Burnout Culture

Really wanted to highlight a post via KevinMD of a burnt-out surgeon. First, I think it gives a good description of how medicine leads to burnout, namely that it's a long process. Individual  moments certainly stand out and can precipitate reactions like a breakdown or quitting, but a physician is set up to break long before any one event pushes them over the edge.

Second, stresses on a physician are multi-factorial. One of the commentators provides a nice framework to categorize the stresses:

1) Workload - too much work, long hours, not enough time for each task
2) Control - limited autonomy, limited schedule control
3) Reward - insufficient monetary, non-monetary, or personal compensation
4) Community - lack of sense of belonging, difficult coworkers or bosses, habitual conflict
5) Fairness - unequal treatment between physicians, or unjustified treatment of all physicians
6) Values - work that conflicts with your broader ideals

Every job has concerns related to some of these categories. What the burned-out surgeon's story makes clear is that many physicians are having stress in almost all these areas: long hours, too much work in those long hours, little schedule control, inadequate support from colleagues, the list goes on. Each physician will have their own mix of personal stresses, but it doesn't tend to be a single one that causes a physician to become burned out, it's the combination of stresses that does it.

Some stresses in medicine are going to be unavoidable. A regular, 40 hour work week for all physicians probably isn't viable without massively slashing overall compensation or having physicians provide horribly substandard care. Full schedule control is impossible in many specialties. Some conflicts between physicians are necessary, even productive.

Yet, there are a lot of stresses physicians face that could be minimized or eliminated. 40 hour weeks may not be feasible, but that doesn't make 60, 70, or 80 hour weeks necessary. Coverage for 24/7 services requires people working when they'd probably rather not and while night shifts are never good for a person's health, many workplaces figure out how to employ people at all hours of the day without causing the system-wide levels of stress seen in medicine. Open conflict between physicians is actually quite uncommon I've found, yet a degree of animosity towards other physicians and healthcare workers seems to run deep and it's completely unnecessary.

The author of the article is American, and the US healthcare system does have its differences relative to Canada, but the contributors to stress are very similar. The major salient difference may work in our favour - while in the US, physicians are often hospital or clinic employees, subject to the whims of their employers, Canadian physicians typically function as independent contractors of sorts, with more collective leeway to make positive changes to reduce our own stress. While our American colleagues are largely confined to railing against the system controlled by non-doctors, Canadian physicians just need to convince each other that this is a problem worth addressing.

However, as the piece laid out, fellow physicians can be the greatest obstacle in taking care of ourselves. Calls for help frequently go unanswered and resentment absolutely exists for those who work less in an effort to recover from or prevent symptoms of burnout.

I think we're getting there, all barriers aside, and while change has been frustratingly slow, it's at least moving in the right direction. Yet, as anecdotes like this make clear, there's good reason to pick up the pace.