I first experienced burnout during my third and fourth years in medical school.
I was trying to balance working 12-hour days through my clinical rotations, while simultaneously spending hours every night studying for board exams and working on residency applications.
I slept poorly. I ate poorly. I worked 80–90 hours each week. I started to develop feelings of resentment towards the healthcare profession because I knew our culture was not only unhealthy, but also unfair to patients and ourselves.
"I was stretched too thin."
— Kristen Fuller, MD
My burnout continued during (and beyond) residency. There was no endpoint in sight. It just became my new normal. Even though I was giving my best to my patients, I knew it wasn’t good enough. I wasn’t performing at my best due to chronic burnout. The COVID-19 pandemic was my breaking point.
But when it comes to burnout, I’m one of a multitude of doctors who’ve experienced this.
The history of physician burnout
Historically, medicine has been seen as an “old boys club,” meaning that you worked hard, kept your head down, and didn’t complain or speak up regardless of how you were feeling.
The prevailing attitude was that burnout is the physician’s problem, and those who cannot “hang” or adapt to new changes and environments were not cut out to be doctors.
This especially held true when electronic medical records were introduced, leaving many “old school” doctors pining for the low-tech past of paper medical charts.
The same goes for radical changes within our healthcare system regarding medical insurance and pharmaceutical companies. The unintended consequences of these changes, which were supposed to help physicians by making us more productive and efficient—and ultimately more satisfied—left us feeling isolated and disillusioned.
Physicians have experienced feelings of burnout for decades. But it wasn’t until the past 10 years or so that we’re talking about this issue on many different platforms, including social media.
Consequences of physician burnout
Physician burnout is an epidemic in the US. It has a drastic negative effect on all aspects of medical care, including career satisfaction.
It’s directly linked to the following undesirable consequences:
Decreased patient satisfaction and quality of care
Increased medical errors that result in increased risk for malpractice lawsuits
Higher physician and ancillary staff turnover
Physician alcohol and drug abuse
Increased rate of physician suicide and mental health conditions (depression and anxiety)
Coping with burnout
Solutions for burnout often target physicians and propose lifestyle changes for a healthy work-life balance. These include:
Daily self-care routines
Adopting a balanced diet and sleep schedule
Greater access to child care
Hobbies to enrich free time
Finding ways to increase efficiency and maximize productivity
These strategies are great in theory and may help alleviate some stress associated with burnout, but research has shown that they don’t have a meaningful impact on physician burnout.
A primary reason is that they don’t address the underlying problems associated with physician burnout: a profound misalignment between physicians’ values and the reconfigured healthcare system.
Competence, autonomy, and connectedness
The problem of physician burnout will not be solved without addressing the issues of competence, autonomy, and connectedness.
Physician autonomy refers to having the right to self-govern and the freedom to exercise professional judgment and care in the treatment of patients.
"We, as physicians, now endure a profound lack of control over our time and patient care."
— Kristen Fuller, MD
How much time we spend with a patient, what is discussed, our decision-making process, and how a patient encounter is documented are all frequently mandated by insurance companies and hospital administration and policy.
Physician competence was defined as having a broad background of medical knowledge and exercising clinical judgment appropriately with each patient. But under recent healthcare reforms, competence has been redefined as compliance with various metrics put forth by insurance companies and hospital administrations. Many of these metrics are not evidence-based.
Competence has also become a matter of clicking a certain number of boxes and placing a quick note in the electronic medical records for billing purposes to satisfy insurers’ demands.
Connectedness is the psychological feeling that one belongs and is connected to others through interpersonal attachments. As physicians, we want to give patients the time and support they need. Additionally, we want the healthcare system to value and recognize our tremendous efforts to provide this care.
The real cost of burnout
While it’s commonly believed that medicine is aimed toward “patient-centered care,” many physicians feel that the healthcare system is increasingly driven by money and metrics, with rewards for professionals who embrace these priorities.
"Without restoring our autonomy, having the ability to connect with our patients and practice medicine using evidenced-based competency, we most likely will continue to experience profound burnout."
— Kristen Fuller, MD
We can only hope that these situations improve over time, and the healthcare industry refocuses its priorities on patient care and physician well-being. Until that happens, we will continue to do our best, and stay focused on providing the best possible care to patients—and to ourselves.Read Next: Real Talk: When you’re thinking of quitting medicine
Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.