It’s no surprise that doctors are prone to burnout, especially during residency training.
But, according to a study cited by Pauline Chen in a recent New York Times column, it’s part of the doctor-in-training culture. In fact, residents “from seven different specialties and found that they set themselves up for burnout by accepting, even embracing, what they believed would be a temporary imbalance between the personal and professional aspects of their lives.”
What happens if that imbalance isn’t so temporary? For instance, primary care doctors are reporting an increasing frequency of physician burnout, facilitated by the increasing bureaucratic hassles and the extra number of thankless hours they have to spend taking care of an unending number of patients.
Without a work-life balance, most doctors cannot be sustained by professional growth alone and “are at risk of burnout, clinical depression or, more commonly, subtle forms of stress,” and indeed, “the danger is that physicians may end up leaving the work force or will become less effective caregivers.”
And that’s exactly what you’re seeing in primary care today.
Related posts:
- Primary care doctors face burnout, and how that affects health reform
- How to reduce primary care physician burnout
- An obsession with making money can be a sign of physician burnout
- Do female doctors hurt physician productivity?
- Newsflash: Doctors’ morale low
- Primary care
- Temporary doctors, and the economic factors leading to their rise
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that’s what you are seeing in all of medicine today, not just primary care.
Meanwhile the fat-cat executives & administrators – who know little of personal sacrifice – and who were going to help doctors manage “the business” so we could enjoy practicing medicine and have some resemblance of a life, are living it up on the money they skim off the top and in the middle . . . treating us like dirt as they do.
We’re “a dime a dozen” . . . and let’s not forget, “disruptive”.
Great system.
My daughter is just starting her 3rd year of med school and we had a conversation about this just last week. She agrees that even at this stage of her training she is feeling the burnout and needs to schedule time for herself.
It is unfortunate that physicians now feel they have to have separation between teir professional and personal lives. As a Family Physician my personal family was always part of my practice life. They all worked in my office at some time or other, I spoke at their schools, served on the local boards and commissions, treated their friends,teachers and neighbors. By having my own practice I could take time off for school plays, vacation around their schedules and pick them up at school when they were sick (or have my nurse do it and bring them to the office for care.)
I learned this from my mentors in residency but I fear this is no longer being modeled to our doctors in training. The separation of physicians practice from family and the community is tragic and unfortunately largely un-noticed. Being a “professional” means more than treating and preventing disease; it should say something about our service to our families and our communities.
Burnout effects all specialties, not just generalists. The pressure to survive with declining reimbursements is HUGE, so we try to cram more time in at work to keep the office lights on and our mortgage paid.
My specialist husband is currently suffering from burnout-stress after 29 years of practice. We kept putting off together time while the needy patients, running the practice and a total a-hole of a partner (but he IS call-coverage) have always come first. I have been at the back of the line and never advance. He “loaned” the practice at least 200 K thinking that things would turn around. Partner put in 0. There is no way out of this short of death. For both of us. This is the macho culture of medicine. I hate medicine and am distraught that two of our children are 3rd year medical students who claim they will live differently, just as my husband did 30 years ago looking at his haggard physician father.
JEB, I when all the badness happened to me (after almost three years of earnest, 24/7 soul-sucking public service to my own home town) I really expected “the good people & professionals” in the community to rise up and do something about it. But they sat back – in fear and trepidation . . . of the mill-town kings who ran the local “non-profit” . . . and let me be professionally robbed/raped/left for dead. A few brave souls spoke out in the very beginning, but it was not enough – as the newspaper cowered to its biggest advertiser.
It’s been eleven years (over four in the blogosphere screaming at the top of my lungs), and the people who did me wrong are still in power – still running the show – even though I have black & white evidence of unethical/amoral/illegal behavior – evidence that should have seen them fired and prosecuted long ago.
What I learned during my training – about service and the way a medical professional is supposed to behave – has been fundamentally useless in the real world.
The real world . . . those communities we’re supposed to become part of, and be so grateful to humbly serve . . . chews you up and spits you out and stomps on you.
More and more physician need to learn to take more control of their careers and establish stronger boundaries early on.
Unfortunately, medical students, residents and young physicians observe imbalance, emotional outbursts and impatience by their professors, mentors, and role-models and they assume that these behaviors and personal sacrifices come with the territory. But it doesn’t have to be that way. Many physicians have made already an effective transition into more life balance and there are many available resources and programs that support them with that goal.
I look forward to getting intubated patients with no family members. That is my burn-out.
Iris Grimm:
You are exactly right. I believe setting limits could be taught to physicians. I was blessed to have two mentors in residency who knew how to be on 24/7 and still set limits. That is a fundamental skill that is not part of any curriculum that I have seen.
So much of what we do to fix problems starts at the top and works down. That is akin to treating a young woman’s butterfly rash with cortisone and missing her lupus diagnosis.
I do not think the powers that be, whether that is the Obama group or the AMA have a clue about what is fundamentally wrong with the delivery of healthcare these days but that won’t stop them from slapping on the hyrocortisone.
I am old enough to know that I cannot tell what the future will bring. We should never quit trying to influence the world. Medicine and “life” is about caring for others.
“Many physicians have made already an effective transition into more life balance and there are many available resources and programs that support them with that goal.”
Pray tell, Iris, WHERE are the resources and programs that help with such goals? Where is the oversight? Where are the checks and balances and boundaries that might allow doctors to take control of their careers?
I’ve been looking for eleven years, and I can assure you, such things are NOT to be found in North Carolina.
The most interesting line from the article is “I lost a few extra hours of sleep each time I did something for …” in other words the only way you can make time for yourself is to sacrifice time to sleep. There is something very wrong in a system where that is the case.
Pretty easy solution. Put yourself first over the interests of the patient. It doesn’t do the patient any good if you are , dead, tired, grouchy, etc…. The patient will most likely live another day. I for one put the number one person in my life first…..ME! Patients come second. Makes everyone happy.
Refreshing to see that some of you are waking up. Prepare to be the new slaves in the biggest sellout to doctors in history. Nothing changes until you say, “NO”.
Paul, I’ve been awake for a very long time.
And you’re right.
Paul,
You are right about saying “no”. Start by saying “no” to contracts with third party payers and just find out how much freedom you can experience.
Thanks Robert and Mary. This is an area that I am passionate about. It is scary to think about turning away a third party payor esp for our community where “the other group” would enjoy the volume we would provide. The contracts aren’t bad enough to be seen as “poison pills” but collective bargaining (sorry, I mean colusion) would go a long way in negotiating fair reimbursement. We have a single “non-profit” hospital in our town in northern new england and have the same difficulties that Mary is steaming about. That her efforts found deaf ears is disheartening. The financial and bylaw enforced coercion that these “charitable” institutions levy feels criminal to private staff like our department. I still will not go quietly into that good nite and am seeking individual council as to what my/our options are. Wish me luck. Thanks
I’m there right with you, Paul. I totally get your passion.
A few weeks ago, I put the N.C. Medical Board on notice: Get a hearing aid. Make the referrals and recommendations that fix this or we will ultimately dance in court. You don’t get to tell the troops that they must blow the whistle on badness – then do absolutely utterly fricking NOTHING to protect them. I’m DONE.
And when I say “we”, I mean the Board can bring JCAHO and DHHS as dance partners.
NONE of what happened to me should have happened under ANY kind of government that prides itself on accountability.
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