Burnout, Gratitude, and the Value of Staying Current: On the Mind of Gus Alva, MD, DFAPA

ON YOUR MIND WITH ERIN CROWN

Series Editor Erin Crown, MHS, PA-C, Psych-CAQ

In this episode of “On Your Mind With Erin Crown,” host Erin Crown sits down with Gus Alva, MD, DFAPA, a California-based psychiatrist and clinical researcher, for a conversation recorded at a regional psychiatry meeting he organized, Jersey City Psychiatry Conference. The 2 discuss clinician burnout, the role of industry in advancing psychiatric treatment, and why staying current with emerging science can change outcomes for patients.

Burnout is a central thread. Crown describes how it shows up across the care team—apathy, irritability, social withdrawal, depression, anxiety, sleep disturbance, and clinical errors—while productivity expectations remain unchanged. The concern is well documented: a national survey of 2440 US physicians found 62.8% reported at least 1 manifestation of burnout at the end of 2021, up from 38.2% in 2020 (P<.001).¹

Alva frames the antidote in terms of gratitude and reconnecting with why clinicians entered the field. “The advice that we dole out to others is something that we should actually be applying to ourselves,” said Alva. He points to hydration, nutrition, physical and mental activity, and sleep, and adds that clinicians who skip forums for learning and connection may be at greater risk of burning out.

Drawing on more than 30 years of investigational research, Alva challenges the view of industry sponsors as adversaries. He notes government investment in drug development is comparatively small, far more programs fail than succeed, and a single failed program can cost hundreds of millions of dollars. Both argue that engaging with sponsors and medical science liaisons, without compromising ethical standards, makes for a better-informed clinician.

Crown illustrates the stakes with a patient who, at an initial visit, gave her 6 months to help before a likely suicide attempt. Aware through conference education that esketamine nasal spray was approaching market, she sustained the patient on hope until its 2019 launch, and the patient ultimately remitted. Esketamine, an NMDA receptor antagonist, was approved by the FDA in March 2019 for treatment-resistant depression, supported by trials including TRANSFORM-2, in which esketamine plus a newly initiated oral antidepressant produced significantly greater improvement in depressive symptoms at day 28 than an oral antidepressant plus placebo.²

The conversation also touches on psychedelics, an area Alva describes as previously explored, abandoned after early missteps, and now returning with lessons learned. Crown says the meeting will help her decide whether to offer psychedelic-assisted treatment on site or build collaborative referral relationships.

Both emphasize that small regional meetings offer what large conferences and virtual continuing education often cannot: practical takeaways clinicians can apply the next day, mentorship, and lasting peer friendships. Alva’s next meetings are planned for South Florida in December and Southern California in the spring, with a return to the New York area anticipated.

What psychiatric topic is on your mind? Let us know at PTEditor@mmhgroup.com!

Ms Crown is a psychiatric physician assistant at State College, Pennsylvania, and owner of Future Options Research.

Dr Alva is a board-certified psychiatrist and the Mood Disorders Section Editor for Psychiatric Times.

References

1. Shanafelt TD, West CP, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. Mayo Clin Proc. 2022;97(12):2248-2258.

2. Popova V, Daly EJ, Trivedi M, et al. Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression: a randomized double-blind active-controlled study. Am J Psychiatry. 2019;176(6):428-438.