I first experienced burnout during my 3rd and 4th years in medical school. I was trying to balance working 12-hour days through my clinical rotations while simultaneously spending hours each night studying for my board exams and working on residency applications.
I slept poorly. I ate poorly. I worked 80-90 hours each week. I started to develop feelings of resentment towards the healthcare profession because I knew our culture was not only unhealthy but unfair to ourselves and our patients. I was stretched too thin.
My burnout started in medical school and continued during and beyond residency. There was no endpoint to my burnout. It just became my new normal. Even though I was giving my best care to my patients, I knew it was not good enough because I was not performing at my best due to experiencing chronic burnout. The COVID-19 pandemic was my breaking point.
The history of physician burnout
Historically, physician culture dictated that you worked hard, kept your head down, and didn’t complain or speak up regardless of how you were feeling. The prevailing attitude was that physician burnout is a physician problem, and those who cannot “hang” or adapt to new changes and environments were not cut out to be doctors.
This especially held true when electronic medical records were introduced, leaving many “old school” doctors pining for the low-tech past of paper medical charts. The same goes for radical changes within our healthcare system regarding medical insurance and pharmaceutical companies.
The unintended consequences of these drastic changes in our healthcare system that were supposed to help physicians by making us more productive and efficient and ultimately more satisfied have led us to feel isolated and disillusioned. Physicians have experienced feelings of burnout for decades; however, it wasn’t until the past ten years or so that we are now talking about this issue on many different platforms, including social media.
Consequences associated with physician burnout
Physician burnout is an epidemic in the United States, and it has a drastic negative effect on all aspects of medical care, including career satisfaction.
Physician burnout is directly linked to the following undesirable consequences:
- Decreased patient satisfaction and decreased patient quality of care
- Increased medical errors resulting in an increased risk for malpractice suits
- Higher physician and ancillary staff turnover resulting in loss of income and revenue
- Physician alcohol and drug misuse
- Increased rate of physician suicide and mental health conditions (depression and anxiety)
Finding a solution to cope with burnout
Solutions for coping with burnout often target the physician and propose lifestyle changes that target a healthy work-life balance. These lifestyle changes include relaxation techniques, daily self-care routines, exercise, adopting a balanced diet and sleep schedule, greater access to child care, hobbies to enrich free time, and ways to increase efficiency and maximize productivity. Although these coping strategies are great in theory and may help alleviate some of the stress associated with burnout, research has shown that these coping strategies do not have a meaningful impact on physician burnout. One of the primary reasons is that these coping skills do not address the underlying problems associated with physician burnout, a profound lack of alignment between physicians’ values and the reconfigured health care system.
The problem of physician burnout will not be solved without addressing the issues of competence, autonomy, and connectedness.
Physician autonomy refers to having the right to self-govern and the freedom to exercise professional judgment and care in the treatment of patients. We, as physicians, now endure a profound lack of control over our time and patient care. How much time we spend with a patient, what is discussed, our decision-making process, and how a patient encounter is documented are all frequently mandated by insurance companies and hospital administration and policy.
Competition vs. Connection
Physician competence was once seen as having a broad background of medical knowledge and exercising clinical judgment appropriately with each patient. Under recent health care reforms, competence has been newly described as compliance with various metrics put forth by insurance companies and hospital administration, and many of these metrics are not evidence-based.
Competition has also become a matter of clicking a certain number of boxes and placing a quick note in the electronic medical records for billing purposes in order to satisfy insurers’ demands.
Connectedness is the psychological feeling that one belongs and is connected to others through interpersonal attachments. We, as physicians, want to give our patients the time and support they need. Additionally, we want the healthcare system to value and recognize our tremendous efforts to provide this level of care. While it is believed that medicine is aimed toward “patient-centered care,” many physicians feel that the healthcare system is increasingly driven by money and metrics, with rewards for professionals who embrace these priorities.
Without restoring our autonomy, having the ability to connect with our patients and practice medicine using evidenced-based competency; we most likely will continue to experience profound burnout.