Clinicians hear so much about burnout and what to do about it once it sets in. But, really, we should each be designing a career for ourselves that prevents burnout form the very beginning. We need to safeguard against the factors that lead to burnout so that it never even begins to set in.
Over the past two decades, there has been a slow but progressive crisis in healthcare being reported in every corner of the country. It’s physician burnout. Many surveys indicate that physician burnout is now at epidemic levels as many doctors have a negative perspective of their future in medicine. The 2015 Medscape Physician Lifestyle Report revealed that nearly 46 percent of physicians experienced burnout. This number is up 8 percent since 2013. Physician burnout has many more consequences than just the healthcare provider having negative sentiments about medicine. The undesirable consequences of physician burnout include:
- A higher risk of making medical errors and consequently a higher probability of being involved in medical malpractice suit
- Delivering inferior patient care
- High staff turnover and decreased satisfaction in the workplace
- Higher risk of drug and alcohol abuse by the physician
- Increased risk of physician suicide
Physician burnout can even have a fatal outcome judging by the many reports of suicide, which are much higher in the physician population that the general population. So in general, physician burnout is not good for anyone. Not for the healthcare provider, his or her family, the patient, or the institution. And more importantly, physician burnout is not solely an American phenomenon. It is a global problem affecting physicians in many western and developing countries. Physician burnout for the most part is a silent but progressive disorder. Initially, all the emotion is controlled until one day it just boils over. The tragic fact is that even though physician burnout is well known, it’s a taboo subject which is not even taught in medical school or typically ever discussed in a residency, because it is deemed to be a sign of weakness. Thus, when it occurs, most physicians have no idea what to do or how to tackle the problem.
Erosion of virtues, depersonalization, and inefficiencies
There is no single cause of physician burnout, but there is a combination of factors which over time slowly erode the virtues and dignity of the profession. With time, the health care provider feels drained of all physical and emotional energy. Second, the physician will develop a feeling of depersonalization which may present as lack of empathy for patients, being cynical or sarcastic about the profession, or show little concern for patient care. Third, the last feature of physician burnout is poor quality of work combined with inefficiency. The physician begins to feel that his work is not important and consequently doesn’t worry about the quality of care being delivered. At this point he has little foresight into the consequence of his actions.
A gradually, progressive course that can become catastrophic
Physician burnout is equally common in both genders and can occur at any age. However, the one common theme is that the problem starts to become more prominent after two decades of medical practice. Physician burnout is not a sudden event, but starts gradually and becomes progressive. The first people to notice the signs may be the physician’s colleagues, co-workers, or the office staff. Often, the family may notice a change at home. When physician burnout reaches a zenith, it can be catastrophic for both the patient and the institution. A complete meltdown may occur with the physician simply giving up.
The work and the environment both contribute to burnout
Over the years, it’s been recognized that the practice of medicine has been changing rapidly. Today, medicine is more regulated than ever and physicians are scrutinized about everything they do and don’t do. For the most part, it is the change in the field of medicine as a whole that is responsible for physician burnout. Being a physician is a very stressful job and the demands by both the patient and the professional are high. Physicians deal with sick, ill, and dying patients and the hours spent looking after these patients are long. This creates emotional stress and – even when home – physicians are rarely able to leave the work behind. In addition, there is always the threat of litigation even if the mistake was minor. For some specialists like surgeons, the stress and worry about patients is never-ending. There is always the worry that the surgery may have caused new medical problems or that the patient may have to return back to the operating room if there’s bleeding or some other complication.
Emergency room physicians have alternating shift work and they often encounter difficult patients. Cardiac surgeons have long surgeries and can’t just go home after the surgery as they have to remain in the hospital for an extra two to four hours to make sure there are no acute complications. Neurosurgeons worry that a surgery may have resulted in a major neurological deficit. These job-related stresses hamper all physicians to a different degree.
The Environment and Co-workers
All physicians have to deal with hospital policies, administrative rules, and other healthcare workers. There can be personality clashes and there’s an endless number of meetings to attend. In addition, physicians are spending increasing time on the computer either dictating patient notes or completing the forms and orders required for patient care. And finally, almost all physicians have to be on call for a certain number of days every month, and in the end, this can take a toll on the family and personal life.
Unlike many other professions, medicine for the most part is not a nine to five job. The hours most physicians put in are long, often including working or at least taking call on weekends and holidays.
Throughout medical school and residency, all doctors are expected work hard, and this expectation continues even after entering practice. Nowhere along the lines from medical school to residency is anyone told to relax and take it easy. The demands of medicine are high and those who fail to keep up are either kicked out or lag behind. For many physicians, there is minimal balance in life. It is work, more work, and then go home and think about work. The majority of physicians are truly hard workers, and they are ambitious, high achievers. They rarely settle for anything mediocre. Most of them strive to be great at what they do and, while this is a great virtue in any profession, it can also come to haunt us.
Most physicians know when burnout strikes. They gradually become increasingly despondent about medicine and have negative perceptions about the future of the profession. Most even admit that they have reached their limit and need a break.
Great news! Burnout is preventable
Experts agree that the emphasis should be on early recognition of the symptoms of burnout before the downward spiral starts and becomes irreversible. Some hospitals have now started to acknowledge the reality of physician burnout and have taken steps to make the working environment pleasant and friendlier. Some even offer counseling to lower the stress.
The biggest challenge in burnout prevention, though, is recognizing the earliest signs of it. Most physicians are reluctant to admit burnout for fear of losing their job and therefore losing their income. Others may continue the blame game. Even when an employer recognizes that a physician is burning out, administrators often offer only individually focused solutions such as wellness classes or mindfulness training. While these strategies do help counter stress, they do not fix the original source of the stress. Most physicians agree that what is needed is an improved work environment with fewer distractions, minimal obstacles to spending time with patients, and less bureaucracy in daily work.
Physicians also universally agree that they need to be treated with respect. Over the years, respect for physicians has eroded and has led to a somewhat deflated morale. Hospitals and outpatient clinicals are often run by non-clinicians who sometimes have little insight into the daily lives of physicians and practitioners. At a minimum, administrators need to respect physicians for their knowledge, skills, and competency.
While all this sounds simple, the problem is not easy to fix and it is not a problem that can be solved by the administrators alone. Sending all doctors to a psychiatrist is not the answer. Currently, evidence is lacking as to what exactly helps reduce or prevent physician burnout, but addressing the current problems in healthcare is a good place to start. Physician burnout is not only an individual’s personal emotional problem, but reflects systemic institutional problems in healthcare. While we may never be able to completely reduce the working hours or the administrative rules that govern us, it’s important that organization leaders start to pay attention to what is happening to physicians. If they don’t do anything, then they’ll be left without the very people who – to a large extent – deliver the very product that enables hospitals and healthcare systems to be viable businesses.
How do you think we can play a role in preventing burnout in our field? What are the strategies that you’ve used?