Physician burnout presents differently in male and female doctors

Numerous studies have shown that an average of 1 in 3 practicing physicians are suffering from symptomatic burnout on any given office day worldwide, regardless of specialty.

The three classic signs and symptoms of burnout are measured by a standardized evaluation: the Maslach Burnout Inventory (MBI).

They are:

1. Emotional exhaustion

The doctor is tapped out after the office day, hospital rounds or being on call and is unable to recover with time off. Over time their energy level begins to follow a downward spiral.

2. Depersonalization

This shows up as cynicism or a negative, callous, excessively detached response to their job duties. Often burned out doctors will begin to blame and complain about their patients and their problems.

3. Reduced accomplishment

Here the doctor starts to question whether they are offering quality care and whether what they do really matters at all.

As more female doctors move into the workforce, researchers are beginning to notice differences in the way burnout presents in men and women. If you think for a moment about the three scales of the MBI, you will probably be able to imagine the differences. Here is what groundbreaking research published in 2011 is showing.

(Note: This study is based on practicing physicians. There is good reason to believe the following burnout symptom patterns are true in any stressful profession such as therapists, law enforcement, military personnel and even parenting.)

The female pattern

Women seem to follow the classic three part pattern of the MBI above, in that order.

Stage one. Burnout in female doctors starts with Emotional Exhaustion. Women traditionally support others in numerous areas of their lives … at home and at work. There is only so much energy and giving to go around.

Stage two. Depersonalization and cynicism. This is a dysfunctional coping mechanism. It feels somewhat better for an instant in time and yet does nothing to relieve the feeling of exhaustion. Cynicism is especially difficult for women to keep up for very long before stage three kicks in.

Stage three. Reduced Accomplishment and doubting the quality of their practice and the difference their work makes in their patients lives.

The male pattern

Stage one. Men more commonly start with depersonalization and cynicism which serves as a coping mechanism for overwhelming stress. “My patients are such a bunch of $%@+!%”. This is, again, a dysfunctional response to the inherent stress of being a doctor and is only a temporary relief. After all, these are the people you spent decades learning to serve.

Stage two. Emotional exhaustion follows. It worsens until they are no longer able to cope.

Stage three. By comparison to the female burnout pattern, men’s stage three is remarkable for it’s absence. Male physicians are far less likely to feel that the symptoms of stages one and two affect the quality of the care they offer. This leads to a cynical, exhausted male physician who keeps going despite burnout because they feel they are still a “good doctor”. This lack of a phase three allows them to continue to practice in denial of their distress despite the exhaustion and cynicism their coworkers and patients witness on the job.

If you are a practicing physician, or a worker in any job you where you are feeling stressed, here are the early warning signs of burnout to watch for.

Women

Exhaustion and a feeling of not being able to recharge your batteries, followed by early signs of blaming your patients or clients.

Men

Cynicism and blaming your patients or clients, followed by exhaustion and falling energy and engagement.

When you notice these signs, take a breath and a break. Recognize them for what they are: burnout. This is a cue to step back, take better care of your own personal needs and create some boundaries for a more balanced life. You, your staff, your patients and your family will be glad you did.

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

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  • Anonymous

    Very interesting results and very believable from a personal standpoint. As a female physician, I experienced significant burnout about 5 years ago and went through all the stages, including the last one where the overwhelming feeling was a sense of unimportance; nothing I was doing as a doctor was helping anyone. That was a desperate feeling. The good news: it is possible to get help and work through burnout. 

  • Anonymous

    If cynicism is a symptom of burnout, I’d say 100% of practicing docs exhibit this and more then periodically.

  • http://www.thehappymd.com/ Dike Drummond MD

    Thanks for posting this Kevin!

    I agree with dlshermd … cynicism is pervasive and at some level may be a pressure relief of some sort. However, if you are a male physician and finding yourself persistently cynical … that is a warning sign of significant burnout.

    And yes kthomp827 there is help, there are resources. The research is pointing strongly to what works at this point. The biggest challenge is the solutions are not institutionalized. It’s every doc for themselves.

    Keep breathing,

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • http://profiles.google.com/andeevb Andee Bateman

    wow.  Good to know it has a name.  Pretty accurate description of what I have seen in floor nurses, sometimes very early on after their orientation, and sometimes after years on the same unit. 

  • Anonymous

    Know as you have a name “physician burnout syndrome”
    Let’s add some symptoms to it
    Pay 30 million to the dsm,American psychiatric association and the FDA

    Patent it

    Put some common salt like shit in a capsule
    Market it as

    Burnax T

    Sell it for 400 dollars for a 10 capsule blister
    And make
    Money money money……

  • http://www.facebook.com/people/Samir-Qamar/1843287708 Samir Qamar

    I would imagine being able to spend more time at home, improved reimbursements, and more satisfied patients from unrushed appointments would cause fewer physicians to experience professional frustration. If in private practice, the direct primary care model is able to dramatically curb such frustration. Most of the time when physicians call our MedLion Direct Primary Care company, it is because they are nearing burnout. It’s nice to be able to offer them an attractive alternative before they throw in the towel.

