By the end of 2021, Anuj Peddada, MD, had hit a wall. He couldn't sleep, couldn't concentrate, erupted in anger and felt isolated personally and professionally. To temper pandemic-driven pressures, the Colorado radiation oncologist took an 8-week stress management and resiliency course, but the feelings kept creeping back.
Still, Peddada, in his own private practice, pushed through, working 60-hour weeks and carrying the workload of two physicians. It wasn't until he caught himself making uncharacteristic medical errors, including radiation planning for the wrong site, that he knew he needed help — and possibly a temporary break from medicine.
There was just one hitch: he was closing his private practice to start a new in-house job with Centura Health, the Colorado Springs hospital he'd contracted with for over 20 years.
Given the long-standing relationship — Peddada's image graced some of the company's marketing billboards — he expected Centura would understand when, on his doctor's recommendation, he requested a short-term medical leave that would delay his start date by 1 month.
Instead, Centura abruptly rescinded the employment offer, leaving Peddada jobless and with no recourse but to sue.
"I was blindsided. The hospital had a physician resiliency program that claimed to encourage physicians to seek help [so] I thought they would be completely supportive and understanding," Peddada said.
He told Medscape Medical News that he was naive to have been so honest with the hospital he'd long served as a contractor, including the decade-plus he'd spent directing its radiation oncology department.
"It is exceedingly painful to see hospital leadership use me in their advertisement[s]…trying to profit off my reputation and work after devastating my career."
The lawsuit Peddada filed in July in Colorado federal district court may offer a rare glimpse of the potential career ramifications of seeking help for physician burnout. Despite employers' oft-stated support for physician wellness, Peddada's experience may serve as a cautionary tale for doctors who are open about their struggles.
Centura Health did not respond to requests for comment. In court documents, the health system's attorneys asked for more time to respond to Peddada's complaint.
A Plea for Help
In the complaint, Peddada and his attorneys claim that Centura violated the state's Anti-Discrimination Act and the Americans with Disabilities Act (ADA) when it failed to offer reasonable accommodations after he began experiencing "physiological and psychological symptoms corresponding to burnout."
Since 1999, Peddada had contracted exclusively with Centura to provide oncology services at its hospital, Penrose Cancer Center, and began covering a second Centura location in 2021. As medical director of Penrose's radiation oncology department, he helped establish a community nurse navigator program and accounted for 75% of Centura's radiation oncology referrals, according to the complaint.
But when his symptoms and fear for the safety of his patients became unbearable, Peddada requested an urgent evaluation from his primary care physician, who diagnosed him with "physician burnout" and recommended medical leave.
Shortly after presenting the leave request to Centura, rumors began circulating that he was having a "nervous breakdown," the complaint noted. Peddada worried that perhaps his private health information was being shared with hospital employees.
After meeting with the hospital's head of physician resiliency and agreeing to undergo a peer review evaluation by the Colorado Physician Health Program, which would decide the reinstatement timeline and if further therapy was necessary, Peddada was assured his leave would be approved.
Five days later, his job offer was revoked.
In an email from hospital leadership, the oncologist was informed that he had "declined employment" by failing to sign a revised employment contract sent to him 2 weeks prior when he was out of state on a preapproved vacation, according to the lawsuit.
The lawsuit alleges Peddada was wrongfully discharged due to his disability after Centura "exploited [his] extensive patient base, referral network, and reputation to generate growth and profit."
Colorado employment law attorney Deborah Yim, Esq, who is not involved in Peddada's case, told Medscape that the ADA requires employers to provide reasonable accommodations for physical or mental impairments that substantially limit at least one major life activity, except when the request imposes an undue hardship on the employer.
"Depression and related mental health conditions would qualify, depending on the circumstances, and courts have certainly found them to be qualifying disabilities entitled to ADA protection in the past," she said.
Not all employers are receptive to doctors' needs, says the leadership team at Physicians Just Equity, an organization providing peer support to doctors experiencing workplace conflicts like discrimination and retaliation. They say that Peddada's experience, where disclosing burnout results in being "ostracized, penalized, and ultimately ousted," is the rule rather than the exception.
