Recently, I attended a conference where a recognized expert in physician burnout was a keynote speaker. As I sat through this lecture on physician burnout, it struck me that we may be approaching burnout in an entirely wrong way. We either look at it from a disease standpoint along the lines of PTSD or depression. Alternatively, we view it as an unsuccessful response mechanism to the pressures of medical practice. But, there are several missing elements to this narrative.
Physician burnout is the inevitable result of a failed medical education system.
I am referring to the professional skills that other graduate students learn as part of their standardized training. The skills that allow you to be an active manager of your own career. The same skills — negotiation, office politics, conflict management, and others — that are shockingly absent in your formal medical training. In the end, physician burnout is due to loss of control. The lack of formal training in professional business skills place doctors at a distinct disadvantage and sets you up for the inevitable “burnout scenario.”
Although the symptoms are psychological and health-related in nature, the primary causes of physician burnout are professional, not medical.
Below is a short list of professional skill and knowledge-gap related issues. There are dozens of others scenarios I could mention:
You are under compensated, leading to financial stress and low-grade ongoing outrage about being treated unfairly.
Compensation issues abound within medicine. You are under tremendous medical debt pressure, and you have a decade or more of delayed wages to recover. The ability to improve your wage structure is called “negotiation.” There is an entire evidence-based approach to get your best compensation package. Nearly every professional graduate program includes negotiation training as part of their formal education. Yet, chances are as a physician, you’ve never gotten a single didactic moment dedicated to this career-enhancing skill.
The good news is that there are CME seminars specifically designed for physicians to learn to negotiate. Self-study and non-physicians courses are available as well. Look for scenarios to practice your bargaining skills, direct application to medical specific career issues and CME availability.
You and your colleagues have poor conflict management skills.
Every day, you are fighting with each other, the administration, the staff and sometimes this even boils over to involve patients. The conflicts and problems are never solved. The negative emotions and grudges simmer, and you grow to resent the very team that you need for support.
Conflict is typically defined as an interaction where interdependent parties want different competing outcomes, and negative emotions are involved. It seems that when you enter a career that is dedicated to the welfare of others, you’d be an expert conflict manager. But, the opposite is true when you survey medical practice.
Conflict is inevitable — You will not agree with everyone all the time. But, conflicts can lead to permanent negative associations and harm if not managed properly. We have all seen minor issues get blown way out of control followed by maladaptive responses like revenge seeking, purposeful reputational damage or refusal to work together. Frequently, the patient bears the brunt of the harm.
Although conflict will happen, the negative long-term consequences should not. Despite the overwhelming need for physician conflict resolution training, the formal training is absent. You’ll need to learn these skills on your own, or at a handful of CME seminars.
You don’t know how to function effectively within an organization. You know how to improve processes or care mechanisms, but you can’t get anyone to listen. You have grown frustrated by years of wasted effort and are starting to not bother when you recognize an issue where your experience could make a real difference.
Office politics — the concept has so many negative connotations, that when you hear it, you think of scheming villains with slicked-back hair and intricate plots that stymy the hero every step of the way. Like most Hollywood perceptions, the reality is very different. “Office politics” is the ability to use the organizational structure, the available resources, and your role as an expert to influence the direction of your organization.
The inability to function effectively within an organization is a major cause of physician burnout. You can’t effect meaningful change and your sense of personal accomplishment and lose the sense that your life’s work is meaningful.
Like the examples given above, office politics is a science and can be learned and applied. You will never get your way every time. But, you can learn to use your position of influence and organization structure to have the most positive effect. Applied over time, this can lead to a tremendous sense of personal accomplishment and recognition within your community — the polar opposite of physician burnout!
Physician burnout is a very serious issue on several fronts. The current popular approaches of addressing physician burnout as a psychological, physiological, or adaptive illness has its merits. But, the primary causes of physician burnout can be alternately viewed as an inevitable failure of professional skills knowledge gaps inherent in the medical education system. We teach you how to diagnose meningitis, not negotiate a fair deal. You understand the Krebs cycle, but you can’t resolve the simmering conflict with the nursing manager. You learn how to suture a ruptured ileus, but you are unable to get your hospital to implement a proven handwashing policy. These and other professional skills deficiencies ultimately lead to the physician burnout scenario.
Here’s the good news: Hopefully, you’ve recognized your own professional skill gaps and now you can do something about it. Take advantage of the CME courses, your colleagues and available self-learning. Become proactive in preventing and curing your physician burnout. Take control of your future. With the proper skillset, you can reach your dreams and really succeed.
Robert A. Felberg is a neurologist and president, Physician Advocates LLC. He blogs at Medical Success Central.
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