's very easy. We offer the free training and the platform and we can help you set up a group in your time zone if you like.

Speaker 1:

You took the question right out of my mouth and I appreciate that You're welcome and, dr Corrigan, thank you so much for your time and again, as always, it's been a pleasure.

Speaker 2:

Thanks for all you do for the fellow worthy physicians out there. Yeah, keep up the good work and I really enjoyed this. Thank you so much.

Speaker 1:

Thank you. Thanks for joining us. If you have enjoyed this episode, click subscribe. Share it with a friend, because we could all use a little bit of normalizing the topic of burnout, knowing that we're not alone. Thanks for tuning in to another episode from the Worthy Physician Podcast. If you enjoyed this episode, be sure to subscribe, leave a review and share it with someone who'd love it too. Don't forget to follow us on YouTube, linkedin, instagram for more updates and insights. Until next time, keep inspiring, learning, growing and living your best life.