Physician Burnout

Why Are We Seeing More Physician Burnout?

Why more “physician burnout?” Webster defines burnout as “exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration”. According to a Mayo Clinic study the number one profession to experience “burnout” is doctors, followed by nurses. I hear these professionals say often: “I hate what I am doing!” Although, I have to say that the medical profession is not the only profession that experiences this feeling. Lawyers are also right up there in the top ten. I was speaking to a malpractice attorney one day and he said, “I hate what I do, but I have a family to support”.

Physician Burnout
Stress as part of Burnout

Why Does it Happen?

There is no one single factor that explains the “why” physician burnout occurs. As in everything in life, it has a multi-factorial cause. I will share with you a few of the causes, although, in no specific order of importance except for the last one (in my opinion). Also this is not an exhaustive list.

Financial

My disclaimer, first of all, is that it is not about the money! There are those that would say that doctors make too much money. I am not about to get into a conversation about how much money someone, a professional, makes because I could talk about sports players, actors and actresses, etc. Yet, there is one important differentiator and that is doctors deal with life and death every day.

They go through many years of additional education and at significant expense. Many start their practice, their professional career, with loans of extraordinary amounts to pay back. Setting up a practice, entering into an established practice, licensing, board certification, hiring and paying of staff, are all costs that need to be paid even before bringing home the first dollar. Add to that the cost of malpractice. Those rates are very high depending on the specialty practice.

Nature of the Work

Every profession or job does have stress factors involved that can lead to burnout. The work environment and the nature of the work itself are two of those factors. Hence, anyone can experience burnout regardless of their occupation when they have elevated stress levels, work long hours, become exhausted, and feel unappreciated or devalued. Therefore, let’s get more specific and look at the specialty/profession of physicians. Here is a quick list of some of the more common items they deal with below:

  • Increased demands and responsibilities – dealing with insurance companies, hospital policies, overhead, and more
  • Tight schedules – too much work to do in too little time
  • Stressful work environment
  • Sick, sometimes very sick, patients
  • Families of these patients
  • Very litigious society
  • Job expectations that are not clearly laid out  
  • Overexertion 
  • Difficult balance between work and home life 
  • Fatigue from long hours 
  • Job monotony leading to boredom – I will go into this a little more below
  • Over expectations
  • Dealing with death 

Boredom

This item is something that can be seen in all jobs and professions. It isn’t unique to medicine, but is another factor in that list of many. Take the example of the general surgeon who has a 12 y.o. girl presenting with appendicitis. That surgeon may have done hundreds of appendectomies in his/her career. As a result, to him/her, it may be just another routine, monotonous procedure to do and, hopefully, it will go well. Giving the preop conversation, what the recovery will be like, and what is done in the procedure is the same speech that has been delivered so many times.

However, look at it from the point of view of the patient. This is her first, and hopefully only procedure related to this diagnosis. It is not routine to her. She may be frightened and need some comforting words from her surgeon, questions to be answered. Hence, this boredom may lead to a casual, maybe perceived non-caring conversation with both the patient and parents. This is just one example but there are thousands of different diagnoses and situations to be considered.

Last, but most important

This reason for physician burnout is most important in my mind. It is unique to the medical profession, and really includes nurses and other caregivers but I am going to focus on the physicians. Here it is: We as physicians are not allowed to deal with our own feelings. Allow me to help you understand that statement. When a person loses a loved one, they may say they are having a hard time dealing with the loss. As a result, in trying to comfort them, they are told that it takes time for the “heart” to heal. That’s very true. Yet, we tell ourselves as physicians that we should not nor cannot get emotionally involved. Yet, we do and, as a result, we have those similar emotions, but we don’t have the healing time to get past it.

A Day in the Life of a Practicing Physician

Take an average day in the life of a practicing physician. In the course of seeing and treating anywhere from 10 to 50, or more, patients every day, the following types of scenarios may occur:

  • We may start the day being called in to pronounce the death of a long-standing patient that just expired. Someone we may have gotten close to and then need to go talk with the family. We may even cry right along with them (yes, crying is OK).
  • Next, leaving that scenario to go discharge a patient who has gotten better (what do you do with the tears, the red eyes?).
  • Go to the next room where you have to tell a patient they have cancer and answer the questions of the patient and the family
  • Go meet a patient for the first time that just got admitted the night before and outline a plan of care/treatment
  • And many more variable situations. There can be anywhere from 10 – 30 patients in a day, and every day

They go from patient to patient, changing emotions, changing mental pathways, constantly without missing a beat. A physician never gets the time to account for their own emotions and feelings. As a result, doing this day after day after day empties their emotional bank, whether they are aware of it or not. This leads to the point of overdraft or even bankruptcy of their own personal ability to continue to deal with this stress. Doctors never allow themselves the time to process grieving and over time get burned out. Physicians just can’t take it anymore.

The Result

In her book Kitchen Table Wisdom, Rachael Naomi Remen, MD, says it so well: “It is not that we don’t care; we care too much.”

Dealing with cancer or a chronic illness, visit I Want to Live.

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