Physician burnout is a multifaceted issue influenced by several systemic factors, including medical training, self-denial, and medical leadership. From the very beginning of our careers, physicians are conditioned to prioritize the needs of our patients over our own, often leading to personal sacrifices. The intense pressures of medical training, combined with a culture of self-denial and the insufficient support from medical leadership, can create an environment ripe for burnout.
In Part 1 we looked at modern medicine, metrics, and the medical personality as causative factors towards physician burnout. In this article, we examine the etiology of physician burnout, specifically the roles of medical training and leadership. Understanding how these elements interconnect is crucial to addressing and preventing physician burnout in today’s healthcare system.
What is it about the process that forms hard-baked doctors from the raw clay of young bright-eyed medical student clay? How do we go from smart, motivated, dedicated, hard-working would-be physicians to the current state of affairs:
What is it about the process that forms hard-baked doctors from the raw clay of young bright-eyed medical student clay? How do we go from smart, motivated, dedicated, hard-working would-be physicians to ... 300-400 US physician suicides a year?
For medical professionals, the bacteria of burnout may be innoculated as early as medical school. An examination of the burnout literature reveals that it is prevalent in medical students (28%–45%), residents (27%–75%, depending on specialty), as well as practicing physicians.
The most dramatic increase in burnout happens when we become “real doctors” and when Samuel Shem’s House of God becomes lived reality. At the beginning of the intern year, 4.3% of internal medicine residents met criteria for burnout as measured by the Maslach Burnout Inventory. By the end of the first year, the rates had increased to 55.3%, and 76% in another study.
The most dramatic increase in burnout happens when we become “real doctors” and when Samuel Shem’s House of God becomes lived reality.
Much literature has been published linking professional and personal stressors in the etiology of doctor burnout.
The leading sources of stressors as reported by the medical students and residents include:
Dike Drummond MD describes how as premeds, several important character traits become essential to graduating from medical school and residency.
However, these personality traits become part of the etiology of physician burnout. He goes on, “The same traits responsible for success as a physician simultaneously set us up for burnout down the road.” He describes 5 personality traits in burned out physicians he sees as a coach:
Further, Drummond describes two “Prime Directives” which are drummed into every physician during training:
Combining these factors, Drummond describes results in, “the conditioning of a well-trained physician. … doctors become hardwired for self-denial and burnout”.
Put the five personality traits together with the two prime directives and you have the complete conditioning of a well-trained physician. Combine this with a training process that is very much like a gladiator style survival contest, and doctors become hardwired for self-denial and burnout”
The number one reason for people quitting their jobs? Their boss/manager/supervisor. A bad supervisor can quickly distort job satisfaction and increase burnout levels.
Leaders that create psychologically unsafe workplaces are particularly toxic. In this situation, dedicated HCPs feel that they cannot speak out, try to change things for the better, and may then lose meaning and purpose.
Normally it’s the direct boss, but often negative attitudes, approaches and cultures come from the top, the medical leadership, or the corporate C-suite.
Organizational factors such as negative leadership behaviors, workload expectations, insufficient rewards, limited interpersonal collaboration, limited opportunities for advancement, and poor social support for physicians may also influence burnout.
Studies have shown that organizations and leaders that provide physicians with increased control over the workplace issues and are more “physician friendly” and “family-friendly”, are more likely to employ physicians with higher career satisfaction and lower reported stress.
Furthermore, evidence supports the effects of an institutional commitment to enhancing physician autonomy and transparent communication, improving the meaning of work, reducing administrative and regulatory burdens, and reducing the stigma related to seeking care.
The business case to reduce burnout and promote engagement is strong; investment is justified, and return on investment measurable.
The business case to reduce burnout and promote engagement is strong; investment is justified, and return on investment measurable.
Medical training, self-denial, and medical leadership play key roles in physician burnout.
Intense medical training instills a culture of self-sacrifice, where physicians are taught to prioritize patients’ needs over their own well-being. This mindset of self-denial often continues throughout their careers, leading to emotional exhaustion.
Additionally, medical leadership may overlook or fail to address the systemic issues contributing to burnout, perpetuating a cycle of neglect for physicians’ mental health. Strong leadership is crucial in reshaping healthcare culture to support physician well-being and reduce burnout.
Next week, we will focus on what we consider the major cause of physician burnout: administration. Both the admin burden we all have to do cover “for free” but also the administrative structures — insurance, EHRs, policies, profits — which create the ideal conditions for workplace toxicity.
In future articles, we will explore how these root causes can be addressed to reduce the burnout burden among doctors, which can only be a good thing for patients and clinicians alike.
Physicians Anonymous offers a number of services for physicians in distress, burnout, mental illness and addiction. All medical students and physicians are welcome.
FREE anonymous physician-only peer-support groups here.
Consider engaging one of our Physicians Anonymous-approved Coaches here.
Prevention is better then cure! Find our about our Burnout Vaccine(TM) which teaches you the skills the med school/residency don’t have time for, to move from surviving to thriving in medicine.
Physicians Anonymous, as a not-for-profit, relies entirely on the service of a group of amazing healers who give their time freely to help their colleagues.
We are always looking for volunteers to help us expand our group offerings, raise awareness, and more. We NEED to shift the needle on physician well-being this year.
All medical students and physicians are welcome.
Become a Physicians Anonymous Grand Rounds speaker – find out more here.
Become a Peer-group co-facilitator (voluntary role, 1 hr a week commitment) – find out more here.
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