Hey everyone, it’s Medicine Mondays. Today I was going to do a short post one “Types of Physician Burnout“.

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Types of Burnout?

Yea.

I think we’ve all heard about “Physician Burnout”. However, it seems to always be lumped into this one “catch-all” category. Now that I’ve given it some thought, and talked with some of my colleagues/friends that are “burned out”, I think there are probably distinct entities within this “burnout” category.

First things first. I don’t think I’ve experienced burnout myself, although I could be wrong. However I imagined that it felt like this:

"The light inside has broken but I still work." – Vending machine from 2014 explains how physician #burnout feels. pic.twitter.com/hXO3oCowb6

— Senior Resident, MD (@ResidentSensei) October 6, 2016

This particular picture of the vending machine seemed to resonate with people. However, thinking back on it, I don’t think this is how it feels for everyone experiencing burnout. Since I never technically felt it myself, I was giving my “best guess” as to what it felt like.

Now, that I’ve talked to more people and experienced more, I am more inclined to believe that I’m wrong, in the general sense. I think there are many different types of “burnout”, and probably within each of those types, different stages. Long story short, I think “physician burnout” is much more complicated than we think.

I’ve been wanting to right about physician burnout for a long time now. However, after a lot of research into it, I wasn’t able to figure out what I wanted to write until now. So here we go:

What types?

Well, let me try to give some very general examples:

Mental

There is probably a lot of “mental” components such as difficulty with the “system”. I think the prototypical setting for this would be the mountain of “paperwork” and endless “checkboxes” that physicians have to deal with. You need to document X, Y, and Z, but if you didn’t document X+Y then it won’t let you sign your document.

Then there is the “always on” mental burden of thinking about work when not at work. Even on vacation, there is the concern that you must have everything done before the vacation, and the dread that when you come back from a week off that you will be getting “crushed” on that first day back. That’s not a great way to spend a vacation.

I am sure there are many, many more. These are just a few I came up with off the top of my head.

Emotional

There is very much of sense of “not being human” when you’re a doctor.  You are expected to do more and take more just because you’re a doctor. The “suffering in silence” is basically the norm for most doctors. This is unfortunate. Depression is a real problem. Physician Suicide is a real problem. There are connections here that we don’t understand.

Delving into this further, the sense of respect that doctors used to receive has been heavily diminished. Now doctors get penalized by patient surveys who complain of longer wait times or not getting the medication they want. Imagine that you are a doctor that takes pride in giving good care of his/her patients. In general, 75-80% of your patients are good and try to listen to what you say. However, there is a 20% or so of them that leaves scathing remarks about the waiting room being too full, chronically arrives to their appointments late, or walks in expecting to be seen right away.

Then the higher ups show you your “low survey scores”. They point to Dr. Smith who has the same scores as you, but sees 10 more patients than you a month. These kind of scenarios continue and you feel less and less like a doctor and more and more like a cog in a wheel. This demonstrates to you that you are “replaceable”. You aren’t a part of a team necessarily, but just another person on the assembly line that is the current health care system. In fact… there is no team.

Physical

Doctors work long hours, and we probably don’t eat as well or exercise as much as we should. Also, for those of us who work the night shift, those kinds of hours are not good for you, and are probably not sustainable. There are exceptions to this rule of course, but I think it would require ample amounts of rest and “normal” hours, such as working a week of nights once a month. I personally do not think that the 7on7off overnight shift is sustainable. Also, whoever coined the term “7on7off” is probably right up there with “Diamonds are forever” when it comes to marketing. The real term for 7on7off is “2 weeks with 2 weekends.”

However, for some reason, this is all “ok”. Be tough. You can work those 80 hour weeks. Oh you’re not a resident anymore? You’re a fellow or an attending now? You can do 100 hours or 120 hours a week once in awhile right?

External Factors

There are other things outside of medicine that can lead to physician burnout. For example, relationship/marriage difficulties, financial problems, etc. Physician Burnout is just burnout that happens to physicians… but did we forget that physicians are PEOPLE? People still have other life problem to deal with outside of medicine. I think that any “burnout” will have an external catalyst. You have all these factors going on in medicine and then this external catalyst happens — and you reach your breaking point.

Breaking Point?

Everyone has a breaking point – but everyone’s is different. However, in my humble opinion, I think “burnout” is a combination of all the factors above, and many other factors I haven’t listed or haven’t considered. I think the evaluation of Physician Burnout needs to expand its scope to delve into each of these factors. The cause of burnout for me would probably not be the same as it is for my wife.

Additionally, these factors can change with time.  For example, when you were a young gun out of fellowship you could work those night shifts with no problem. However, now you’re 10 years in — and you’re still working the night shift because your job won’t let you change, or you need that extra money, or whatever the reason. Your breaking point at 35 isn’t the same as 40.

The opposite can also be true. At 35, fresh out of fellowship, maybe you had some financial difficulties, like a house foreclosure or something which killed your credit, that really made life difficult. However, by 45 you’ve paid down most (or all) of your loans, your credit score is 820, and you’re not worried financially anymore.

Long story short, I truly believe that every doctor has a story.

If the brain was so simple that we could understand it, we would be so simple that we couldn’t. – Emerson Pugh

Physician Burnout is not just one box, it’s many boxes, and much more complex than I think anyone could imagine.. If it was so easy that we could do one “burnout” seminar and feel better, than it probably wouldn’t exist anymore right? The idea of “solving it” like it’s a math problem probably isn’t the correct way to go about it. The issues are probably much more deep-seeded that we think, and will require a multifactorial approach over a long arc of time.

Like I’ve said before, this may even be the normal evolution of medical student to retiring attending. It’s just a matter of when.

TL;DR

Physician Burnout is much more complex than I think anyone could imagine.