Back in the 1990s, while working as a writer and reporter for the Colorado Academy of Family Physicians, I wrote an article called “Beware of Physician Burnout.”
In this article, I warned doctors about trying to be super heroes and provided suggestions on how they could prevent this so-called “burnout.”
Since that time, there has been considerable buzz in the media about “physician burnout.” In December 2015, a study done by the Mayo Clinic found that more than half of US physicians were “burned out.”1
And in January 2016, Medscape published a report warning that burnout among US physicians had reached a critical level.2
Among the factors contributing to burnout listed in the report were:
• Too many bureaucratic tasks
• Spending too many hours at work
• Increasing computerization of practice
• Feeling like a cog in a wheel
• Too many difficult patients
• Too many patient appointments in a day
• Insurance issues
“It’s clear that physicians are increasingly dissatisfied with their work, resentful of the time required to transcribe and translate information for the computer and the fact that—in that sense—the work never stops,” states a perspective piece in The New England Journal of Medicine (NEJM). “Burnout is widespread in the workforce and more than a quarter of residents have depression or depressive symptoms.”3
But is burnout merely a euphemism for something more insidious and pernicious—something more disturbing that affects every part of our medical system, starting with medical school and residency training? Is it a new epidemic among us?
A quick check of the most current version of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), the diagnostic bible for psychiatrists, reveals no discrete disorder called “burnout.” The term that comes closest is “impairment.”
And, in fact, it is well recognized that physicians as a group are more inclined to become “impaired” than the general population.
“The culture of medical care and behaviors modeled in physician training have been faulted for promoting attributes that can interfere with physician wellness or obtaining clinical care,” states an article in UpToDate. The article describes a particular type of physician impairment—that resulting from substance abuse.
“The ability to perform under stress and despite personal difficulties is a hallmark of the profession. Physicians are taught to place their own needs secondary to others’,”4 the same article goes on to say.
While it’s certainly true that constantly stressed-out physicians who are pushing the boundaries of their own strength and emotional reserves may turn to drugs and alcohol to mask their discomfort and keep on going—that is not the same thing as burnout.
Truthfully, what is called burnout should more accurately be recognized for what it really is—abuse. It is also a way to conveniently label the victims and draw attention away from the victimizers.