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Burnout and the Ethos of Medical Practice

      To the Editor:
      The article by Shanafelt et al
      • Shanafelt T.D.
      • Hasan O.
      • Dyrbye L.N.
      • et al.
      Changes in burnout and satisfaction with work-life balance in physicians and the general US working population.
      published in the December 2015 issue of Mayo Clinic Proceedings describes the very serious and worsening problem of burnout among American physicians, and the editorial by Ariely and Lanier
      • Ariely D.
      • Lanier W.L.
      Disturbing trends in physician burnout and satisfaction with work-life balance: dealing with malady among the nation's healers.
      attempts to elucidate the causes, noting asymmetrical awards, loss of autonomy, and cognitive scarcity. I could not agree more on one point that Ariely and Lanier made, that the “micromanaging of physicians' time and decisions” in the name of productivity by their corporate overseers is a major factor in the burnout and that it needs to be addressed.
      The social and cultural influences that have altered the ethos of medical practice are complex, and I have described them in detail elsewhere,
      • Eiser A.R.
      The Ethos of Medicine in Postmodern America: Philosophical, Cultural, and Social Aspects.
      along with possible remedies. In addition to that analysis, I strongly believe that medical societies need to be more proactive in developing and advocating positions to resist and modify the corporate control of medical practice. It is not a coincidence that physician burnout has grown exponentially and in parallel with the increase in the corporate control of medical practice. This organizational change has occurred without the careful scrutiny of serious research on the long-term unintended consequences such change engenders in health care processes. Both research into and advocacy for maintaining and strengthening the role of medical professionals in the face of managerial technocracy are urgently needed.
      The scrutiny of the quality of medical care is here to stay, but quality medical care also requires professionals with a satisfying work environment who find their work appreciated and respected. No one expects to eliminate the corporate entities that control medical practice today, but with effort, we can get them to be mindful that respectful interaction with clinicians is essential to quality medical care and physician well-being.

      References

        • Shanafelt T.D.
        • Hasan O.
        • Dyrbye L.N.
        • et al.
        Changes in burnout and satisfaction with work-life balance in physicians and the general US working population.
        Mayo Clin Proc. 2015; 90: 1600-1613
        • Ariely D.
        • Lanier W.L.
        Disturbing trends in physician burnout and satisfaction with work-life balance: dealing with malady among the nation's healers.
        Mayo Clin Proc. 2015; 90 ([editorial]): 1593-1596
        • Eiser A.R.
        The Ethos of Medicine in Postmodern America: Philosophical, Cultural, and Social Aspects.
        Lexington Books, Lanham, MD2014

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