Every industry has been grappling with the issue of burnout. As described by the Maslach Burnout Inventory, burnout is characterized by emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment. Physicians seem to be particularly vulnerable to its debilitating effects, even compared to professions with a similarly long training pathway1. CMA’s 2021 National Physician Health Survey showed that 53% of MDs reported feeling burned out, up from 31% four years earlier2. The recent pandemic magnified problems for most; 60% feel that their mental health is worse than pre-pandemic2. In this post, we will explore the reasons why physicians are more prone to burnout relative to other professions and shed light on the challenges they face.
Demanding work environment and long hours
The responsibility of caring for multiple patients, making diagnoses, and managing complex cases under time constraints can be emotionally and intellectually draining. Combining this with long hours (including on-call and overnight shifts that disrupt sleep patterns) can leave physicians physically exhausted and prone to chronic fatigue.
Emotional toll and high-stakes decision making
MDs regularly deal with life altering situations and are relied upon to make rapid high-stakes decisions. The emotional toll of witnessing suffering, delivering bad news, or losing patients can be overwhelming. The need to balance empathy with objectivity adds an extra layer of emotional strain.
Lack of autonomy and control
Physicians, particularly those working in a large academic hospital system, often face limited autonomy and control over their workflow and work environment. The pressures to navigate bureaucratic hurdles instead of focusing on patient care can lead to frustration and disillusionment. Fifty-nine percent of Canadian physicians say that they are dissatisfied with efficiency and resources at work3.
Administrative burden and EMRs
In recent years, MDs have experienced an increase in administrative tasks, such as documentation and billing. The introduction of electronic medical records (EMRs) was intended to streamline processes but has, in reality, led to additional work. There is also the unwritten expectation to volunteer for unpaid or undervalued work such as teaching, research, and committee work.
Work-Life imbalance
The demanding nature of medical practice often leads to a significant work-life imbalance. Long working hours, irregular schedules, and on-call responsibilities can strain personal relationships, disrupt family life, and impede self-care activities. This can result in decreased overall life satisfaction.
Perfectionism and high expectations
Physicians tend to be driven by a strong desire to provide the best care possible for patients; similarly, society places high expectations on MDs as gatekeepers for health. Patients are living longer with more complicated diseases and tend to be more demanding than in the past. Perfectionism can lead to self-imposed pressure and fear of making mistakes. The fear of disciplinary or legal action adds to stress, leading to heightened anxiety levels.
Lack of emotional support, self-care and stigmatization
Physicians tend to prioritize the well-being of their patients over their own. They often leave little time for self-care activities such as exercise, hobbies, and spending time with loved ones. Like other public service professions, MDs exist in a culture that discourages seeking help for mental health issues, leaving them to suffer in silence. A worrisome trend is emerging: 48% of Canadian MDs screened positive for depression on the Patient Health Quesionnaire-2 (PHQ-2), and 14% reported suicidal thoughts in the previous 12 months3.
Physician burnout is a multifaceted issue with significant consequences for both healthcare professionals and patients. Recognizing the challenges and implementing effective interventions such as fostering a supportive work culture, promoting work-life balance, and providing accessible mental health resources are crucial steps in mitigating burnout. Prioritizing mental health of MDs can ensure that they can continue to deliver high quality patient care while leading fulfilling and balanced lives.
Author: Dr. Krishna Sharma, Chief Medical Officer, Specialty Medical Partners
References:
Burnout among physicians compared with individuals with a professional or doctoral degree in a field outside of medicine. Mayo Clinic Proceedings Vol 94(3), March 2019, pg 549-551.
2021 National Physician Health Survey conducted by Canadian Medical Association
“From data to action: understanding the drivers of physician wellness. Regression analyses – 2021 National Physician Health Survey results.” Canadian Medical Association November 2022.
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