  • Chrysalis Angel

    You will see mistakes being made at an increasing rate, also.  Prescriptions written with the wrong dosages, mistakes in charting, ie they forget to chart important information. The work load begins to increase, they can’t keep up. Their appearance begins to look frazzled, and you can see the strain on the individual. Colleagues may need to step in to help these practitioners.  Someone needs to help them.  They need intervention before they get to this point, and become a danger to their patients or themselves.  

    Administration needs to take these physicians seriously when a physician finds she/he is suffering.  If they request a lighter work load, relief from being on call, while working a full clinical schedule – They need relief!  Get it for them!  Administration can be part of the problem in burnout.  If they care nothing for the physician’s needs of time off and relief from call, they are part of the problem and not the solution.  We need to take care of the people trying to deliver good patient care.

    • http://www.thehappymd.com/ Dike Drummond MD

      Burnout affects so many aspects of medical care. It decreases quality and patient satisfaction and increases physician and staff turnover and malpractice risks.

      And as I said in the article, decades of surveys have shown the average level of daily burnout across all specialties worldwide is 1 in 3 docs on the job. It is a pervasive, hidden negative influence on the delivery of healthcare. Here’s the good news.

      Research is also showing the tools that work to prevent and treat it. And there are practice models developing that wring a lot of the stress out of clinical practice. It is a very interesting time for making huge advances in this issue. Hopefully we will look back some day at this as a thing of the past … just like the physicians doing cigarette ads. Burnout … that’s so 2012 … !

      My two cents,

      Dike
      Dike Drummond
      http://www.thehappymd.com

  • Anonymous

    Some physicians take their burnout on their families first and it can destroy marriages.

  • http://www.facebook.com/yterri48 Terri Young

    While having the most respect for doctors and nurses, I would like to say something here. As a patient, I have been effected by this in a great way. I have been cut down in ways I never imagined by doctors, accused of lying and being a drug addict. Causing me to go from one doctor to another for treatment. Like looking for a job, this doesn’t look good. I have developed an anxiety about seeing doctors and I am still sitting here unable to live a life due to major back pain after 12 years of seeking help. 
    I hope this will help in your studies. Thank you. 

  • Anonymous

     thanks for posting this Kevin. It’s scary that I see myself describing here. Luckily I’m still at stage 2. Being a female physician, professional work load and work load at home are overwhelming begin to affect marriage. I hope more physicians speak out and seek help before it’s too late. We sometimes seeing stress and inability to cope with it as incompetent. We just ignore the signs and keep on going. And I can the dead-end road here if we continue to bury all the stress and pretend like nothing has happened .

    • Chrysalis Angel

      Remember to stand up for your needs, too.  In order for you to be the kind of provider you wish, it’s important to realize your needs are every bit as important as your patients’ needs.  Your family is the most important safety shield you have, I hope that you can work out a more satisfactory arrangement for responsibilities there. I wish you well in this.

      I don’t believe it’s gender specific in anyway.  If anything, men are more apt to feel they have to handle it and cope alone.  I feel women are always a little better at introspection, and have that ability to recognize a situation is sucking the life out of you, and knowing change must occur.  Putting off help will only jeopardize marriages, professional standing and possibly an entire career.

  • http://twitter.com/KarenSibertMD Karen Sibert MD

    I’m inherently uncomfortable with drawing broad conclusions about gender temperament.  Different personality types experience all kinds of emotions in different ways.  I think you could make the same argument more effectively looking at different medical specialties as opposed to different genders.  The temperament and interests that lead people to go into surgical specialties as opposed to primary care specialties may well lead to different patterns of burnout. 

  • http://www.mywhitecoatisonfire.com/ Lumi St. Claire

    As a female physician who did leave clinical medicine, I think there is value in looking at potential gender differences when it comes to physician burnout, especially when it comes to self-identification.  But I also have to agree with what Karen posted regarding other factors like temperament and specialty.  I’d also put in my two cents and say that burnout can be a very individualized experience, based on not only who you are but WHERE you are.  I know that while some of my own dissatisfaction came from large systemic issues in medicine that I had no power to change, I was also very affected by the way my own institution went about making decisions (without the physician voice being heard).  

    There IS life after clinical medicine!  I’ve never been more satisfied with my career than I am now.  Thanks to Dike for writing and Kevin for posting such an important topic.

    Lumi St. Claire, MD
    http://www.mywhitecoatisonfire.com

  • http://www.threehourmidlifecrisis.com/ Dike Drummond MD

    In my coaching practice helping burned out docs redesign their career … this gender difference is blatantly obvious. The men on average are in MUCH worse shape by the time they ask for help. The reason …. “I couldn’t have been burned out, I was still practicing good medicine”. 

    The women ask for support far earlier … when just a minor course correction is all they require. I am pleased to have this research data to back up what I notice in the field.

    Bottom Line — MEN … if you are cynical, snarky, sarcastic, blaming your patients and worn out … it is time to get support.

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

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