"Dr. Peddada's case represents the unfortunate reality faced by many physicians in today's clinical landscape," the organization's board of directors told Medscape in a written statement. "The imbalance of unreasonable professional demands, the lack of autonomy, moral injury, and disintegrating practice rewards is unsustainable for the medical professional."
"Retaliation by employers after speaking up against this imbalance, [and] requesting support and time to rejuvenate is a grave failure of healthcare systems that prioritize the business of delivering healthcare over the health, well-being, and satisfaction of their most valuable resource — the physician," the board added in their statement.
Peddada has since closed his private practice and works as an independent contractor and consultant, his attorney, Iris Halpern, JD, told Medscape. She says Centura could have honored the accommodation request or suggested another option that met his needs, but "not only were they unsupportive, they terminated him."
Yim says the parties will have opportunities to reach a settlement and resolve the dispute as the case works through the court system. Otherwise, Peddada and Centura may eventually head to trial.
Current State of Physician Burnout
The state of physician burnout is certainly a concerning one. More than half (53%) of physicians responding to this year's Medscape Physician Burnout & Depression Report said they are burned out. Nearly one quarter reported feeling depressed. Some of the top reasons they cited were too many bureaucratic tasks (61%), too many work hours (37%), and lack of autonomy (31%).
A 2022 study by the Mayo Clinic found a substantial increase in physician burnout in the first 2 years of the pandemic, with doctors reporting rising emotional exhaustion and depersonalization.
Although burnout affects many physicians and is a priority focus of the National Academy of Medicine's plan to restore workforce well-being, admitting it is often seen as taboo and can imperil a doctor's career. In the Medscape report, for example, 39% of physicians said they would not even consider professional treatment for burnout, with many commenting that they would just deal with it themselves.
"Many physicians are frightened to take time out for self-care because [they] fear losing their job, being stigmatized, and potentially ending their careers," said Peddada, adding that physicians are commonly asked questions about their mental health when applying for hospital privileges. He says this dynamic forces them to choose between getting help or ignoring their true feelings, leading to poor quality of care and patient safety risks.
Medical licensing boards probe physicians' mental health, too. As part of its #FightingForDocs campaign, the American Medical Association hopes to remove the stigma around burnout and depression and advocates for licensing boards to revise questions that may discourage physicians from seeking assistance. The AMA recommends that physicians only disclose current physical or mental conditions affecting their ability to practice.
Pringl Miller, MD, founder and executive director of Physician Just Equity, told Medscape that improving physician wellness requires structural change.
"Physicians (who) experience burnout without the proper accommodations run the risk of personal harm because most physicians will prioritize the health and well-being of their patients over themselves…[resulting in] suboptimal and unsafe patient care," she said.
Helping Doctors Regain a Sense of Purpose
One change involves reframing how the healthcare industry thinks about and approaches burnout, says Steven Siegel, MD, chief mental health and wellness officer at the University of Southern California's Keck School of Medicine. He told Medscape that these discussions should enhance the physician's sense of purpose.
"Some people treat burnout as a concrete disorder like cancer, instead of saying, 'I'm feeling exhausted, demoralized, and don't enjoy my job anymore. What can we do to restore my enthusiasm for work?' "
Siegel recognizes that these issues existed before the pandemic and have only worsened as physicians feel less connected to and satisfied with their profession — a byproduct, he says, of the commercialization of medicine.
"We've moved from practices to systems, then from small to large systems, where it seems the path to survival is cutting costs and increasing margins, even among nonprofits."
The Road Ahead
Making headway on these problems will take time. Last year, Keck Medicine received a $2 million grant to launch a 3-year randomized clinical trial to help reconnect physicians and other clinicians with their work. Siegel says the trial may serve as a national pilot program and will eventually grow to include 400 volunteers.
The trial will investigate the effectiveness of three possible interventions: (1) teaching people how to regulate their internal narratives and emotions through techniques like cognitive behavioral therapy and acceptance and commitment therapy; (2) providing customized EHR training to reduce the burden of navigating the system; and (3) allowing physicians to weigh in on workflow changes.
"We put physicians on teams that make the decisions about workflows," said Siegel. The arrangement can give people the agency they desire and help them understand why an idea might not be plausible, which enriches future suggestions and discussions, he says.
Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.
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Cite this: Seeking Help for Burnout May Be a Gamble for Doctors - Medscape - Sep 08, 2023.