Why 'Burnout' Is the Wrong Term for Physician Suffering

Wendy Dean, MD; Austin Charles Dean; Simon G. Talbot, MD


July 23, 2019

Make no mistake, no nefarious entity is solely responsible for this situation. No single administrator is making decisions expressly intended to harm his or her staff.

Rather, the focus on "burnout" and bolstering resilience arose in acknowledgement of physician dissatisfaction. In the absence of an alternative explanation, researchers latched onto "burnout" as an explanation, because the symptoms seemed to fit. Even better, there were well-marketed programs used in other professions, which administrators, who were also overburdened, could turn to for ready solutions to their employees' distress.

Unfortunately, surveys confirmed that physicians were struggling, but most of the burnout inventories used did not assess for systems challenges that physicians were pointing out as the source of their distress. Once there was the diagnosis of "burnout," we all failed to revisit that conclusion, even though physicians continue to suffer as burnout interventions abound.

One of the reasons for this is that there has been an erosion of the partnership between physicians, other clinicians, administrators, insurers, and national policy-makers in understanding the impact of policy and regulatory changes on clinical work. In most cases, meaningful input from clinicians is lacking before leadership (at many levels) makes decisions about how care is delivered, how physicians are incentivized, or how work hours are allocated.

While any one of the decisions that regulators, legislators, and administrators make might be innocuous, the sum of their decisions has become a tangle of contradictory requirements in the treatment room, which in turn has led to an epidemic of moral injury as physicians try to parse the impossible with every patient encounter.

The primary challenge for doctors is that we have not made it a priority to shout about our experience.

Administrators' primary sin is that they are not listening carefully to what those at the front lines of care are saying, and they are not making substantive changes based on that feedback. The primary challenge for doctors is that we have not made it a priority to shout about our experience.

For healthcare organizations to implement changes that truly improve physician well-being, they need to listen to how physicians experience their work life. Clinicians need to participate in focus groups, listening sessions, and truly confidential free-text surveys from leadership asking for unvarnished input. They need to watch their organization stand up in opposition to another performance metric, or another regulatory requirement, or another satisfaction survey, in defense of their staff. They need to see their practice environment change in response to their feedback or in the resources allocated to care. Physicians need to see that administrators are making a concerted effort to understand their distress and make real changes to mitigate the drivers.

Administrators also should be included in the experience of delivering care as regular team members on rounds or in the clinic or in the community. Watching clinicians try to develop treatment plans while balancing all of the competing allegiances facing them would be helpful. Watching them do it for 60 hours (or more) every week, all year long, would be eye-opening. That might help them realize that we are experiencing something bigger than "burnout," and that gaslighting us, telling us that wellness initiatives will solve our distress, only alienates their clinicians.

The challenges in healthcare are enormous and are felt by all involved—patients, clinicians, and administrators. It's time to make concerted efforts to understand the physician's perspective and the environment of moral distress that is the healthcare industry. Only then can we do what is really necessary: work together in the service of the patients who entrust us with their care.

When physicians fail to listen to their patients and consider their unique circumstances, they risk missing important diagnostic and therapeutic opportunities. When organizational leadership doesn't listen carefully to what drives physicians' distress, no meaningful progress can be made toward alleviating it. No amount of healthy dieting, rest, or exercise will fix what ails us.

We cannot outrun a dysfunctional healthcare system.


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