Physician Burnout: Definition, Controversies and Etiology

The last episode waded into the murky waters of graduate business education. Anyone listening to that podcast should have emerged with serious doubts about whether an MBA is a desirable credential for healthcare, much less for healthcare leadership.

This Licensed to Lead Podcast is the first of four episodes zeroing in on physician burnout. What is it? Why is it? And how is it that the word “burnout” has become radioactive? This episode defines the terms, takes a look at the assessments used to determine the presence of burnout, and fleshes out the controversies and the causes.



Part 1: What is burnout? How is it measured?

Research tells us that on day one of medical school, medical students have lower rates of burnout and depression than a matched cohort. The impending medical students are more mentally healthy and stable than their counterparts. Research also tells us that once in medical school, students develop very high rates of depression and burnout. So they go in more mentally stable than their peers, and they get sick. The “canary in the mine” analogy is apt.

And everyone who’s anyone in the world of burnout agrees:

The World Health Organization, Berkeley professor emeritus Christina Maslach (of the eponymous Maslach Burnout Inventory), even Pamela Wible, MD (author of “Burnout is Bullshit!”) agree that burnout is an occupationally induced syndrome. It is caused by the workplace. It’s not the doctor’s lack of resilience or predisposition to mental illness or Patchouli oil deficiency that creates a 50% burnout rate. Doctors don’t start out with it. A damaging work environment ushered in by unenlightened, unskilled, or uncaring leaders is the source.

How is burnout measured? In 1981, Christina Maslach and Susan Jackson developed the Maslach Burnout Inventory (MBI). The standard 22-item questionnaire has three domains:

1. Exhaustion, typically emotional exhaustion
2. Cynicism (or depersonalization), a loss of caring about work, colleagues and patients
3. Inefficacy, feelings of incompetence

There are multiple versions of the MBI which have been adapted for various groups as well as truncated versions which correlate well with the original MBI.


Part 2: What’s so controversial about burnout?

The word “burnout” has become radioactive. It has been co-opted by resilience consultants and administrators who prefer to “fix” doctors rather than crawl into that coalmine to eliminate the toxicity. This is a masterful sleight of hand by those who control the direction, the dollars and the microphones in our healthcare institutions.

Another area of controversy is whether the “burnout” accurately captures the issue. Drs. Wendy Dean and Simon Talbot believe the term “moral injury” is a more accurate description of what happens to doctors in toxic institutions. They describe this as the trauma done to physicians who succumb to the influence of a pernicious system that doesn't share the professional values of physicians—a pernicious system that constructs barriers to doing the right thing.

Pamela Wible, MD says we should dump the term burnout because what’s really going on is a systematic violation of human rights. That argument is particularly relevant to medical students and residents who are vulnerable to abuse of power by those with influence over their career options.



PART 3: Physician Burnout Data and More

The causes are not a mystery.

The RAND/AMA survey of 2013 spelled it out—physicians are dissatisfied by:
-being thwarted in their attempts to provide high quality care
-the electronic health record which is dysfunctional and drives an inordinate amount of meaningless work for physicians
-In addition to the above, other sources list the following elements:
-high workload with long work hours and time pressure but no recovery time
-chaotic work environments
-lack of control over work
-values dissonance which prioritizes corporate profits over care of patients

A disconcerting component of all the burnout research is the serial documentation of relentlessly high physician burnout without a focus on the ultimate source of the problem: leadership. In the next episode: a summary of the harm done to physicians, patients and practices, and the enormous financial impact. Then a no-holds-barred discussion of the real issues, which are created by leadership invested in the status quo.

The Business of Health Care Depends on Exploiting Doctors and Nurses by Danielle Ofri, MD, PhD

A note from the Licensed to Lead podcast host Patty Fahy, MD:

Thank you for reading and listening. Visit FahyConsulting.com to learn more about how we work with physicians and other leaders to create healthy work cultures. Also—join future podcast conversations by sending me an email or leaving me a voice message. I would love to hear YOUR voice!
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