Career and Life Planning Guidebook for Medical Residents

SECTION I: T MINUS THREE YEARS as an “erosion of the soul”. 32 Burnout results from the mismatch between who people are and the work they are asked to do. It is an assault on the spirit, values, dignity andwill which attack the very essence of a physician’s identity. Talbot and Dean called this “moral injury”. 33 Physicians commit suicide more frequently than the general population—400 deaths per year—despite similar rates of depression and other associated mental illnesses. Rates of burnout are higher among female physicians, as are rates of suicide. For male physicians, the rate ratio for suicide is 1:4 versus the general population, and for female doctors it is 2:3. The physician suicide rate was 28-40/100,000 in the general population. The overall rate was 12.3/100,000. 12 These are sobering statistics. Theyhighlight thatwhile there may be questions regarding the prevalence of burnout, and how the dimensions through which physicians experience it are associated with professional dysfunction, physician wellbeing is being adversely affected. There are many avenues to explore: The association of burnout with major depressive disorder as well as other psychiatric disorders, standardization of the definition of burnout, standardization of the measurement tools, evidence- based interventions etc. Practically, then, how does one cognitively set out to find meaning? Dr. Frankl treated some of his depressed and suicidal patients by having them volunteer. The interjection of this meaning and purpose in their lives from this type of service was restorative. If volunteering helped interject meaning and purpose back into the lives of Dr. Frankl’s depressed patients, it would seem to follow that physicians would be resistant to a loss of meaning in work and desensitized to the consequences of meaninglessness. Practicing medicine, as previously stated, is so steeped in deep fundamental meaning, it is problematic to figure out how one would set out to lose a sense of meaningwhile laboring as a doctor. As noted above, a result of their groundbreaking research, Maslach and Leiter argue that burnout is not primarily a problem related to individuals. They contend it is a problem with the social environment and the relationship of people to their work. When the human side of work is not recognized and or does not match the one who is tasked with doing the work, then there is a concomitant increase in the risk of burnout which comes with potentially staggering consequences. The prevalence of burnout in physicians speaks much more about the current state of health care and the conditions under which doctors practice than it does about the physicians themselves. The data is relatively consistent in viewing burnout as an organizational issue that needs to be addressed on that level. 34 As you’ll note below, being able to identify those organizations that recognize burnout and have strategies to prevent is a crucial skill for physicians to develop. There is no singlemagic bullet. Instead, organizations should reinforce individual clinicians’ ability to find meaning in their work, reduce clinicians’ work that is external to patient care, and define an organizational culture with values that make clinicians proud. 23 CAREER AND LIFE PLANNING GUIDEBOOK FOR MEDICAL RESIDENTS 40