'Only a Sociopath Could Work for a Large Health System,' Doc Says Sardonically

Amanda Loudin

February 17, 2023

A frustrated physician recently voiced some strong words in Medscape's recent US Physician Burnout & Depression Report: "Only a sociopath could work for a large health system and not be burned out. Anyone who cares about patients is doomed to burnout."

It's no secret that today's large healthcare organizations are leaving physicians feeling overwhelmed, beaten up, and exhausted. Medscape's report showed that 53% of physicians feel burned out by job requirements; 65% say that burnout has impacted their relationships, and other statistics say that physicians are leaving clinical medicine because of all this pressure.

What is it about being employed by large organizations that can be so negative?  In another study, MEMO — Minimizing Error, Maximizing Outcomes — researchers at the University of Wisconsin surveyed more than 400 doctors to learn about how their working environments corresponded with medical errors. More than half of the physicians reported time pressures when conducting physical examinations. Nearly a third felt they needed at least 50% more time than was allotted for this patient care function, and nearly a quarter said they needed at least 50% more time for follow-up appointments.

Some have asked: Can anyone, then, thrive in today's healthcare environment and avoid burnout?

Although the frustrated physician noted above may sardonically say that a doctor needs to be sociopathic to enjoy it — lacking in feelings for others — "It's a very small number of doctors who get in it for the wrong reasons and therefore care about their own benefit and not their patients," says psychiatrist Wendy Dean, MD, CEO and co-founder of Moral Injury of Healthcare, a nonprofit organization addressing workforce distress in healthcare. "Those are the outliers."

The vast majority of physicians do care about their patients — deeply, says Dean. They struggle under the weight of the healthcare system and yet must find ways to get through. Today, thriving in an imperfect system requires honing new skills, asking for help when needed, and pushing for systemic and cultural change.

"We've been assessing and trying to address burnout for half a century," says Dean. "Despite all the good intentions, and people dedicating their entire careers to solving the issue, we've barely made a dent."

With the advent of new technological requirements on the job and more demands from increasingly larger healthcare organizations, the risk for burnout is higher than ever before. "There's an increased burden of regulatory-mandated and cumbersome administrative workload per patient," says Shomron Ben-Horin, MD, co-founder of Evinature. "Often the computer/paperwork before and after a procedure is much longer than the procedure itself."

Often the computer/paperwork before and after a procedure is much longer than the procedure itself. Shomron Ben-Horin, MD, co-founder of Evinature

Meeting insurance requirements is increasingly cumbersome, too, and preauthorizations and debates with payers over medical approval may put physicians frustratingly in the middle.

"This increases the psychological burden for physicians who may feel responsible for wrongdoing no matter which option they deem better," Ben-Horin says. "Add in physician accessibility around the clock via mobile phones, emails, and apps, and you end up on call even if you're not officially on call."

Why Some Physicians Suffer More

Some physicians are more likely to suffer burnout than others, says Jessi Gold, MD, assistant professor in the department of psychiatry at Washington University in St Louis School of Medicine. "The self-valuation concept comes into play here," she says. "If you make a mistake, do you blame yourself or see it as a growth opportunity? If it's the former, you're more likely to burn out."

Ben-Horin adds that the most patient-centric doctors are the ones who struggle most. "These are the doctors we'd all love to have as a patient," he says. "But they are burdened by the extra tasks of the job, and they are the most stressed by the environment."

So too are those physicians who never master compartmentalizing their feelings and emotions. "We learn in training to compartmentalize our emotions," says Dean. "You can't allow yourself to get emotional while performing chest compressions on an 18-year-old kid. So you shut it all away; otherwise, you might lose the patient."

This turn-off switch becomes automatic, but it also comes at a cost. "When doctors were interviewed about [Buffalo Bills player] Damar Hamlin going into cardiac arrest on the football field, they talked about how a life and death situation is so common that they have to put the emotions away, work on the patient and move onto the next," says Dean. "The next patient needs you just as much. We must lock away our feelings and manage the situation."

Gold explains that burying feelings, however, is a symptom of burnout. "We have to remove ourselves from the situation to protect ourselves," she says. "We can't cry in these situations, but we can't bury our feelings either."

Instead, Gold suggests, a good medium may exist. "You may not be able to address them in the moment, but you should sometime after," she says.

This is just a starting point on how to remain a dedicated, caring physician without burning out. "The system is pretty broken, and to survive it first means wanting to survive it," Gold says. "There's a lot of focus on resiliency and lack thereof if a physician expresses burnout, but that's a false notion. Doctors are a resilient bunch but even they get burned out."

Change for the better must come from several places. One is asking for help, something that can be hard for a group conditioned to keeping a stiff upper lip. "Just because your peers might look healthy (emotionally) doesn't mean they are," says Gold. "We've normalized this culture of burying feelings, but that doesn't mean it's right."

Ben-Horin also advocates diversifying your work. This might include engaging in research and academics, for instance. "This not only makes you a better broad-perspective doctor but allows you to psychologically switch gears on research days," he says

The biggest place to make change, however, is within the healthcare system culture itself. The AMA created a series of recommendations to address burnout at the resident and fellow level, a good starting point to carry through into staff work. The steps include creating a well-being framework; gathering a team to support a well-being program; developing the program in a way to foster fun and connectivity among the staff; fostering individual well-being that addresses emotional and physical well-being; and confronting burnout and creating a sustainable culture of well-being.

On a personal level, it's essential that physicians keep close tabs on themselves and peers. "Understand the signs and symptoms of burnout by taking stock of where you are emotionally," says Gold. "Have a place and time at the end of a hard day to reflect or find a ritual that helps you and stay with it."

You might also reach out to a therapist or a peer when you're struggling. Having honest conversations with peers can go a long way. "Find a confidant that allows you to be vulnerable," Gold recommends. "Acknowledge that this is hard and that you might need help taking care of yourself. The system needs to change, but we can also learn to survive in the meantime. You don't have to be a sociopath to make it."

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