Signs of a toxic workplace include overbearing/unreceptive leadership, long hours, huge workloads, lack of growth, and excessive mundane tasks.
Physicians stay in these environments for many reasons, such as learned helplessness or a culture of silence.
Strategies to make employment more tolerable could include working with administrators to find solutions, taking time off, and asking for more pay or less work.
Physicians spend years in graduate school and post-graduate training. Their resilience built up over long years of study, however, doesn’t insulate them from workplace toxicity, which can make working in medicine intolerable and contribute to clinician burnout, according to a KevinMD article.
Recognizing the signs of this kind of workplace is the first step toward developing strategies to make it more bearable and sustain long-term employment.
Defining a toxic healthcare environment
Experts have offered their take on what characterizes a toxic healthcare environment. Observations from the KevinMD research, as well as from articles published by Cleveland Clinic and Reflections of a Millennial Doctor, yield a list of possible red flags:
Too much bureaucracy and not enough flexibility
Too many mundane/rote tasks (for example, excessive data input into EHR)
High patient counts (for example, seeing 20+ clinic patients in one morning)
Feeling fatigue, sleeplessness, headaches, or joint pains induced by the workplace
Abundant microaggressions in the workplace
Lack of motivation, opportunity for growth, appreciation of work
Work-life imbalance compromises quality of life
Malignant colleagues, executives, or administrators
Management doesn’t address issues and simply replaces disgruntled employees
Psychiatrist Robert Emmons, MD, writing in the Journal of American Physicians and Surgeons, cited other characteristics, such as:
Surveillance that benefits the organization and not patients
Punishment by administration for refusing to go with the flow
Excessive certification and testing
Scapegoating clinicians for the organization’s problems
Pay that is lower than expected or below fair market value
Why docs tolerate these environments
Reasons why physicians choose to remain employed in such environments can be idiosyncratic, but some common themes seem to crop up, according to KevinMD.
The first is learned helplessness, which refers to the phenomenon in which a person grows accustomed to and accepts the abuse of their environment without trying to escape.
Physicians are used to putting their heads down and not complaining, a behavior learned during medical school and residency. This tendency could play a role in their persistence in a sour work. If a physician does complain and refuses to follow procedure, this could be perceived as a betrayal by administrators.
What you can do
There are steps a physician can take to help resolve workplace issues and avoid burnout, as suggested by the KevinMD article:
Setting limits and saying “no” (for example, refusing a last-minute sick visit from an unscheduled patient when the clinic is packed)
Taking a break from checking work email on days off
Negotiating extra pay for administrative tasks
Talking it out with a supportive network of peers
Taking advantage of an employee coaching program (if available)
Knowing if the situation isn’t improving and it’s time to make a change
Note that a reduced workload or increased pay may not always be the right answer for every physician. Sometimes getting leadership on board in listening and responding to physician concerns may do the trick. Compromising with administration can go a long way toward making a workplace more tolerable.
What this means for you
Toxic workplaces are a far too common reality in medicine. It’s important to identify these situations based on the signs and take steps to alleviate the stress. Sometimes that may mean looking for new employment. There are, however, strategies that can be employed to possibly improve your work situation before you consider quitting and working elsewhere.