COMMENTARY

Antidotes to Burnout: Fostering Physician Resiliency, Well-Being, and Holistic Development

Herdley O. Paolini, PhD; Burt Bertram, EdD, LMFT, LMHC; Ted Hamilton, MD, MBA

Disclosures

April 19, 2013

In This Article

Physician Burnout

During the past 20 years, many studies have documented the pervasiveness, symptoms, and root causes of physician dissatisfaction and burnout.[1,2,3,4] Physician burnout, which directly affects quality of care, safety of patients, treatment outcomes, patient satisfaction, nurse turnover, hospital staff morale, and financial performance, occurs at alarmingly high rates.[5,6] As stated succinctly by Dyrbye and Shanafelt,[7] "Physician burnout is threatening the foundation of the US medical healthcare system.

Despite ample evidence that depression, suicide, and substance abuse disorders are more prevalent among physicians than the general population, the mental health of physicians consistently receives low priority.[5] This stark reality was dramatically brought into focus with the recent publication of the first national study of burnout among physicians in the United States. The study explored burnout rates by specialty and compared physicians with workers in other fields, showing them to be at significantly greater risk for burnout, with almost 1 in 2 physicians experiencing burnout symptoms.[4] These findings confirm previous data showing that more than 40% of all practicing physicians currently suffer or have suffered from burnout, and 45% of primary care physicians would quit medicine immediately if they had the financial means.[8]

Root Causes of Burnout

Physician burnout stems from multiple interrelated causes: excessive workload; loss of autonomy; administrative burdens and consequent inefficiencies; ever-present litigation threats; decline in personal meaning from the loss of mitigating factors (eg, relationships with patients and colleagues); and difficulties integrating personal and professional life.

The culture of medicine. The root causes of burnout are thought to be exacerbated by a culture that can be compared with Hollywood's depiction of the American "Wild West," with its strong, silent, and self-contained heroes who never showed a hint of weakness. Part of the problem has to do with how physicians are trained. Medical school is a Darwinian grind,[9,10] compounded by high-stress residency that focuses solely on technical training without the professional development needed by the new physician to navigate the complex intra- and interpersonal demands of current practice.[11]

Some will argue that physicians today are being trained in a more integrated way. Although that may be true in terms of what is seen on the explicit curriculum, it is not what it is often found in the implicit or "hidden curriculum." Like most of us, physicians learn what they see and experience, not what they are told.[12] This was illustrated by the widespread protests from residency faculty to the recently mandated reduction of resident duty hours to the equivalent of 2 full-time jobs.

The practice environment. The practice of medicine has become a complex business enterprise. Physicians expected long hours, personal sacrifice, and high demand. What they did not bargain for are the realities of today's practice environment. Front-line physicians spend a large proportion of their time doing paperwork and dealing with bureaucratic issues to care for their patients.[13] They practice in a highly litigious environment in which every patient they see is a potential lawsuit, mandating the unfulfilling practice of defensive medicine. The latest survey indicates that 60% of physicians aged 55 years or older have been sued.[14]

Reluctance to seek help. Physicians often believe that they should be able to avoid depression, or just "get over it" on their own. Fear that a depression diagnosis could hurt their medical licensing is common, and many physicians appear to avoid treatment completely to protect confidentiality about their mental health.

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