Avoiding Physician Burnout Is Critical
By Richard Gunderman, M.D.
A colleague of mine in primary care medicine has decided to leave the practice of medicine. She is very well trained, has impeccable professional credentials, and works in a thriving practice.
Over the past several years, however, she has noticed an unrelenting decline in the sense of fulfillment she derives from her work. She feels increasingly frustrated with what she calls the "bureaucratization" of medicine, and resents spending "more time filling out forms than caring for patients." My colleague is suffering from what is commonly described as burnout.
A new report in the Archives of Internal Medicine indicates that rates of burnout among U.S. physicians significantly exceed those of the general population. This is a very serious issue with effects that will ripple throughout society, and it warrants widespread, earnest attention. The solution, though, does not lie in incentivizing physicians with money or restructuring systems to minimize stress on physicians – it lies in finding earnest professional fulfillment.
Medicine is not a job. It is not even a career. At its heart, medicine is a calling.
According to psychologists, signs of burnout include decreased enthusiasm for work, growing cynicism, and a low sense of personal accomplishment. As the name implies, individuals suffering from burnout feel as though a fire that once burned inside them has dwindled, and perhaps even been entirely extinguished.
Of nearly 7,300 physicians who participated in the Archives of Internal Medicine's national survey, 46% reported at least one symptom of burnout, and the overall rate of burnout among physicians was 38%, as opposed to 28% among other U.S. workers.
The highest rates of burnout were reported among primary care physicians, including family physicians and general internists.
Why should rates of burnout be higher among physicians? For one thing, physicians tend to work longer hours than other workers, on average about 10 more hours per week. Moreover, striking an appropriate work-life balance appears to be a bigger challenge for physicians, in part because they often tend to keep work and personal life more separated than other workers. The issue of physician burnout is important.
As the U.S. population grows and ages, the number of physicians needed to care for them increases. When burnout leads physicians to reduce or cease their practice altogether, patient access to medical care is diminished. Moreover, burned-out physicians are likely to be less productive, make more mistakes, and generally deliver a lower quality of care than their fully engaged colleagues. Finally, physicians are human beings too, and their suffering should summon no less compassion and concern than anyone else's.
To enhance fulfillment and quality of work, it is necessary to focus on the work itself. In the case of medicine, do physicians recognize what they find most fulfilling? If they cannot see the target they are aiming for – in this case, the aspects of their work that they find most meaningful and take most pride in – they are unlikely to hit it. What does their best work look like? Are they making full use of their knowledge, skills, and innate abilities? Are they growing and developing as human beings? Do they feel that they are making a real difference in the lives of their patients and communities?
Burnout is not a disease. It is a symptom.
The key to combating physician burnout is not to reduce stress, but to promote professional fulfillment. And promoting professional fulfillment is not merely a matter of reducing costs and error rates or increasing clinical efficiency.
If we are genuinely concerned about physician burnout, we need to focus less on reducing stress and more on promoting what is best in physicians: compassion, courage, and above all, wisdom. Only by keeping what matters most at the forefront can we reap a full harvest of professional fulfillment.
