Physician Burnout: What It Is and Its Impact on Future Doctors

Physician burnout is a widely discussed topic among practicing physicians and public health researchers. Many studies have been done showing the implications of burnout on patient satisfaction, career satisfaction, and care outcomes. A few studies even try to measure the dollar cost of burnout to society. However, very few articles appear to address the impact of physician burnout on one very important demographic in medicine: future physicians. Future physicians, such as residents and medical students, are molded by the doctors who come before them. The prevalence of physician burnout is likely to affect the outlook future physicians have regarding their own careers and the possibility of them experiencing their own burnout as well.
Background
Physician burnout in the United States is becoming more common. According to one recent study, roughly 45% of physicians reported feeling signs of burnout, an increase from 39% in a study conducted in 2013. Put another way, nearly 1 out of every 2 physicians has experienced burnout or will in the future.
According to an article by Dr. Dike Drummond, there are three “cardinal symptoms” of physician burnout: exhaustion, depersonalization, and lack of efficacy.
1) Exhaustion refers to both physical and mental exhaustion, but often the mental exhaustion carries greater weight. Physicians will feel that they are deplete in both physical and mental energy.
2) Depersonalization is the act of separating one’s mind and body from reality or its consequences. Often, physicians will communicate with sarcasm or cynicism about patients or about the job.
3) Lack of efficacy refers to feelings of ineffectiveness in their role as a healthcare provider. Often times, physicians will feel that the work they do does not make a difference in the patient’s life or in the world. Their work gradually loses meaning over time.
Reasons for Losing Your Passion
According to AAFP, there are five sources contributing to the burnout of physicians.
1) The Practice of Clinical Medicine. Medicine is a high-stress environment affording care providers little control. This aspect of medicine takes a large physical energy toll on the physician.
2) Specialty or Job Specific Issues. Each field carries its own unique challenges, whether it’s the long hours for surgeons or administrative problems regarding insurance reimbursement for family medicine clinic.
3) Maintaining a Personal Life. Physicians work long hours and managing work-life balance becomes a challenge. In the professional setting where overnight call and 24 hour shifts are common, lack of a personal life can quickly drain a physician’s physical and emotional energy.
4) The Conditioning of Medical Education. Physicians pick up many maladaptive behaviors in medical school and post-graduate training. As residents, physicians are taught to practice medicine and seemingly to ignore everything else.
5) The Leadership of the Hospital or Workplace. The quality of the workplace is heavily dependent on the leadership skills of the supervisors and this is no different for physicians.
How It May Affect New Doctors
Students and residents are still developing themselves and their self-image as clinical leaders. In addition to serving as teachers, physicians also serve as role-models for future physicians, presenting to them a template to emulate. The self-image of future physicians could be impacted negatively by physicians who are burned out. In addition, students who work with burned out physicians are more likely to burn out themselves. This, in turn, can lead to future doctors who experience problems in their practice.
A study was conducted to determine the effects of burnout on student misconduct and perspective regarding their career as physicians. It was reported that students who experienced burnout are more likely to conduct themselves inappropriately. The study found that students were more likely to participate in misconduct regarding clinical responsibilities and patient care compared to academic misconduct, such as cheating. Students who have experienced burnout are more likely to hold less altruistic views of their roles as physicians in society. In addition, this less altruistic view is associated with professional distress and lower quality of life. The study further argues that this “professional distress” leads to more problems of misconduct than personal distress
Conclusion
Physician burnout is very common and is increasing in prevalence. The causes and consequences of physician burnout are well covered. However, the consequences pertaining to the teaching of future physicians are less well covered. Two strong studies have demonstrated the possible consequences of the future physician workforce should physician burnout not be addreessed. Medical students model themselves after their attending or senior physicians. Studies have shown that students are more likely to burn out and to have a negative view of their role as physicians in society if their preceptors are burned out. This may possibly lead to higher levels of burnout in the future physician workforce. Currently, the consequences for physician burnout can be very severe, even involving physicians and medical students committing suicide due to depression from being burned out. Solutions to address the issue of physician burnout are very needed.
Encouraging Reminder for Medical Students
Reading through this article, you may be dreading your medical career experience. The purpose of this article is to inform you of a topic that isn’t readily discussed during medical school and among medical students. It is meant to start a conversation on a topic that you may otherwise skip or may not hear about until you finish your training. However, as medical students, you can have an impact on your clerkship experience and may even help alleviate burnout for some of the practicing medical professionals who mentor you. “Having a motivated and resourceful medical student really freshened up my mood,” an obstetrics and gynecology attending mentioned. “It’s exciting to learn new updates in medicine through my medical students. They’re more up to date on some things than I am.”
Many preceptors also welcomed the opportunity to impart their knowledge and experience on future physicians and really appreciate students who are open to learning new things. One of the biggest reason cited for burning out is not feeling as though one makes a difference in the world. Mentoring a medical student changes that for some attendings. “It feels great to know that your mentorship makes a difference in someone’s life and career. To also have them go out and make a positive impact on the lives of patients, it makes you feel like your efforts to make a difference just grew exponentially,” stated a family practice physician from Las Vegas.
For other physicians, some enjoy the added company in addition to the teaching. For solo private practice physicians, having a medical student is an opportunity to regularly speak in-depth about issues in healthcare and medicine. “Often times, you have so many thoughts and ideas and no one to bounce them off of. Being able to get good feedback from my discussion with the students keeps me sharp,” stated in an internist. “Especially in internal medicine, topics for discussion can be extremely broad and enjoyable with a motivated student.”
As medical student, you can really make a difference in the lives of many people, whether they are patients or other healthcare professionals. Take the time to discover the opportunities to make a positive impact while on clerkship and you’ll be rewarded not only with great evaluations, but with stamina for a long, prosperous, and burnout-free career. One of the strongest protective factors against a burnout is having good experiences and memories early in your clinical training. Fortunately, a good deal of wonderful experiences are within your control as medical students.
About the Author
Aaron Hamlin is the pen-name of a Family Medicine resident physician in California. He received his training from University of California, Irvine and graduated medical school in 2016. In his spare time, he enjoys writing and spending time with his fiancé. He is interested in improving healthcare for under-served populations.
References
Drummond, Dike. “Physician Burnout: It’s Origin, Symptoms, and Five Main Causes.”
Family Practice Management. 2015 September. (5): 42-47
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Tait. “Relationship Between Burnout and Professional Conduct and Attitudes Among US
Medical Students. JAMA. 2010; 304(11): 1173 – 1180.
Goldman, Matthew; Shah, Ravi; Bernstein Carol. “Depressiona nd Suicide Among Physician
Trainees: Recommendations for a National Response.” JAMA Psychiatry. 2015.
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Montgomery, Anthony. “The inevitability of Physician Burnout: Implications for Interventions.”
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