Elements Leading to Physician Burnout (Part 3)

Physician work-related stress is a significant problem.^1–3 U.S. physicians report higher than normal burnout rates⁷and increased health problems, including alcohol use problems,^5,6 excess weight,^7,8 poor sleep,⁹ less exercise,^8, and low career satisfaction.¹⁰ Physicians experience the burnout triad of:

Emotional exhaustion (and depression) – discussed in Part 1 of this series.
Interpersonal disengagement (Depersonalization) – discussed in Part 2 of this series
Low sense of personal accomplishment¹¹ – Part 3

Changing Sense of Personal Accomplishment & Regret

A low sense of personal accomplishment is a signal of burnout for most professionals³⁹; however, the standard measure of personal accomplishment may not be appropriate for physicians⁴⁰. Physicians perceive medicine as a calling, a lifelong career, and a core component of their identity. From medical school onward, physicians define their worth by a dedication to patients. The meaning of being a “doctor” starts with “white coat ceremonies⁴¹” at the end of medical school. Physician performance rarely drops significantly at the first detection points of burnout, although it reduces efficiency⁴² and impacts time spent with patients and their overall satisfaction.⁴³ In disasters or pandemics, we readily see a willingness to jump in and dedicate themselves entirely to the task, independent of the risk or challenge. Therefore, even if feeling burned out, physicians are not likely to deny patient care impact or describe their work as meaningless until very late. It would go counter to their sense of identity as physicians.

Sense of personal accomplishment both improved and worsened during the COVID-19 pandemic in terms of external validation. While many people do celebrate healthcare workers as heroes in the pandemic, physicians surveyed also described a feeling of anger and betrayal when protective gear and medical equipment are not available, or others downplay the severity of the disease or spread misinformation.⁴⁴

Career Regret: The experience of career regret is a better measure of lost professional identity. They may express regret for a past decision to enter medicine; older physicians, the desire to retire early.⁴⁵^–47 The simple statement, “I regret going into or staying in medical practice,” is profound in a career where that choice had lifelong implications. Further, it is a safe question to ask. Most physicians would likely answer very negatively. An increase in career regret, as with depersonalization or exhaustion, is a clear sign of burnout.

A supporting system cannot wait until career regret is prominent, and the physician has chosen to seek one-to-one counseling. At that point, the impact is typically profound, since seeking counseling is unfamiliar to many physicians. By the time physicians consider counseling, it is often late in burnout; 10% of such physicians think of leaving medicine.¹⁷

How can Lift help?

While a changing sense of personal accomplishment and regret are part of the burnout triad, we reject the view that these terms are crushing weights that you cannot handle or that you must build up a barrier in defense. This element of burnout is not out of your control. At Clinical Tools, we propose solutions that lift health care providers up, empower them, and build upon their existing strengths, talents, and experience. Start with who you are, lift yourself, your colleagues, and the healthcare profession up.

References