Physician Health

Revealing the ripples of burnout

In the summer of 2012, the U.S. medical community still hadn’t experienced its collective “aha!” moment in understanding the prevalence of physician burnout.

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“People would ask me, ‘Why are you studying this? Do doctors really have it worse than anyone else?" says Lotte N. Dyrbye, MD, MHPE, professor of medicine and medical education at the Mayo Clinic Alix School of Medicine and one of the relatively few researchers looking into the phenomenon at the time. “There wasn't a good sense nationally of whether this was a problem for the profession or just a niche issue affecting a handful of less-well-adapted physicians or learners.”

That moment would come in August with the publication, in JAMA Internal Medicine, of a study by Dr. Dyrbye and others at Mayo Clinic comparing burnout among U.S. physicians with the general population. There was already lots of data on physician burnout, but this was the first national study. It concluded that burnout was, in fact, more common among physicians than among other workers and that doctors working in specialties at the front line of access seemed to be at greatest risk. It found burnout symptoms in more than 45% of the physicians surveyed.

“After many years of feeling like we were running uphill, trying to understand whether this was a real issue, suddenly, seemingly overnight, we were getting very different questions, like, ‘How do we fix this?’” Dr. Dyrbye recalls.

Since then, most interventions aimed at curbing burnout have been directed at individuals. This has given rise to an array of time-management and self-care techniques, as well as corresponding data on their effectiveness. But while resilience is an important bulwark against burnout, it is sometimes overemphasized in organizational efforts, leaving physicians and medical students with the feeling that no one is looking out for them.

“The message they’re getting seems to be, ‘You just need to be stronger to deal with your working environment. You’re not committing yourself to those individual strategies sufficiently,’” says Colin P. West, MD, PhD, professor of medicine, medical education and biostatistics at Mayo Clinic Alix School of Medicine and co-author of the 2012 study.

The medical community has needed a second revelation, Dr. West says: that individual-directed measures are simply a first step. The real solution to burnout is changing the working and learning environments at academic and community medical centers.

The good news, for starters, is that every major accrediting and licensing organization in the United States has now meaningfully endorsed the need for culture change.

Read this story in its entirety as featured in the latest issue of AMA Moving Medicine.