Henry Kuerer, MD, PhD, FACS, CMQ
You would think that 15 years after experiencing my first episode of burnout, studying the subject and continually lecturing on it would ultimately have prevented it from coming back. This has not been the case. Burnout for me has been like the stock market—mostly going up and sometimes, though rarely, going extremely low.
How many reading this article routinely receive 100 or more work emails a day that often demand an immediate response? There are only so many hours in a day. We have to be accountable to our loved ones and ourselves. If you think you can take good care of your patients without taking good care of yourself and family, then you are dead wrong.
I hypothesize that what may have worked before to mitigate burnout may no longer work now. Why? Because one thing is certain: We change, and so do our work environments. Often we have minimal to no control over life and family events. Add to that the realities of practicing healthcare in the digital age, such as the burden of constant increases in expenses related to delivery of optimal patient care.1
We age, our energy levels decrease without appropriate renewal, and our goals within our careers change. What might have worked as part of your personal wellness strategy may no longer be effective. As this article will describe, I may also have some underlying core issues to better manage.
In the academic world, senior faculty commonly take on many other roles and duties. And most of the time, we do not give up things to make time for new roles.
To some extent, it is on us to speak up about toxic work environments to ensure that we deliver the highest-quality patient care with appropriate resources to be efficient and effective in our practices and hospitals. On the other hand, we are responsible for our lives and our behaviors. We need to set personal boundaries. We also need to enforce these boundaries and sometimes get help to strike a balance.
The statistics on physician suicide are alarming and tragic. A recent survey on physician burnout and suicide reported that about 23% of us have thought about suicide.2
Each year, at least the equivalent of 2 to 3 entire medical school classes of physicians die from suicide. It is quite sobering when you think about it in those terms.Burnout
Burnout is a syndrome of emotional exhaustion, depersonalization, and feelings of low personal accomplishment. It is an epidemic among us and much more common among physicians compared with other working adults. Depending on specialty, nearly 50% of US physicians meet the criteria for professional burnout.3
Our jobs as physicians can provide rich meaning to our lives, but factors beyond our control undermine this. In short, our work can be tough both physically and emotionally, and it takes a toll on our professional performance and satisfaction as well as on our personal health and happiness.
Long hours and demands for routine excellence, often in the most difficult situations, are the norm for cancer clinicians. Decreasing rates of reimbursement and increasingly complex rules of reimbursement further frustrate our efforts to achieve work-life balance. For those in academic medicine, funding for education, clinical trials, and basic research is at an all-time low despite the expectation that we will continue to excel in these arenas without appropriate resources. Trying to compensate by increasing already busy practices while maintaining our essential missions of teaching and research further compounds the problem. When burnout and career dissatisfaction ensue, everyone in our circle is adversely affected: our patients and their families, our colleagues and our staff, our trainees and students, and our families.Denying That Problems Exist Does Not Make Them Go Away
Physicians share an unwritten but clearly understood code of rules, norms, and expectations. These often include coming in early and staying until the job is completed, working nights and weekends, seeing a high volume of patients under pressure, meeting multiple simultaneous deadlines, keeping emotions or personal problems from interfering with the job at hand, and facing adversity with vigor and resolve.
Pretending that burnout and other such maladies are a problem of the weak, the lazy, or the uncommitted is unhelpful. Many of us trained with mentors who perpetuated these myths, and we are at risk of repeating the cycle. Despite the prevalence of burnout in hospitals and clinics throughout America, we have increasing productivity requirements, creating “new normals” and all the while we are expected to continue delivering the same quality of care and to make the same contributions to research, education, and administration. We are not weak, lazy, or uncommitted. We are simply human. However, the bills must be paid.