With 44% of physicians self-reporting burnout in the 2019 Medscape National Physician Burnout, Depression & Suicide Report, most will agree the profession is in crisis. Of the 29 specialties included, all had at least 1 in 4 members reporting burnout, many with more physicians suffering from burnout than not. Hardly a U.S. problem, burnout affects physicians around the world as well as medical students, and I would surmise, nurses, mid-levels, and healthcare workers across the board.
You can hardly breathe the word burnout without hearing its companion buzzword: resilience. Drilled into medical students, we are taught that the only way to prevent burnout is to train ourselves: maintain a good work-life balance, exercise, create a support network, use mindfulness and meditation, and participate in activities that help us connect with our identity. Don’t get me wrong, I believe this is all good advice, however it relies on the assumption that we (physicians, medical students, etc.) are the problem. We are too weak to handle the stress of medicine. We have maladaptive habits that needed to be corrected with wellness programs. We must harden ourselves as we enter the profession.
As Nisha Mehta, MD discusses in her article, “Physician Burnout: Why It’s Not About Resilience,” physicians have always worked in a difficult profession. What has changed is not the people, but the pressures of the profession. Looking back at the Medscape report, physicians don’t blame their burnout on medicine, but too many bureaucratic tasks/charting (59%), spending too many hours at work (34%), increasing computerization of the EMR (32%), lack of respect from administrators/employers or colleagues or staff (30%) as well as insufficient reimbursement, lack of autonomy, regulations, feeling like a cog in a wheel, and an emphasis on profits over patients.
It is this environment, which takes compassionate, caring, and driven people with a desire to serve and breaks them until they lack the will to go on. It is no wonder the suicide rate for male physicians is 40% higher than the general population, while the rate for female physicians is over twice the rate of the general population.
With that in mind, let’s ask ourselves: if 44% percent of physicians nationally were robbed in the hospital parking lot on the way to their car, what would the profession do? Would medical schools teach martial arts? Would hospitals offer classes on dealing with fear on the way to work or shame their employees for not being able to take a punch? Of course not! Physicians and the AMA would demand more security guards and better lighting, changing the system to correct the problem. Due to consolidation and a meteoric increase in the percentage of hospital-employed physicians, physicians are not able to make many of these changes on their own. But hospital systems aren’t going to voluntarily reduce the RVUs or spend more money to improve the work environment purely out of benevolence.
I get it: Physicians are burnt out. They are tired, overworked, many have lost their purpose or their identity, and want to use the precious time they are not charting to participate in activities other than medicine. But it is this attitude, suffering in silence, and lack of a vocal united profession that benefits hospital systems and allows this toxic work environment to continue.
So if we want this to get better, both for ourselves, our patients, and the profession as a whole, we need not just to acknowledge the problem, but that it is up to us to fix it. This will involve physicians not only demanding change, but proposing solutions: showing their benefit to us and our patients. But all of this starts with changing the conversation from the idea that burnout is a result of a physician’s shortcomings or weakness.
Resilience aside, it’s time to fight to fix the system instead of continuing to accept it.
Daniel Berger is a medical student.
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