voices in the family

Physician Burnout

In a recent national study, nearly 50 percent of physicians surveyed reported at least one symptom of burnout. Some pointed to emotional exhaustion, depersonalization in their relationships with patients, and a low sense of accomplishment.

The study concluded that burnout is more common among physicians than among Americans who work in other fields — and that physicians in specialties considered at the front line of care seem to be at greater risk.

Dan Gottlieb explores the topic of physician burnout – who’s at risk, what’s at stake for doctors and their patients, and what’s being done to energize and strengthen weary medical professionals.

Dan’s guest include Colin West, Liz Ferron, and Erin Lockard.

Colin West, M.D., Ph.D. is a co-author of the article “Burnout and Satisfaction With Work-Life Balance Among U.S. Physicians Relative to the General US Population” (August 2012). His research at the Mayo Clinic in Minnesota focuses primarily on physician well-being, evidence-based medicine and biostatistics, and medical education.

Liz Ferron is a clinical behavioral specialist at Physician Wellness Services in Minneapolis.

Erin Lockard is a local hospitalist who shared her experience with burnout and explains how changing jobs helped her cope and carve out a more holistic lifestyle.

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  • The teacher

    I am a patient as well as the parent of an ER doc. Your program on physician burnout was wonderful-the topic need more discussion.
    1. As a patient, I am appalled by the lack of attention given me, even when I stand my ground. At a recent consultation , my specialist arrived with a computer in hand, sat down and began to question me as he typed in my responses. He did not look at me. At the end of our ten minutes.as he was leaving, I asked him to remain so that I could speak with him. His response”I just spent ten minutes with you.” I explained that I felt that beyond his typed notes he would know nothing of me, had not looked at my hands or face or even looked me in the eye. Poor medical care!!
    My daughter is an ER doc, having trained at one of the country’s most prestigious and busy hospitals. Unfortunately, she is just a cog, at the beck and call of an insurance company’s decisions about what care is warranted, what procedures needed, even though it is she and not the insurance folks who have seen the patient. The excellent training she received to think, make independent well reasoned decisions is not what is championed.In a busy ER with many beds to manage, speed and “move’em along” is what is preferred. But why should this excellent doc consider leaving her clinical practice or changing jobs? I did not hear anyone in your program suggest that perhaps the culture of medicine should change, that perhaps that old boy school of pushing residents ( yes, there are rules about hours, but the work load has not changed) to the point of fatigue, of allowing insurance companies and others to make decisions about patient care and the time needed to be given to good care, all need to be changed. I did hear that those suffering burnout should step back, take a new job, re evaluate their priorities and try to be “good enough” instead of perfect. Hmm. I do not want a “good enough” doc caring for me. I want the best, a doctor who cares, can hear my concerns, can look at me and not the computer when discussing those concerns and who can make good medicine based decisons for my care.
    Thanks for an enlightening program.

  • Edmund L. Erde

    Tuning in late, I heard a great deal about professional autonomy. Having taught medical ethics full-time in medical schools from 1975-2010 in several states, i believe criticism of physician autonomy was sorely lacking from the conversation. Much that compromised professional autonomy comes from a variety of failures of physicians and the culture of medicine. From snake-oil quacks to advanced specialty care, conflicts of interests and violaitons of patients’ rights were rampant. Much of practice is habitual and not up-to-date. Pharaceutical companies manipulated from medical school through residency and full practice. Fraud and abuse are hugely damaging. Doctors did not police their ranks–even licensing boards could not do a good job, given limited resources and membership populated by doctors who were too sympathetic to their rogue colleagues. In short much that contributes to burnout is an attempt to forge better accountabiity. Too often doctors allowed misbehaviing students and colleagues to go on practicing with little or no active concern for patients. I saw and heard a great deal that reflected burnout and compassion fatigue. But the causes are no by any means due to external forces acting on medicine from without. I do not know whether Jung’s archetype of the shadow, or the Judeo-Christian notion of original sin, or Oliver Wendell Holmes, Jr., are right about inborn evils, but it makes no sense to think doctors are better people than those who populate any other profession or trade.

  • Duncan Wright, M.D.

    Thank you for the program, which presented very well the human cost of physician burnout (which I have experienced myself). It is more difficult to briefly describe the systemic causes of burnout. Perhaps one of the obstacles to systemic analysis is the word burnout itself; it implies an individual malfunction. Alienation is a word which captures both the human experience and a systemic analysis.
    One doctor said she felt like a factory worker. As Karl Marx noted, the factory worker experiences alienation in four ways:
    1) Workers are related to the product of their work as to objects. What they have made does not belong to them, yet dominates them. ( similar to depersonalization)
    2) Workers see their work as way to satisfy other needs.
    3) Workers become alienated from their fellow human beings: the life of others ,of humanity becomes a means of sustaining their individual existences. ( for example, doctors who are overworked to the point where they cannot care for their families.
    4) Workers become alienated from their own bodies. (for example a caller mentioned his physician wife who was neglecting her health while working 70 hours a week. ).

    The systemic cause implied in the term “alienation”
    is the domination of society by a small class that owns most corporations.
    Systemic solutions include setting up medical care cooperatives and strong doctors unions.
    Reference: McClellan, David (1971). The Thought of Karl Marx.

  • er doc

    Thank you for this program. I think its great that this issue is coming more regularly to the forefront and I commend the physicians willing to publicly discuss their own stories here.

    Physicians, by training and by the nature of their work, suffer from PTSD, anxiety, and burnout. Our training sets us up for it. It is inevitable. Unfortunately, no one trains you how to deal with it. The proverbial answer is “oh you just get over it, or you dont.”

    A portion of the burden regarding this issue is certainly on physicians, as an employment species, for having doggedly accepted the application of the american corporate greed and business model to be applied to the healing arts. Shame on us for not having the chutzpah to change ourselves, enlighten our employers, and afford real change in our work environments.

    Still, healthcare institutions are at fault for not recognizing that physicians are human. They are at fault for not recognizing that the core of he healing arts is that doctor patient relationship. It is that element which is most significantly lacking in our current healthcare system and which contributes to both patients and healthcare providers feeling like cogs, numbers, diagnoses, etc.

    I think it is wonderful that we are now starting to recognize the severe consequences our current medical climate has on our physicians ad the care they provide. But there is little movement across the USA to change this greedy culture which encourages dissociation and depersonalization in medicine. Hospitals and doctors need to realize that we are dealing in human currency which is infinitely more valuable than any revenue that can be brought from an unecessary expensive procedure.

    We live in an extremely emotionally, mentally, and ethically ill society, not to mention a physically ill society. It is not just physicians who suffer daily burnout. Our entire society runs on fumes (or Dunkin, depending on who you believe). I want to see more articles about how to change this culture. I want to see more physicians emboldened to do so for themselves. I want to see physicians stand together as a group to affect this change, to stop being so fearful. As physicians, we control many more outcomes than I think we believe we can.

    Programs like these are a good start, but sorely lacking in this discussion were solutions. Stepping back is not simply enough. We need to take more drastic, sweeping steps toward enlightenment. Sadly, corporate greed may once again, get in the way.

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