Without question, the interconnectivity created by social media is a plus when it comes to talking about physician burnout, suicide and policies affecting our practice of medicine. We are no longer in independent silos with the surgeons suffering in one corner and pediatricians elsewhere. Physicians are no longer isolated contemplating if what they are experiencing is just unique to them. We are developing collective voices. It is incredible to believe a profession that requires some of the top academic performers and minds of any field is struggling with basic concepts of control, equity and justice in the workplace — but we are.
As we have advanced the discourse externally about the collective pressures we face, we are simultaneously paving a path for students and residents who enter the workforce that will hopefully look different than the highly regulated and micromanaged medical world we currently practice in. But collective work is not enough. As individual attendings and seasoned physicians, we must mirror balance in our professional lives. To defend against burnout and physician abuse, we must teach our new physicians the art of saying no. Helping our new residency graduates and medical students recognize these abusive work environments, prioritize their happiness and values so that they can avoid pitfalls is essential. In order to do so, we must recognize the role we as attending’ play in perpetuating physician abuse and burnout. We are part of the problem.
”You cannot teach what you do not know,” so the saying goes. As attending physicians, many of us are still learning how to say no. When we graduate residency many of us are straddled with considerable debt from student loans. We are used to working long hours that are out of our control. For a finite time, shorter for some trainees than others, we are beholden to hospital schedulers, program directors, and ACGME requirements. However, this period passes, even during the longest training process. Then, one is left with life after training. This is the life we have worked hard for, made promises to our significant others and family that it would be better. However, if one does not prioritize the things that matter to you outside of medicine, create boundaries, by saying no to unreasonable requests, it will not be better. This is where the dream is deferred, and many of us find ourselves hopeless and disappointed. Mastering the art of no is important for physician well-being.
There are many of us out in practice, those who are seasoned, who have not yet figured out how to create professional boundaries for themselves. Our residents and students look to us for mentorship and leadership. We sit on hospital boards and committees but do not speak up. If we do not continually advocate for ourselves, they are left uncertain of their capability to do it. In my work with those in training, many are overwhelmed by the culture of negativity that surrounds us. While we continue to practice heroic measures in our fields, we are clinical innovators; we are academically astute, and the work-life balance perils in our personal lives are blatantly apparent. This generation of upcoming future physicians needs us to stand up and be accountable. While, as mentioned, there are many collective improvements, on a daily basis we falter in the decisions for personal wellness that we fail to make. It is a disservice to our profession and those behind us.
Residents who work with physicians who have an antiquated perspective of extreme self-sacrifice become indoctrinated in a negative culture. The expression of professional success has long been sacrificing one’s well-being for patient care or medical service. We criticize our colleagues who recognize their need for rest, who prioritize special moments in the lives of their family members. We continue to make it difficult for mothers who are working, fathers who want to spend time with a newborn. These are physician culture issues as much as they are institutional problems. Therefore, it is imperative that we stop affirming this malignant perspective and say no. While those who choose to work in this manner make a decision to do so, others should not feel bullied or pressured into a physician-led culture such as this.
There is nothing more troubling than watching a senior physician who has lost grip and control over the most precious commodity of their own time. Work does not define you unless that is your choice. We can all pursue excellence and be the best physicians we can for our patients but still take care of ourselves. It is a difficult balancing act but one that matters as much as completing charts and attending CME. It is the great juggling task of our profession. The more we as attendings and seasoned physicians model this behavior, normalize balance and disavow the culture where physician personal needs are unimportant the easier it will be to transform the landscape of medicine from the external pressures we face. We must humanize the way in which we work as colleagues and physicians if not for our own benefit, then let’s do it for those behind us.
N. Bande Virgil is a pediatric hospitalist.
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