Physician Health

Burnout’s other dimension: Eroded sense of medicine as a calling

Timothy M. Smith , Contributing News Writer

Burnout’s effects on physicians are well documented, but new research puts a finer point on the issue. A core motivation for many physicians to practice medicine—a calling to help people—may be undermined by physician burnout.

The study, in Mayo Clinic Proceedings, looked at responses from more than 2,200 physicians to assess their identification with medicine as a calling, defined as committing one’s life to work that is personally meaningful and serves a social purpose. Physician respondents’ sense of calling was measured using six validated true-false items:

  • “I find my work rewarding”
  • “My work is one of the most important things in my life”
  • “My work makes the world a better place”
  • “I enjoy talking about my work to others”
  • “I would choose my current work life again if I had the opportunity”
  • “If I were financially secure, I would continue with my current line of work even if I were no longer paid”

Experiencing at least one symptom of burnout was associated with less identification with each of the six calling items—sometimes by more than 60 percentage points. For example, 93 percent of those who have no burnout symptoms said they would choose their work life again if given the opportunity, compared with only 32 percent of those who were completely burned out.

Respondents who were completely burned out had significantly lower odds than physicians with no burnout to say that work is one of the most important things in their lives, that their work makes the world a better place, or that they enjoy talking about their work.

“At a societal level, the public benefits from having a group of individuals who are motivated to do work that goes beyond satisfying personal self-interest,” wrote the authors, Andrew J. Jager, Audiey Kao, MD, PhD, and Michael A. Tutty, PhD. Jager and Dr. Kao work in the AMA’s Ethics Standards Group, of which the latter is vice president. Dr. Tutty is group vice president of Professional Satisfaction and Practice Sustainability at the AMA.

“In many ways, the trust that society has in the medical profession depends on confidence that physicians hold the interests of patients and the public as paramount,” the authors wrote.

Which points to a troubling possibility. “[P]hysicians who do not view medicine as a calling may assign relatively greater value to their work as a means to earn a living,” the authors wrote. “Therefore, one potential consequence of professional burnout is physicians who are less intrinsically and prosocially motivated because they see medicine less as a calling but more as a job—a way to simply earn a paycheck.”

Primary care physicians who see medicine more as a calling report greater satisfaction in, for example, treating patients who struggle with substance dependence and obesity, the authors noted. If physicians do not see the practice of medicine as personally meaningful and serving a greater good, the authors added, “[their] performance may suffer and, more importantly, so too may the quality of care that patients receive.”

The authors also cited research showing that financial incentives aiming to encourage better performance may have the unintended consequence of exacerbating the problem by undermining professionals’ sense of autonomy and competence.

“Payers, policymakers and practice leaders should take care to foster a workplace environment that promotes physician well-being and implement performance-based incentives that support a sense of calling and prosocial motivations,” the study said.

Given the study’s cross-sectional design, it cannot establish whether higher physician burnout causes a lower sense of calling or whether, conversely, a higher sense of calling offers “some degree of protection against burnout,” the authors wrote. They added that more research, such as longitudinal studies, is needed to better understand the directionality of the link between professional burnout and physicians’ sense of calling.

The AMA’s STEPS Forward™ collection of practice improvement strategies helps physicians make transformative changes to their practices. It offers modules on preventing physician burnout in practicepreventing resident and fellow burnout and improving physician resiliency.

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