The Multifactorial Contributors to Physician Burnout

“National studies indicate that at least 50% of US physicians are experiencing professional burnout. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness.” ~ Dr. Tait Shanafelt & Dr. John Noseworthy, Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout

Physician burnout remains a significant concern to me, and to many others in the medical community, as well as to society as a whole. This past Friday, I tuned into the National Academy of Medicine live webcast “Establishing Clinician Well-Being as a National Priority”. This was an engaging event that highlighted a lot of the work being done in terms of physician wellness and burnout prevention. Having seen first hand in my own home how insidious burnout can be, I am always to encouraged to see the initiatives that continue to unfold in the area of physician health and wellness. About 5 years ago, my husband Colin, who is a Radiologist, started to develop overt signs of burnout. Collectively, we started to recognize the signs, which proved to be the most important step toward his personal search toward managing his symptoms.

Why are so many physicians experiencing burnout?

Where do I begin? The causes are multifactorial and unique to each physician, but some key factors include the following:

•  The culture of medicine – a well-known hidden curriculum exists in medical education that promotes selflessness and the dangers of ‘narrowing professional identity’. Asking for help is not really encouraged, and stress and sleep deprivation can take their toll leading to mental health concerns that may be overlooked as just an expected outcome or part of the training. Unfortunately, these perceptions continue once in practice and serious emotional distress can be left to fester instead of a physician reaching out for help. By this time, it may not be a physician’s accepted personal practice and they may have other fears such as how others will perceive their competence or persecution by regulatory bodies.

•  The professional demands – such as workload, complexity of medicine, advancing technology, and lack of control. In the National Academy of Medicine (NAM) multi-author discussion paper, Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care, they discuss one of the significant drivers of burnout, as work-related factors where, “Work process inefficiencies (e.g., computerized order entry and documentation), excessive workloads (e.g., work hours, overnight call frequency, nurse-patient ratios), work-home conflicts, organizational climate factors (e.g., management culture; lack of physician-nurse collaboration, value congruence, opportunities for advancement, and social support), and deterioration in control, autonomy, and meaning at work have been associated with burnout among physicians and nurses.”

•  Lack of time and excessive stress – ultimately, these factors impact personal wellness in all realms – social, emotional, physical, nutritional, and spiritual. In some cases, the time and stress pressures originate outside of the professional scope but serve to create a sense of imbalance in a physician’s life overall. As the NAM discussion papers indicates – “Research, however, suggests that individuals who choose to become physicians are not inherently more vulnerable to stress and burnout.” Physicians as humans are susceptible to the consequences of stress both personally and professionally. The perfectionist-superhuman is an incorrect label often given to physicians by others, and sometimes unknowingly, to themselves.

But thankfully, the culture is shifting…

From my experience in physician health, the barriers are breaking down and the culture is shifting to one of acceptance, humility and asking for help as a strength, not a weakness. The following excerpt from the article Breaking the Stigma – A Physician’s Perspective on Self-Care and Recovery by Dr. Adam Hill in the New England Journal of Medicine is hopeful of the direction we are headed in – “Many physicians fear that showing vulnerability will lead to professional repercussions, judgment, or reduced opportunities. My experience has been that the benefits of living authentically far outweigh the risks. When I introduced myself in an interview for a promotion by saying, “My name is Adam, I’m a recovering alcoholic with a history of depression, and let me tell you why that makes me an exceptional candidate,” I got the job. My openly discussing recovery also revealed the true identity of others. I quickly discovered the supportive people in my life. I can now seek work opportunities only in environments that support my personal and professional growth.”

In a couple of weeks, we will discuss some of the interventions for physician burnout.

SaraTMD

Resources

Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout – Tait D. Shanafelt, MD and John H. Noseworthy, MD, CEO

In a first for U.S. academic medical center, Stanford Medicine hires chief physician wellness officer – Stanford Medicine News Center

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