Beyond burnout

The issue of clinician burnout may be taken to another level, that of moral injury, defined as an inability to provide high-quality care and healing in the context of healthcare delivery. more»

Read more in my latest entry on the Musings blog of the JAAPA Editorial Board here.

JAAPA is the official publication of the American Academy of Physician Assistants.

Clinician burnout: A hot topic

Lately, clinician burnout has become a hot topic.

Judging by the speed at which Shanafelt et. al.’s study “Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population” has seared through cyberspace, the problem of professional burnout seems to be resonating with large numbers of practicing clinicians, especially those who work in the front lines of primary care medicine.

Why the surge in interest? Because the problem appears to be widespread, perhaps much more so than anyone in the business of medicine realized. And it seems to be most prevalent in specialties involving front line access to care.

Compared with a cohort of 3,442 US adult workers, doctors were more likely to manifest symptoms of burnout and to express dissatisfaction with work-life balance.

Professional burnout negatively influences the quality of medical care and increases the likelihood for medical errors. On a personal level burnout contributes to severed relationships, alcohol abuse and thoughts of suicide. And burned out clinicians are more likely to opt for early retirement.

In a career path that has the potential for meaningful and fulfilling work, why do nearly half of all clinicians report symptoms of burnout? Has this always been the case among medical professionals, or are these latest data straws in the wind?

Perhaps a relative loss of autonomy might be a contributing factor. Fifty years ago most physicians set up private solo practices. As individual entrepreneurs, they set their own hours, charged their own fees and took no orders from third-party payers. All that has changed dramatically. Nowadays, the majority of physicians work as employees in hospitals, clinics or large group practices. Administrators determine their salaries, daily patient load, hours worked, benefits accrued. In short, modern clinicians have experienced a loss of autonomy, a factor which contributes to lack of work satisfaction.

But there might be more to it than that.

Physicians are highly educated workers. Yet compared with high school graduates, individuals with an MD or DO degree have a greater risk for burnout. Interestingly, individuals possessing undergraduate or graduate degrees (including doctorates) other than an MD or DO degree are at lower risk for burnout. Perhaps the relative lack of respect afforded to doctors as a group by society at large might be a contributing factor.

(Lest you think this observation a bit far-fetched, in my defense I offer a bumper sticker which I chanced to encounter just the other day: “Be Kind to a Nurse: After all, someone has to intervene on your behalf to make sure doctors don’t kill you!”)

Most highly educated professionals are not employees in a service-based industry. Clinicians work in stressful environments, caring for folks who are vulnerable, sick and depressed. When problems arise (as they inevitably do), doctors are expected to take things in stride and roll with the punches. Many times they find themselves in precarious situations where the likelihood of getting sued is high. I don’t imagine that tenured university professors fall into the same category.

A more important question is how to deal with the problem of physician burnout. After all, the healthcare system itself stands to suffer immensely with the loss of significant numbers of practicing clinicians already in short supply.

Dr Richard Gunderman offers some wise words to this end:

Only by keeping what matters most at the forefront can we reap a full harvest of professional fulfillment. Burnout is not a disease. It is a symptom. To combat it, we must focus primarily on what underlies it. And here the key is not eradicating the disease but promoting professional wholeness, which flows from a full understanding of the real sources of fulfillment.

In Dr Gunderman’s words: “Medicine represents one of life’s greatest opportunities to become fully human through service to others.”

On that score I think that William Osler and Albert Schweitzer would agree.

Albert Schweitzer in Aspen, Colorado (Life Magazine)