Physicians, Burnout and Rust

When asked last week to write an article about physician burnout I had to laugh. Really, laughter was the only choice. After all, laughter is indeed good medicine. You see, lately I have been feeling an increased affinity for the 38% percent of practicing physicians reported to be burnt out, according to the most recent issue of the Archives of Internal Medicine.

A sad number isn’t it? Burnout is a syndrome described by a triad of emotional exhaustion, detachment or cynicism,  and a low sense of accomplishment. The authors, Shanafelt, et al. used the gold standard Maslach Burnout Inventory to assess burnout in over 7000 American doctors.  Try these numbers on for size:

  • 46% of all physicians reported at least 1 symptom of burnout
  • 37% felt their work schedule did not leave  enough time for personal or family life
  • 38% of US physicians had high emotional exhaustion, 30% had high depersonalization, and 12% had a low sense of personal accomplishment.

All of this brings me back to a conversation I had a few years back. I was out of residency and had been working for Kaiser for some time. Long enough for the penny to seem a bit less shiny. I was enjoying a glass of wine with friends around my old backyard table. One of them, a pilot and I started talking about work. Our careers, which we had long dreamed of having, and for which we had worked incredibly hard, were in ways somehow lacking.  As cool as being a doctor or a pilot sounds when one dreams it up, in the end what you have is a job that has long hours, enormous stress and may not fully pay your bills. Too cynical? Maybe.

As I read about physician burnout for this article, it occurred to me that perhaps we were making too much of ourselves. The Pub Med search entry “physician burnout” yields no less than 1,233 articles. Are we really that much worse off than the rest of the population? Well, yes we are. The Shanafelt study compares our rate of burnout to that of population-matched controls and  suggests that

the experience of burnout among physicians
does not simply mirror larger societal trends.

And, burnout in physicians has disturbing consequences. This study also measured the rates of depression and suicidal ideation amongst doctors, both found at alarming levels. Emotionally detached doctors are less likely to be empathetic and more likely to make errors. They are more likely to leave the profession altogether.

I met with my financial planner yesterday for a regular review. We talked about this issue of burnout for a while. I learned that he has been concerned by the increasing numbers of physicians sitting before him to ask how they can afford to get out of the field. Pauline Chen in this week’s NY Times writes that this trend

has serious repercussions in a system already facing a severe doctor shortage as it attempts to expand coverage to 30 million or more currently uninsured Americans.

So what do we do about this? I read a good dozen articles on burnout. Each offered a similar list of platitudinous suggestions for the suffering colleague. Exercise more. Spend more time with loved ones. Consider a change. Set limits at work. Only this recent article by Shanafelt et al. delves into a discussion about the need for evidenced based recommendations and system-wide change.

Most of the available literature focuses on
individual interventions centered on stress reduction
training rather than organizational interventions designed to address the system factors that result in high burnout rates…Given the evidence that burnout
may adversely affect quality of care and negatively affect physician health, additional research is needed to identify personal, organizational, and societal interventions to address this problem.

As to my own fight against the  burnout triad (loss of enthusiasm for work, cynicism and a low sense of personal accomplishment), I am on most days winning. I do find that the best approach is humor. My patients make me smile. I find enjoying the bond with my patients and their families can get me through even the hardest days. I do not tend to be cynical by nature so when this mood hits me it can truly seem comical – as if I am doing a bad imitation of a cranky doctor. To maintain a sense of pride in my work I try to continue to challenge myself by aggressively reading about any new patient diagnosis or diagnostic dilemma. Outside work, by taking on jobs that challenge me in new ways like writing, bike repair and learning German. I do this to avoid the apparent alternative to burnout presented first by President Millard Fillmore and later, Neil Young: rust.

And, when I have a vacation I work hard to follow the Dalai Lama’s teaching:

In dealing with those who are undergoing great suffering, if you feel “burnout” setting in, if you feel demoralized and exhausted, it is best, for the sake of everyone, to withdraw and restore yourself. The point is to have a long-term perspective.

Vacations do not involve using the electronic medical record, email, Twitter or my cell phone. But these steps are only stop-gap measures while I and nearly half of the physicians in this country await more research and, perhaps more importantly, system-wide changes.

2 thoughts on “Physicians, Burnout and Rust

    1. I suspect (but have no data to support this) that we at Kaiser are doing very well compared to elsewhere. I have always felt lucky to work at TPMG and am secure in the knowledge that while burning out, I am doing it in a practice that has my best interests at heart because it knows that when happy I will serve my patients well.

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