Physician burnout: is there any one cause?

burnoutshotHealth care has received a rude wake-up call. With one of the highest rates of depression among professions – more than 45% across all specialties – physicians are burning out at a rapid rate. According to dermatology specialist and physician burnout coach Dr. Elizabeth Hughes, studies show that an average of 54% of physicians across all specialties have experienced burnout. As recently as 2005, it was 31%.

“Burnout,” says Hughes, “is the most significant challenge facing health care in the 21st century.” Left untreated, burnout can lead to dissatisfied and underserved patients. Worse, it can lead to medical errors, increased risk of litigation, patient mortality, and physician suicide.

“We are facing some powerful changes in medicine,” says internist and addiction specialist Dr. Michael Schiesser, “changes that are just bringing out the possibility of burnout that has been there all along.” Among the most obvious are the current administrative demands upon physicians alongside the downward pressure on compensation.

While surface causes of physician burnout are often readily seen, burnout remains difficult for physicians to admit. Theirs is an inherently and uniquely difficult work. Much scrutinized, they must treat illness and anxiety on a daily basis. It is a profession in which the stakes, and the level of expertise required to meet them, are high. Education and training is costly, hours long, and a personal life challenging to maintain.

To manage the demands of a medical career fosters the very individual traits that can lead to burnout: idealism, empathy, and a type-A personality. These traits very often form a kind of fire wall between the physician and his ability to recognize the signs of burnout and to seek the necessary help to prevent or treat it.

That reticence to be vulnerable and admit to ourselves that we are spiraling downward, says Hughes, leads to a deteriorating quality of life, including work overload, loss of control, lack of reward and community, feeling like a cog in the wheel, a diminished sense of personal accomplishment, and the sacrifice of family, hobbies, friendships, and other non-medical life goals.

Sadly, a habit of not having these life-invigorating resources to rely upon becomes ingrained and results in alienation from what was once a promising career choice. “Burnout leads to disengagement,” notes Hughes. “I see it as a real mismatch between the skills and expertise that physicians spent years honing and how they actually spend their time. This leads to frustration that physicians can’t do the jobs they’ve been trained to do.”

Though the cost for not doing so is great, physicians are notoriously hesitant to ask for help and sometimes with good cause. Burnout is often viewed as the physician’s fault, as if the reason a health care worker is burned out is because he or she is failing and not that the system is failing the physician. And physicians, as a group, can be their own worst critics.

“We want to see ourselves as always capable, not vulnerable, and that we don’t make mistakes” says Dr. Darcy Constans, a family physician at Seattle’s Polyclinic and a Leading WellTM team member at Physicians Insurance. “Because we are ultimately the ones responsible for everything, we must also be responsible for our own burnout.”

And yet, physicians experiencing burnout are not the most subjective observers of their medical issues. Says Dr. Mick Oreskovich, a Seattle psychiatrist and leading national researcher on burnout, “Those suffering from burnout or depression often have pretty delusional thinking. They are going to work thinking that they’re still doing a good job. They are often the last person in the room to know how depressed they are.”

Schiesser says that society nevertheless expects physicians to be flawless and on call to meet patient needs when, in fact, “physicians (also) have personal circumstances that need help and attention.”

Hughes calls for nothing less than a “culture of wellness” within the health care profession, because “when physicians aren’t well, the patients can’t be well either.” She quotes author Michael Scott, who said, “Put on your own oxygen mask before helping those around you.”

How ironic that the very traits that can make someone a quality doctor can also lead them to a predisposition for burnout. The key to helping patients be happy and healthy is to maintain the qualities that keep you connected to them and their care, while quite consciously fending off the pressures that prevent sharp focus and high touch healing from taking place.

Watch for Part 4 of our burnout series —  Physician burnout: solutions.

Meanwhile, read the rest of the burnout series:
– Part 1: Physician burnout: recognizing the signs
– Part 2: Physician burnout: impact on you, your team, and your patients

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