How Can Our Profession Combat Physician Burnout?

The numbers are getting worse and alarmingly so. In 2012, 45.8 percent of physicians reported having at least one burnout symptom.¹ That number is higher than burnout rates for other professions with similar educational backgrounds and career demands. The figure rose in a 2014 follow-up study to a burnout rate of 54.4 percent with job satisfaction rates dropping from 48.5 percent in 2012 to 40.9 percent in 2014.^1,2

The problem is real and not a contrived “snowflake” issue. Today's physicians do not lack the toughness of previous generations.

Although there have been no studies in podiatric medicine, our allopathic and osteopathic colleagues have researched the topic extensively over the past decade.³ It is time the podiatric profession takes note and honestly examines the problem. Our patients' well-being and the profession’s future are at stake.

I am the poster child for podiatric physician burnout risk. Often colleagues will say to me they have no idea how I do everything I do professionally. I take the comments as compliments, validating my Midwestern work ethic. Maybe I should take those comments as warning signs.

The American Orthopedic Association takes a detailed look at this topic in orthopedic surgery.³ The op-ed in the Journal of Bone and Joint Surgery reviewed physician burnout, specifically burnout onset and course during one's career, and examined preventative and therapeutic strategies for physician burnout. It appears that burnout begins in medical school and only worsens during residency. Burnout affects physicians in all types of practice models.

The authors succinctly describe burnout and its consequences: "Burnout is characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a low sense of personal accomplishment. Studies suggest that burnout erodes professionalism, influences the quality of care, increases the risk of medical errors, and promotes early retirement. Burnout contributes to adverse consequences in relationships, alcohol use, and suicidal ideation; the personal consequences are noteworthy. The hallmarks of burnout are physical exhaustion, poor judgment, cynicism, guilt, feelings of ineffectiveness, and a sense of depersonalization."³

The concept of physician well-being is emerging as a critical concept in the war against physician burnout. Well-being "goes beyond merely the absence of distress and includes being challenged, thriving, and achieving success in various aspects of personal and professional life."⁴ Education and support are foundational to establish physician well-being. Intervention must be built on a base of training and support.

The complex web of dealing with "impaired colleagues" is a tricky subject. Impaired does not necessarily mean substance or alcohol abuse. It can also describe depression and suicidal ideation.³ We say we are equipped to deal with impaired colleagues but reality argues otherwise. We fear the consequences of intervention and worse, are either too apathetic or busy to notice, let alone intervene.

I live in a lovely neighborhood in suburban Indianapolis. Our neighborhood does not have very many homes. Consequently, the number of actual neighbors is relatively low. I recently learned of a neighbor who committed suicide on Christmas Eve. He was a physician. I knew him but not well. His children and my children went to school together. In discussing the tragedy with other neighbors and professional colleagues, I repeatedly heard he was "under a lot of stress."

The tale is heart-wrenching. Avoidable? Who knows but I think having a professional network to unpack the things weighing on him could have only helped.

The podiatric profession is a gloriously diverse group. While we all do not agree on all matters all the time, like it or not, we are a family. To quote former President Barack Obama, "It is that fundamental belief … I am my brother's keeper, I am my sister's keeper, that makes this country work. It's what allows us to pursue our individual dreams and yet still come together as one American family. E Pluribus Unum. Out of many, one."⁵

References

1. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012; 172(18):1377-1385.
2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clinic Proc. 2015; 90(12):1600–13.
3. Ames SE, et al. Burnout in orthopaedic surgeons: a challenge for leaders, learners, and colleagues: AOA critical issues. J Bone Joint Surg. 2017; 99(14):e78.
4. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009; 374(9702):1714-1721.
5. Barack Obama’s remarks to the Democratic National Convention. New York Times. Available at https://www.nytimes.com/2004/07/27/politics/campaign/barack-obamas-remarks-to-the-democratic-national.html . Published July 27, 2004.