The profession of medicine is as delicate as it is noble. As physicians, we are in constant human interaction that has its roots in moral and ethical soil. Before we take the Hippocratic Oath, we make a personal promise to ourselves that is no less important. We vow to help others to the best of our abilities, planning to give our all each time, and we pledge to everyone we treat that they will get our support, knowledge, and effort to trust us with their lives. Medicine arose out of the primal sympathy of man to another man. The simple nature of this profession explains why burnout is so detrimental: It hits us at the very core of what makes our professional and personal lives meaningful.
Those not in the medical field do not understand that feeling, so it is not surprising that physicians suffer from higher burnout rates than any other profession in the United States. Indeed, even those working in medicine do not share all the same responsibilities or effects; a surgeon’s interaction is different from a cardiologist’s, an internist is different from a dermatologist, and so on. Consequently, the potential “mistakes” we make—the errors responsible for—carry different meanings, significance, and impacts. If we were to use a scale to quantify such an impact, would it not be appropriate to use one that measures aspects such as morbidity and mortality? After all, these are measuring sticks and guides for us.
Does it not follow that physicians who deal with high-acuity situations, more complex problems that require extensive interventions, and circumstances where the margin of error is minimal to nonexistent need to be held to the highest of these standards?
This is by no means an attempt to belittle some branches of medicine. We are a team, complementary and necessary, and each of us is important in our own right. The effects of stress on some specialties are direr than on others, not for degree of importance, but the demand concerning the burnout risk factors. It is no wonder, then, that burnout among physicians varies in intensity and prevalence across specialties.
Several Medscape surveys have shown that burnout is most prevalent among surgeons, emergency room physicians, acute care physicians, obstetricians, oncologists, and primary care physicians. These same surveys, along with numerous research studies, have also shown that severity is highest among these same specialties. It is important to note that the difference between the least burned-out specialty (dermatology, at a rate of 37 percent) and the most burned-out specialty (critical care, at 53 percent) is 16 percent.
It is also important to note that the highest rates range from 49 percent to 53 percent. Therefore, almost half of all physicians are burned out, no matter the specialty. Further magnifying this point is that high-burnout specialties such as acute care, surgery, and emergency medicine all have a minimum allowed margin of error.
Let’s look at this reality again. Profession A has a very narrow margin of error. Of the physicians practicing profession A, 50 percent are burned out. Burned-out physicians make more mistakes, so one in every two physicians will make errors beyond the narrow margin, which will lead to high morbidity and mortality rates. Considering that patients trust their lives and outcomes to such physicians, do we truly grasp the potential consequences?
Now let’s add another factor. Of those physicians who are burned out, the level of burnout is, on average, extremely high. On a scale of 1 to 5, with five being severely burned out, physicians rate their burnout at 4.2. Of course, the more severe the burnout, the more likely it that its consequences will be suffered personally and professionally. Knowing that, can we imagine the impact it will have on our patients?
Burnout has been likened to malignancy because it is progressive. Students, as well as residents and attendings, suffer from it. Further, burnout is an international problem with rates increasing across the globe, and it is more common in females, with over 60 percent of women physicians surveyed reporting burnout. Like malignancy, it tends to go unnoticed until its manifestations can no longer be ignored.
According to studies, burnout is on the rise. In 2019, 44 percent of physicians suffered from burnout. On a personal level, there is an increased number of suicides among physicians, with a rate of three hundred to four hundred suicides per year due to depression and burnout. 50 % of medical students are burned out and 10% have suicidal ideations, which have been linked directly to burnout. Once burnout is reduced, suicidal ideations tend to decrease also. Obesity, alcohol and drug abuse, and depression are also more common among burned-out physicians, and burned-out physicians suffer more problems at home with their families and friends, and in general, are much less happy and satisfied as human beings.
This has led to the realization that burnout is a global problem magnified by its effects on physicians as professionals. According to a 2019 Medscape report, physicians interviewed about burnout reported reduced productivity with a decline in their work quality. Further, burnout dulled clinical skills, which in turn produced less-thorough evaluation and intervention. This same report showed burned-out physicians to be less patient (48 percent), have decreased motivation or energy (39 percent), have worsening communication, and listening skills (37 percent), have withdrawal behaviors and avoidance of helping others (40 percent), develop poor attitudes (37 percent), and have decreased empathy (35 percent).
The effects of burnout include poorer relationships with patients and staff. Physicians become more irritable and angrier, have decreased tolerance and patience, care less about their patients, and have poor therapeutic alliance and connection with everyone around them. Other studies have demonstrated an increase in medical mistakes, higher morbidity and mortality rates, and decreased physician-patient satisfaction surveys.
In my journey to combat my struggles with burnout, I saw the wreckage the medical field has experienced. The solutions that have been offered to me were like Band-Aids—they did nothing to address the most significant contributors to the hostile environment of the healthcare system: lack of connection, lack of relationships, and lack of ethics.
I recognize that there are aspects of the path to becoming a physician that contributes to burnout. After all, it takes a vast amount of organization, delayed gratification, and general grit to get through the demands of undergraduate and medical school. The problem is that long hours and huge lists of tasks don’t complete residency. That’s just the beginning.
It isn’t medicine driving physicians out—it is the system we are forced to work within our profession.