When I quit my clinic job after four waves of the COVID-19 pandemic as an intensivist, I decided not to work in direct patient care for a while. I expected harsh criticism from my colleagues. Surprisingly, that never happened. The feedback was unexpected, at least for me. Most of my colleagues admired my decision. They called me brave for taking the leap, and many admitted thinking about the same for a while but lacked the courage.
That made me realize that the problem might not be me. If so many good and hardworking physicians – used to working long hours, nights, weekends, and holidays without complaining – are exhausted and considering switching fields or leaving medicine altogether, there must be something else. So, it’s worth looking at the bigger picture.
Why do physicians struggle all over the world?
Surveys in 2022 in Germany and the U.S. came to similar conclusions about what contributes most to physician burnout.
The leading issues seem to be:
- Lack of autonomy
- Loss of control over one’s work and even private life
- Increasing computerization
- Administration taking time away from patient care
- Insufficient salary
- Lack of respect from patients
- Shortage of health care professionals leading to increasing amount of working hours
But studies rang alarms about physician burnout before the COVID-19 pandemic. According to Medscape National Physician Burnout, Depression & Suicide Report 2019, 44 percent of physicians reported experiencing burnout already in 2019. Unfortunately, this number has grown to 47 percent in 2022.
COVID-19 is not the cause. It only brought the problems to light.
As the pandemic arose and the numbers grew, news about overloaded hospitals flooded the media. Soon we started to see it in our own units, which was more than tangible.
The feeling of loss of control, rapidly increasing work, self-isolation, fear of the virus, and the stress of treating COVID-19 patients were key factors targeting the already weak points. Feeling overwhelmed and desperate was aggravated in many of us.
No wonder the already tired health care workers felt enormous pressure.
By the pandemic’s beginning, health care systems worldwide were operating on the edge due to the shortage of nurses and physicians. COVID-19 only challenged an already cracked system and highlighted its deficits.
Where can we find the solution?
To find a solution to burnout, we need to understand that it is a workplace problem, not an individual problem. Burnout is an occupational syndrome that goes back to organizational factors, so that’s where we need to look for solutions.
Yet, burnout is often falsely treated as an individual dysfunction. Practicing self-care, being mindful, finding new hobbies, etc., is common advice. Sadly, even those experiencing the symptoms of burnout and struggling with daily life tend to blame themselves for it and are reluctant to ask for help.
Of course, factors that make one prone to or resilient against burnout exist. We can do a lot to avoid or overcome the symptoms, but sustainable solutions are elsewhere.
Significant changes must be reforming workplaces to restore joy and engagement among health care professionals.
The following studies offer ideas for making sustainable changes and improving physician well-being:
- Impact of Organizational Leadership on Physician Burnout and Satisfaction – “The leadership qualities of physician supervisors appear to impact the well-being and satisfaction of individual physicians working in health care organizations.”
- Organizational strategies to reduce physician burnout and improve professional fulfillment – “… systematic reviews and meta-analyses reveal that organization-based interventions are more effective at reducing burnout than individual-based interventions.”
- Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review – “The results of our study suggest that organization-directed workplace interventions that improve processes, optimize EHRs, reduce clerical burden by the use of scribes, and implement team-based care can lessen physician burnout.”
- Organizational strategies to reduce physician burnout: a systematic review and meta-analysis – “… physicians could gain important benefits from interventions to reduce burnout, especially from organizational strategies, by viewing burnout rooted in issues related to the working environment and organizational culture.”
Letting go: How to change the culture of health care
Would we recommend our patient ignore sleeping disorders, headaches, loss of appetite, irritability, and anxiety? I don’t think so. So why do we do it ourselves?
We go to medical school and grow up in a system that puts a nearly impossible set of expectations on us to be “good doctors.” Experienced colleagues emphasize them during our training, and we never question them. Society also sees physicians as workaholics and perfectionists. It seems almost obligatory to put our own needs aside and make patients always come first.
But how can we help patients if we struggle and don’t have our basic needs covered?
We don’t allow ourselves to show signs of “weakness” because we think it would be complaining, so we keep working harder and harder. But burnout would not exist if working harder was the key to feeling more fulfilled in our profession.
The sooner we let go of these unrealistic expectations, the faster we understand that it’s our right to have a balanced and healthy life while practicing medicine. We shouldn’t accept choosing between private and professional life. Having an accomplished personal life would only make us better doctors, not worse.
Thinking back on my experiences as a clinician, changes in my work schedule would have made a significant difference. Getting enough sleep, having sufficient time for my patients, my family, and my education as a physician could have been a game-changer as I was always passionate about medicine and, especially, intensive care. But when my job started to impact my life and health destructively, I decided the price was too high. It was time to take a break. And I can say I’m not the only one.
It is time for a change globally in health care. Some organizations have already recognized the burning problem. The Mayo Clinic, for example, worked out nine strategies to fight physician burnout on the organizational level.
Check them out for a broader idea of where to start addressing the problem of disillusioned, exhausted, dispirited health care professionals in your clinic and make medicine a fulfilling and sustainable career path.
Zsuzsa Csik is an anesthesiologist in Brazil.
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