The medical profession is waking up to the fact that too many doctors are burned out in their jobs with plenty of public handwringing. There’s no question it’s a big issue for physicians. But should the rest of us care about it?
I’m not sure, and I study doctors and how they work.
There isn’t a lot of systematic research linking burnout among physicians to the health of their patients. I’m not saying that physician burnout doesn’t matter for patients. It likely does. If my auto mechanic is burned out, it probably affects the quality of repairs I get, just as an emotionally exhausted clinician may not be at the top of his or her game.
If that’s the case, why aren’t we talking more about what physician burnout means for patients rather than just what it means for doctors? As a paying customer, is it my obligation to worry about how those who provide me with a service — and who are amply compensated for it — can feel better about what they do? Plenty of workers, from fast-food cooks to bus drivers and accountants go to work feeling burned out every day, yet we aren’t devoting pages of analysis to them even though they, too, deserve to have work that is joyful and rewarding. Nurses have experienced burnout for decades, yet there hasn’t been the same intense hue and cry for them as there is for physicians.
I’ve researched doctors for a couple decades, written books about them, worked alongside them, and know many doctors personally. I also interact with them as a patient. What bothers me in the current discussion of doctor burnout is the lack of blame being laid on the doorstep of the medical training apparatus — medical schools as well as residency and fellowship programs. They have largely ignored this growing problem for years in the students and trainees they work to turn into competent physicians.
Instead, organized medicine lays the blame mostly with external forces like the corporatization of health care; the fragmentation of patient care; rising workloads; the incessant drive to make medical practice more efficient; and use of the dreaded electronic medical record. It’s true that these have made doctors’ workdays more negative, with decreased autonomy, damaged relationships with patients, and heavier workloads. My own research bears this out.
But it is a downstream part of the problem. An earlier one is that too many doctors-in-training, most of whom enter medical school as young and idealistic, get put in a deep hole before they even get into their work careers as full-fledged physicians. Solid research shows that by the time many medical students and residents enter clinical practice full time, they are already burning out in high numbers. That undermines their desire to pursue the more altruistic, patient-centered form of professionalism that satisfies many physicians and gives intrinsic meaning to their work. While still in training, many report poor quality of life, and suffer from depression and psychological distress, all correlates of burnout.
Knowing early that burnout may lie ahead, many young doctors make pragmatic career choices that emphasize establishing a good lifestyle and creating a balanced identity. Such choices let them pursue work and non-work interests equally and act as spouses, parents, and friends without being undermined by the demands of being a physician.
I don’t blame them. By the time their medical training is over, physicians have already devoted a good chunk of their earthly existence to working hard, achieving, and making sacrifices just to have an opportunity to go into the profession. And many of them accumulate mounds of debt to fulfill that opportunity that will require years to pay back.
This focus on career pragmatism isn’t simply driven by general “millennial values,” although there is no doubt that generation is more aware of the limitations of going all-in on any career. I believe it is an indictment of what is not happening in the critical years during which young men and women should be groomed to become competent, well-adjusted physicians able to thrive in a difficult job.
Too many medical schools are nibbling at the margins of curriculum overhaul needed give students the well-rounded education they need to practice as doctors without feeling overwhelmed. And many medical residency programs still see their trainees as at-will employees rather than as highly talented assets in the most impressionable stages of their careers, employees who require a significant investment of resources to develop fully. Despite the rhetoric about change, medical school and residency and fellowship cultures overemphasize academic credentials and book smarts while largely ignoring ways to give students the street smarts, business training, resilience, adaptive mindsets, and emotional intelligence they need to navigate difficult and uncertain work circumstances.
Because many role models in medical training are burned out themselves, they often lack the compassion and motivation to teach young doctors about the full rewards and realities of being a doctor, thus spreading their own psychological distress like a contagion.
Add to all of this the fact that the environments in medical school and beyond remain highly pressured, overly controlling, ultra-competitive, and power laden to the point where many young physicians feel unempowered right away, and the stage is set for early career burnout to occur. It makes no sense — no other industry I know treats its most prized talent this way.
I want to care that many doctors are burning out in their jobs. I think that everyone should be aware of this reality, given that health care is a service industry and physicians provide many of its most important services. But I would care more if the profession and its training institutions took their culpability more seriously by shining a light directly on what they must do — and do quickly — to create doctors who are psychologically and emotionally prepared for what they will encounter in their jobs.
We don’t have the luxury to roll out curriculum reforms in a piecemeal fashion, or think that widespread culture change will occur naturally without dramatic structural overhaul of the institutions involved in medical training. We need an educational revolution right now: radical shifts in the content of what medical schools and residency and fellowship programs teach their students, how they evaluate and interact with them, and greater awareness that they have the first and most important responsibility for preventing burnout in doctors.
Without these, we can expect the problem of physician burnout to get worse, and I as a patient will keep wondering why I should care.
Timothy J. Hoff, Ph.D., is professor of management, health care systems, and health policy at the D’Amore-McKim School of Business and the School of Public Affairs and Policy at Northeastern University in Boston; a visiting associate fellow and visiting scholar at the University of Oxford; and the author of “Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health” (Oxford University Press, September 2017).
