Another physician recently asked the large Physician Mom Group for their take on the causes of burnout in women. The usual list of things filled the comments:
- EHR
- Too many patients, too little time
- Too many meetings
- Others expecting 100% all the time at work and at home
- Managing home and work life
- Being the breadwinner
- Not getting enough time with family
- Having to work at home (finish charting)
- Paperwork: FMLA, prior authorizations, etc.
- No reward for working over time
- Lack of understanding from administration
- Gender pay gap
- Implicit bias towards women (assertive vs bitch, bad day vs emotional/crazy, etc) from all directions-patients, nurses, admin, etc
- Taking call
- Being expected to be available 100% of the time thanks to modern technology
- Not enough maternity leave
- No childcare options at work
- Feeling bad for taking a sick day or being unable to do so
- No support for working part time
- Inadequate/incompetent support staff
- Entitled patients/patients dictating their care
- Turning the healthcare industry into a service industry where patients are customers
- Increasingly complicated insurance hoops to jump through
- Decreasing reimbursement for more work
- Being called providers and people not understanding the difference between and NP/PA and an MD/DO
- Too much necessity to oversee midlevels
- Being called nurse and patients asking when they will see the doctor
- Lack of control over your schedule
- Ungrateful families and patients
- Providing care that really just delays death
- Difficult conversations
- Lack of mentorship
- Lack of women in leadership
- Not having flexibility with your day to go to school events, etc
- Not enough time for self care
- Fear of malpractice lawsuits
- Fear of repercussions/reprimands
- Taking all the responsibility without any autonomy/authority
However, a couple people mentioned that “physician burnout” is basically a terrible label for a terrible problem. It puts the blame on the victims themselves. A rose by any other name would smell so sweet. Perhaps, we have failed ourselves with allowing this label to be the overarching theme for physician wellness programs. The name itself does not identify the perpetrators. And let me tell you, the physicians suffering from burnout are NOT the ones causing it. They are the ones hiding in the corner dreading the next time that someone tells them to take care of themselves. They are the ones that don’t really want to talk about it at all. It’s almost MORE traumatizing to do so. They are the ones silently searching for answers and how to repair their broken selves. They are likely not asking much from anyone else because they are doing it all. They feel isolated and alone. They are ashamed to speak up for fear of seeming weak, whiny, or otherwise withered. Some people don’t even believe that burnout exists and push these concerns aside. Some people say it’s all the specific physicians fault for not saying “no” soon enough, or for not saying “no” at all.
But wait, what am I describing? Sounds like an awful case of emotional, verbal, even physical abuse. It certainly harkens the very concerns that victims of sexual assault express. Let me be clear, I am not saying that physician burnout is sexual assault nor am I saying that it is as horrifying. However, the victim blaming and the overall culture that contributes to the problem has got to come to an end. In these ways, it is frighteningly similar to sexual assault.
Sure, we would encourage a victim of abuse to seek counseling, try to find joy in other avenues, and lean on your supporters–just as we encourage our burned out physicians. We would encourage them to visualize happiness and strength. But we wouldn’t expect that to stop the original assault or reverse it. The perpetrator is still out there. Even when that justice is served, the trauma still remains. With the #metoo movement, we are finally exposing the monsters, the culture that contributed to the multitude of crimes, and we are finally starting to listen to the victims. Is “physician burnout” a #metoo situation? Have we been verbally abused? Emotionally abused? Physically abused? Has our knowledge, willingness to accommodate, and desire to care for another human being been taken advantage of? Have we essentially been brainwashed to believe we made this happen to ourselves? Or does the “boys’ club” of yesteryear still hold its reign over the medical culture–where locker room talk shouldn’t be appropriate but occurs anyway, where women are made to believe they don’t and can’t contribute the same way as men and therefore don’t deserve to be paid equally or even respected equally?
What is it about the culture of medicine that has allowed all of this to happen? We have sat on our hands, with our mouths shut, for too long. Now it’s an epidemic. But those at the top don’t want to take responsibility. Those that created the hierarchy of providers and laid the foundations for our medical education (including long hours, pimping, shame, competition) have washed their hands of any wrongdoings. Since they are mostly retiring and walking away, perhaps they don’t even realize that the culture they shaped has this effect on the new generation. They often chide that we are simply “millenials” that are lazy and entitled. You often hear comments that newer doctors just don’t want to work as hard. When, in all reality, the generational difference comes down to respect. This generation is taking to the streets (and social media) to demand change, to demand respect (no matter your race, your gender identification, your religion, your occupation, your wealth). This generation of physicians values family and personal well being and we prioritize them differently. This generation of physicians values human beings. And guess what?! Physicians are HUMAN too. (Nurses, administrators, insurance companies, families, and patients please read that last sentence over and over again until you say it in your sleep.) We value human life and even more so the quality of that life. Therefore, we shouldn’t be putting it back on the newer physicians to fix themselves while being held down by the constraints of a system they didn’t create. The entire culture needs a change. The list above is full of problems that can be changed at group, institutional, even governmental levels. That’s what it will take to end the epidemic of “physician burnout”. We have to bring the overbearing culture to justice so that we can start moving in a more positive direction.
What are some things you can do to change the culture?
How can we stop the “moral injury”/”moral abuse”?
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Thank you for writing this blog and shedding more light on the issue