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At the recent National Resident Matching Program’s Match Day, more than 30,000 four-year medical students across the United States found out where they had “matched” for their residency training. As they took this next step in the long path to completing their medical training, some said it might have been the happiest day of their lives.
Unfortunately, for many, the excitement of being a physician does not last. Stress and burnout are increasing among physicians, residents and medical students and occur more often for those in the field of medicine compared to other U.S. workers. Recent statistics indicate that half of physicians report at least one symptom of burnout.
As professors in the medical school at Northwestern University, we each see how burnout and stress affect physicians and trainees at every career stage.
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Laypeople who get their medical knowledge from television’s Grey’s Anatomy might think it takes years of facing extreme life stressors such as bomb threats and arsonists to make a doctor think the job is taking too much of a toll. But in reality, the accumulation of job-related stressors and other life events is the more typical path to burnout.
For example, Jamie (not his real name) is an internal medicine attending physician three years out of fellowship and is considered a rising star in his medicine subspecialty of cardiology. A team leader on a critical-care service that is short-staffed, he has had no weekends off for two months.
His father lives in a different state and has been diagnosed with prostate cancer, but Jamie has no time to visit him. One of Jamie’s patients suddenly and unexpectedly died during a fairly routine procedure. Jamie has no “debriefing” or outreach of support following this event and says he feels devastated, cannot sleep or eat.
These symptoms of burnout, defined as emotional exhaustion, depersonalization and persistent perceptions of a lack of accomplishment, can manifest in even the most resilient and hardy individuals.
In medicine, the consequences of burnout can be dire for the clinician. They include increased rates of alcoholism, decreased empathy, strained personal relationships and a higher risk of suicide.
For their patients, physician burnout is also associated with reduced quality of care, higher rates of medical errors and lower patient satisfaction with care. Physicians with burnout are more likely to retire earlier or leave medicine altogether.
Programs in medical schools across the country offer an array of activities for students and residents to reduce their levels of perceived stress and lower risk of burnout. Interventions that provide individuals with ways to address the day-to-day stress in their work lives have shown some effectiveness.
For example, programs that teach mindfulness reduce stress and anxiety and improve self-efficacy and empathy.
Our team teaches stress reduction to groups at high risk of stress and burnout, including physicians and medical students. We focus on skills to increase positive emotion, including noticing positive events, gratitude, mindful awareness and self-compassion.
Much of the feedback we receive from the students is positive: “The program puts a lot of my problems into perspective. I’m more able to be aware of when I’m over-focusing on small problems and look at my life in a more positive manner,” one female third-year medical student commented.
However, physicians, residents and students often complain that individually focused skills programs fall short of addressing the serious problems of burnout. In fact, recent evidence suggests that making such individually focused programs a required part of the curriculum for medical students is ineffective.
Other feedback from medical students suggests that the problem may be that individually focused programs are viewed as a quick fix that doesn’t address the root causes of burnout. As one male medical student in our program recently said, “It feels like the administration is just trying to put a Band-Aid on the problem.”
Some were especially offended that taking this route did not address the actual underlying problems at a systems level.
“Why not change the system to make it less stressful and reduce burnout? I resent that the onus is on students to cope instead of the system to adapt,” one female third-year student wrote.
Indeed, robust research has shown that key drivers of burnout in medicine are structural-level factors such as work compression of too many tasks in too little time; too much time spent on documentation for electronic health records rather than patient care; decreased autonomy as medicine has become a corporate enterprise; a decreased sense of community; problems in work/life integration; and isolation.
These challenges — combined with the physician’s reluctance to complain for fear of failure at self-sacrifice and altruism — have resulted in a potentially toxic stew.
Programs that aim to improve the medical work culture and reduce the burdens of the job have some modest effect on burnout. For instance, a Stanford University program has been testing a structural intervention, where in exchange for activities such as taking an extra clinical shift, mentoring students, or serving on a committee, emergency department physicians are given vouchers for meal delivery or dry cleaning pickup, easing the burden of tasks outside the job, which in turn helps to reduce stress associated with the job.
Structural changes can be slow, and few institutions have the resources or the political will to make major changes within the constraints of the current health care system. All this needs to change before we will see broad and sustained improvement.
Institutional changes will have the most powerful impact on physician stress, burnout and resilience. Thoughtful reconfiguring of the longstanding implicit values of medicine and medical education is in order. This will likely be a years-long process requiring interventions at multiple levels.
Structural changes need to occur in medicine in order to ensure the future health of the physician workforce. But at the same time, we must give medical students and physicians individual-level tools that empower them to focus on themselves.
This may leave them better equipped psychologically to remain as enthusiastic about the job now and going forward as they were on Match Day.
Judith Moskowitz, Ph.D., MPH, is a professor of medical social sciences and director of research at the Osher Center for Integrative Medicine at Northwestern University, and she is also a public voices fellow through The OpEd Project.
Joan Anzia, MD, is a professor of psychiatry, longtime residency director, and physician health liaison for Northwestern Memorial Hospital.
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