Burnout, Gratitude, and Staying Current: Insights from Gus Alva, MD, DFAPA

The Burnout Crisis

Burnout is a central theme of the discussion. Crown describes how this syndrome manifests in medical teams as apathy, irritability, social withdrawal, depression, anxiety, sleep disturbances, and clinical errors, while productivity expectations remain unchanged. Data supports this concern: a national survey of 2,440 U. S. doctors found that 62.8% reported at least one burnout manifestation at the end of 2021, a significant increase from 38.2% in 2020 (P<.001). Alva proposes gratitude and reconnecting with one's original motivation as an antidote. „The advice we give others should be applied to ourselves,”Alva emphasized. He lists hydration, balanced nutrition, physical and mental activity, and adequate sleep, noting that clinicians who neglect learning forums and connection face higher burnout risk.

Drawing on over 30 years of experimental research, Alva challenges the perception of the industry as an adversary. He notes that government investment in drug development is relatively small, many programs fail, and a single failure can cost hundreds of millions of dollars. Both agree that interacting with sponsors and medical science associations, without compromising ethical standards, creates a better-informed clinician.

Industry Collaboration and Emerging Treatments

Crown illustrates the stakes with a patient case. At the first visit, the patient gave her only six months of time before a probable suicide attempt. Informed through conference education that esketamine nasal spray was nearing market launch, Crown kept the patient hopeful until the 2019 launch. The patient entered remission. Esketamine, an NMDA receptor antagonist, was approved by the FDA in March 2019 for treatment-resistant depression, based on studies like TRANSFORM-2. In that trial, the combination of esketamine plus a newly initiated oral antidepressant produced significantly greater improvement in depressive symptoms at day 28 compared to antidepressant plus placebo.

The discussion also covers psychedelics, a field Alva describes as previously explored, abandoned after early errors, and now revisited with lessons learned. Crown explains that 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 lack: practical ideas applicable the next day, mentorship, and lasting friendships among colleagues. Alva's next meetings are scheduled for December in South Florida and spring in Southern California, with an anticipated return to the New York area.

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Psychedelics and Regional Connections

Erin Crown is a psychiatric assistant at State College, Pennsylvania, and owner of Future Options Research. Dr. Alva is a board-certified psychiatrist and editor of the mood disorders section for Psychiatric Times.

References 1. Shanafelt TD, West CP, Dyrbye LN, et al. 2. Popova V, Daly EJ, Trivedi M, et al.