Burnout in the Medical Profession Part 1: Burnout Phenomena

Burnout in the Medical Profession Part 1: Burnout Phenomena

Understanding the Phenomena of Burnout in the Medical Profession Series
Part 1: Burnout Phenomena

I assume that most physicians enter the medical field believing that hard work and dedication would provide them with the knowledge and skills they need to provide the best care for their patients.

In the past, there was a direct career path and a person would just have to follow the path to meet their personal goals of having a great career. Changes in the health care system have happened in the last 30 years, resulting in an increased workload, more patient hours, less recognition for hard work, increased chance of litigation and, for many, decreased financial rewards.

Over and above the health care infrastructure changes and excessive cognitive demands caused by the need for processing overwhelming amounts of information, can add to a person’s stress. Rapid evolution in the practice of medicine, increased patients demands, technology, growing bureaucracy, workload, conflicts, legal issues and health care infrastructure changes: all have increased the complexity in our careers. It will not be getting easier in the near future. There will only be more pressure, greater demands and fewer people employed to do the work due to cost-cutting that most organizations need to go through. Budgets are running very close to the minimum and need to be balanced despite demands on patient care, technology and personnel. The only aspect that one can count on is the ability to cope with change, to adapt to ever-changing policies and technology and to shift the practice to adapt. As our careers evolve on a daily basis, there is a certain amount of uncertainty in our environments, in our practice and our future plans for retirement.

Contemporary medicine is intense and we all face a daunting uphill struggle against piles of paper, less time, increasingly demanding patients, complaints, managing our own practice and what appears to be doing more and more. It is, unfortunately, the direction of almost everyone’s career. The reality of day-to-day clinical practise is different than the residency training we received and perhaps what we were told in school.

Physicians work in emotionally-charged situations associated with suffering, fear, failures and death, culminating in difficult interactions with patients, families and staff. Health professionals are held by society and also hold themselves to high standards of skills, knowledge and performance. It is believed they should always be at the peak of their ability to do whatever is needed and be emotionally available and compassionate. The rewards for this level of commitment are status, admiration, respect, proper equipment, space to do our jobs and financial compensation. All of these expectations are changing, as there has been a dramatic decrease of control and autonomy in the patient-physician relationship, conflicts with peers, over-controlled by staff and administration, and yet we continue to fulfill our side of the contract with a sense of confusion, disbelief and wondering where it will lead us. All of these factors contribute to increasing levels of anger, frustration, stress and yes, burnout.

Burnout is a syndrome and can be a combination of exhaustion, emotional and physical, which can lead to a low sense of accomplishment, decreased job performance, reduced job commitment and low career satisfaction. Burnout has many characteristics including fatigue, exhaustion, inability to concentrate, depression, anxiety, insomnia, irritability and increased addictions. The most distinct characteristic is a loss of interest in work and family life.

Factors independently associated with burnout include younger age, having children, area of specialization, numbers of night on-call per week, numbers of work hours per week, and having compensation entirely based on billing.

  1. A nationwide, multispecialty survey of more than 2000 physicians in 2011 found that almost 87% of respondents felt moderately to severely stressed and almost 63% admitted feeling more stressed and burnout now than they had felt 3 years ago. (“Mid-career burnout in generalist and specialist physicians”, “Burnout and career satisfaction among American surgeons”, “Results from CMA’s 1998 physicians survey point to a dispirited profession”, “Physicians Burnout”)
  2. A new survey by the Canadian Medical Association published in 2018, completed by 2,547 physicians and 400 medical students reported elevated burnout in more than one in four physicians and in 48% of medical students. Interestingly, physicians in practice for more than 30 years had a higher sense of well-being.

The trend from current studies still suggests the rate of emotional exhaustion, fatigue, tiredness, excessive amounts of work, lack of personal and family life balance is around 30-38%. It is supported by national samples of members of subspecialty societies. Almost 2/3 of Canadian physicians (62%) have a workload they consider too heavy and more than half (50%) felt their family and personnel life has suffered; 27% said they were on-call too often. Among rural physicians, 43% agreed that a lack of locums has affected their ability to take family and vacation time. Studies suggest that difficulty balancing personnel and professional life, administrative tasks, lack of autonomy and patient volume are the greatest sources of stress.

As stated earlier, major factors that act as stressors in our profession are information overload by the rapid advance in information technology, by the information explosion in the literature, on the internet, which is accessible not only to us, as physicians, but to our patients. The rapid advancement of technology has necessitated the development of updated knowledge and skills in diagnostic and therapeutic procedures. Our workload has expanded and at the same time, we are working with shrinking resources and budgets. Other factors we are dealing with are increased consumer demand and expectations from patients. It can also be a deficiency or lack of educational opportunity, free time ability to ventilate, poor institutional support, inter-personnel pressure caused by managing our office, surrounding hospital staff, disruptive meetings and, surprisingly, sometimes having to handle a strong emotional reaction following a patient’s death. It happens to all of us. As the stress builds up burnout can be just around the corner.

The worst outcome I can imagine is when a physician ends his/her life. There is grief and loss and guilt amongst colleagues. It is a shocking event, time for a pause among us, for a time of reflection. We may realize that many times, we do not treat our colleagues as we should. Too often we strive to make ourselves look better at the expense of another colleague. Criticism comes easy and is often delivered in a humiliating rather than a constructive way. I know doctors who ignored personal physical symptoms that would have triggered an investigation in a patient, and unfortunately forgetting that these symptoms could lead to serious issues. Mental health is even more challenging because we hide it. Deep down many physicians still perceive mental illness as a weakness rather than a disease. Well, guess what? We are just as vulnerable as everyone else, and due to the stresses and nature of our work even more so than the general public. We need more than a pause and a moment of reflection, we need dramatic changes in our priorities.