Burnout is a myth. Dedicated clinicians, working under circumstances that connect their skills and compassion with opportunities to impact patients, won’t experience burnout any more often than they might by doing other jobs. The story we tell — the one that dissatisfaction is this system’s inevitable byproduct — perpetuates more harm than we know.
This is what I’d like to believe. I’d like to write about the many opportunities to do great work within our system and how few barriers there are between skills, empathy, and the capacity to do good for our patients. The care of sick people, after all, is one of the most inherently rewarding career areas we could pursue. And yet, immense dissatisfaction becomes a defining quality of these professions. Why?
We fail to completely understand this problem’s greatest source. We believe, and say, and write, that burnout is generated by untenable volumes of labor, a productivity squeeze, and the sense of lost control over the mechanics of the work that we do. But in our analysis, we identify the numerators of the burnout equation only. The total etiology is at once more insidious and more fundamental — easier to describe and immensely more difficult to improve.
An enormous volume of work can become tiresome, and it can test us, and it may push us somewhere we might not otherwise go. But if that work is important, if it’s impactful, if it means something real to us and to our patients, its result will not be dissatisfaction. To see the rest of the burnout equation, we need to look beyond health care.
We’re dissatisfied because the onerous volume is there, without a doubt, but the opportunity for impact is dwindling. We bend over backward to make time for teaching, for listening, and to make sure that patients understand what we advise.
And many patients will do their best. But the impact — the changes in life quality and expectancy — of the interventions our system provides through pills and procedures is in many cases much smaller than the impact of access to healthy food, or of meaningful education. The health outcomes associated with smoking cessation are monumental in comparison to the effects of, say, taking a statin.
Our patients demand passive solutions, we say, and we groan when the noncompliant patient returns because he did not adhere to diet or medication recommendations. Meanwhile, the insurer, which dictates that patient’s choices to a great extent through the presence or absence of financial incentives, refuses to reimburse for programs that drive lifestyle change.
What we perceive as burnout is the sense of powerlessness against the weight of a social-economic system that influences patients’ health outcomes to a far larger degree than we ever could. What we’re experiencing is the same futility felt by a teacher tasked today to instruct a student in multiplication tables, who knows that he may have no warm bed tonight.
Volume is a factor in the burnout equation, but the potential for impact is its heavier counterpart. We are being robbed of the chance to help our patients as well as we could by a perverse system revolving around twisted financial incentives. We do not need to accept this, and frankly, the ethical response is to refuse to accept this. We chose these paths to help people. Right now, that means engaging with a system defined by its severe dysfunction and refusing to accept that burnout is a natural experience in health care.
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