title: Self-care as a professional imperative: physician burnout, depression, and suicide.
abstract: OBJECTIVE
  Burnout has been identified in approximately half of all practicing physicians, including anesthesiologists. In this narrative review, the relationship between burnout, depression, and suicide is explored, with particular attention to the anesthesiologist. Throughout this review, we highlight our professional imperative regarding this epidemic.
  
  
  METHODS
  The authors searched the existing English language literature via PubMed from 1986 until present using the search terms physician burnout, depression, and suicide, with particular attention to studies regarding anesthesiologists and strategies to address these problems.
  
  
  RESULTS
  Burnout and depression have increased among physicians, while the rate of suicide has remained relatively the same. There are many factors associated with burnout and depression as well as many causes. Certain individual factors include sex, amount of social support, and mental health history. Systems factors that play a role in burnout and depression include work compression, demands of electronic health records, production pressure, and lack of control over one's professional life. Medical license applications include questions that reinforce the stigma of psychological stresses and discourage physicians from seeking appropriate care.
  
  
  CONCLUSIONS
  The concept of physician well-being is multidimensional and includes factors related to each physician as an individual as well as to the working environment. Anesthesiologists must actively engage in self-care. Anesthesiology practices and healthcare organizations should evaluate the balance between demands they place on physicians and the resources provided to sustain an engaged, productive, and satisfied physician workforce. National efforts must be rallied to support physicians seeking help for physical and psychological health problems.
authors.affiliation: Department of Anesthesiology, Duke University School of Medicine, Box 3951, DUMC, Durham, NC, USA. catherine.kuhn@duke.edu.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Kuhn
authors.affiliation: Department of Anesthesiology, Duke University School of Medicine, Box 3951, DUMC, Durham, NC, USA.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Flanagan
mesh_terms: D002055:Burnout, Professional / Q000209:etiology*; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000209:etiology*; D006801:Humans; D010820:Physicians / Q000523:psychology*; D012648:Self Care; D013405:Suicide