Recovery and prevention

5 facets of physician burnout

There are different types of burnout. Recovery is an individual journey for medical students and doctors.

Physician burnout is often attributed to systemic problems in the health care environment.

Being buried in paperwork, overbearing caseloads and EHRs are just some of the components preventing physicians from practicing medicine the way they would like to. Over 40% of physicians said they were burned out in Medscape’s 2018 National Physician Burnout & Depression Report.

To assess physician burnout, many studies use a version of the Maslach Burnout Inventory (MBI), which measures three characteristics: emotional exhaustion, depersonalization and low personal accomplishment.

A recent JAMA review highlighted the difficulty of assessing the accurate number of burned-out physicians without a standard definition of burnout or method of measuring it, though a related JAMA editorial noted that chronic occupational stress is clearly a serious problem among today’s physicians.

Burnout starts in medical school

Burnout is also a problem among today’s medical students, which suggests that systemic change is required in medical schools as well.

“The data shows that burnout starts before students get to residency. It’s important to start being proactive in medical school,” says Steven Gates, DO, vice president of graduate medical education at Corpus Christi Medical Center-Bay Area in Texas.

Preventing and recovering from burnout are individual journeys. Here are 5 things to keep in mind about burnout.

1. There are different types of burnout

A study from the Journal of Graduate Medical Education classifies burnout in two categories: circumstantial, or rooted in environmental issues, and existential, or rooted in uncertainty about one’s role as a physician. The study authors concluded that categorizing burnout might help identify better interventions and recovery options.

Recovery from circumstantial burnout tended to involve actions such as resolving workplace challenges, nurturing one’s personal life and taking more time off of work, while recovery from existential burnout tended to involve talking about it, connecting with patients and colleagues, and redefining one’s professional identity.

2. Many people don’t want to talk about burnout

There’s a myth that physicians are expected to be perfect, says Tami Hendriksz, DO, the associate dean of clinical education at Touro University College of Osteopathic Medicine-CA.

“It’s hard for students to reach out if they feel like they’re the only one struggling and getting help,” Dr. Hendriksz says.

Dr. Gates believes estimates of physician burnout are underreported.

“A lot of people try to hide it,” Dr. Gates says. “They don’t wear a sign that says, ‘I’m burned out.’ ”

Nicolet Finger, OMS III, took a leadership role in the group MIND (Mentality Initiative to Nurture Doctors) at the University of North Texas Health Science Texas College of Osteopathic Medicine. At first, the group wasn’t very popular because people didn’t like talking about their emotions, she said. She and a friend stood up in front of classrooms and talked about mental health, which in turn helped others share.

“I shared my personal struggles of feeling inadequate and it was a chain reaction of people sharing their vulnerabilities,” Finger says. “I told a classroom full of students that I laid on my couch for two hours a day the first year of medical school and questioned if this was really for me.”

3. Not everyone recovers the same

Addressing chronic occupational stress requires an individualized approach.

“Ten minutes of meditation a day isn’t going to help everyone,” Dr. Hendriksz says. “We don’t do as good of a job customizing our medical training for each of our learners.”

Take a step back and remember what used to make you happy before medical school, Finger suggests. It’s easy for hobbies to fall by the wayside and to only focus on medical school or practicing, but it’s critical to make the time, she says.

“We lose our hobbies that we came into medical school with,” Finger says. “We see the number we got on a test and it seems to matter more than everything else, and we sacrifice our happiness.”

4. Looking at the big picture

Physicians experiencing chronic occupational stress are less likely to identify medicine as a calling, according to Mayo Clinic Proceedings.

Keeping focused on a core identity is crucial to fighting against a low sense of personal achievement, a symptom of burnout, Dr. Hendriksz says.

She suggests medical students write a letter to their future selves about the type of physicians they want to become.

“In those moments when it feels as if medicine is becoming pointless, pull it out and read it as a reminder of everything you have accomplished and how you want to practice medicine,” Dr. Hendriksz says.

5. Mentors make a difference

In the Meaningful Medicine Mentoring Program at Marian University College of Osteopathic Medicine, first-year students are matched up with a physician mentor to foster resilience through relationships and role modeling.

Sometimes mentees enroll in the program and request specific characteristics in mentors related to personal experiences. For example, a student might want to be paired with a mentor who has a family to learn from a role model with experience balancing medicine and family.

“Role modeling and demonstrating gratitude in daily work and finding deeper purpose in serving patients is a key part of resilience,” Emily Young, MD, co-director of the program, says.

Further reading:

Doctor burnout: Two brand-new JAMA studies raise more concerns

5 ways to maintain mental wellness and avoid burnout

Imposter Syndrome: preventing it, overcoming it and the link to burnout

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