In Part 1 we looked at modern medicine, metrics, and the medical personality as causative factors towards physician burnout. In Part 2 of this series, we will look at further at the etiology of physician burnout, specifically the roles of medical training and leadership.
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:
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.
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”.
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.
In this article, we have described how medical training, culture, and poor medical leadership contribute to physician burnout.
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.