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Physician Burnout: A Leading Indicator of Health Performance and “Head-Down” Mentality in Medical Education—II

      To the Editor:
      Regarding the editorial by Olson
      • Olson K.
      Physician burnout—a leading indicator of health system performance [editorial]?.
      published in the November 2017 issue of Mayo Clinic Proceedings, the author observes the importance of physical and psychological burnout within the context of the modern health system. She asserts that physicians are “exiting their careers in medicine faster than they enter.” Despite current measures to reduce physician burnout, 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 between 2011 and 2014.
      reported that the crisis continues to worsen, and satisfaction with work-life balance showed similar deterioration. Olson concludes that burnout reduction and wellness promotion are of paramount importance and argues that improvement lies within minimizing the stigma associated with burnout and reducing workplace stressors. These measures, while a good start, only address the “effect” vantage point of this problem. Perhaps instead of trying to treat the results of the problem, we should focus on attempting to find and change the source or “cause” of the problem to begin with.
      Interestingly, McBee et al
      • McBee E.
      • Ratcliffe T.
      • Picho K.
      • et al.
      Contextual factors and clinical reasoning: differences in diagnostic and therapeutic reasoning in board certified versus resident physicians.
      reported that burnout and work-life balance dissatisfaction rates are even higher among residents than board-certified physicians. As current trainees ourselves, this data is alarming. We, as a newer generation of physicians, should be invigorated and excited to transition from residencies and fellowships into careers as attending physicians. If more and more of us drag across the finish line of training feeling drained and overwhelmed, maybe it's already too late. Olson mentioned “workplace stressors.”
      • Olson K.
      Physician burnout—a leading indicator of health system performance [editorial]?.
      As trainees, we learn from very early on in medical school that you put your head down, work, then work even harder. Complaining is unacceptable, and seeking help is a sign of weakness. The only justification for the perpetuation of this cycle from one generation of physicians to the next is “we all had to go through it, so you do too.”
      Maybe this archaic mantra is the reasoning behind Olson's desire to reduce the stigma of burnout and even the prevention of seeking help at a time when a physician may need it most. Recent literature demonstrates that physicians do not use currently implemented wellness resources. One study identified 9 institution-wide measures that improve physician wellness.
      • Shanafelt T.D.
      • Noseworthy J.H.
      Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout.
      However, while these measures have demonstrated potential, they are only beneficial if used. In a separate study, only 5% to 7% of physicians, scientists, and administrators use “peer support resources” annually, despite measures to “minimize potential stigma and reduce barriers to seeking help.”
      • Shanafelt T.D.
      • Lightner D.J.
      • Conley C.R.
      • et al.
      An organizational model to assist individual physicians, scientists, and senior health care administrators with personal and professional needs.
      Given the higher burnout rates among resident physicians, this population should be targeted to establish behavioral patterns early, thereby altering the culture of the medical field as new physicians enter. Perhaps wellness as a process should be automated with resources offered during annual physicals or hospital-provided financial counseling. Such processes standardize wellness without the stigma of asking for help or association with performance indicators. Although Olson highlights a great start, the true obstacles are the culture and the “head-down” mentality on the pathway to becoming an attending physician. Cultural changes need to be made, and finding creative ways to do so earlier in the process, particularly in medical school or residency, will be for the better.

      References

        • Olson K.
        Physician burnout—a leading indicator of health system performance [editorial]?.
        Mayo Clin Proc. 2017; 92: 1608-1611
        • 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 between 2011 and 2014.
        Mayo Clin Proc. 2015; 90 ([published correction appears in Mayo Clin Proc. 2016;91(2):276]): 1600-1613
        • McBee E.
        • Ratcliffe T.
        • Picho K.
        • et al.
        Contextual factors and clinical reasoning: differences in diagnostic and therapeutic reasoning in board certified versus resident physicians.
        BMC Med Educ. 2017; 17: 211
        • Shanafelt T.D.
        • Noseworthy J.H.
        Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout.
        Mayo Clin Proc. 2017; 92: 129-146
        • Shanafelt T.D.
        • Lightner D.J.
        • Conley C.R.
        • et al.
        An organizational model to assist individual physicians, scientists, and senior health care administrators with personal and professional needs.
        Mayo Clin Proc. 2017; 92: 1688-1696

      Linked Article

      • Physician Burnout—A Leading Indicator of Health System Performance?
        Mayo Clinic ProceedingsVol. 92Issue 11
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          Like the proverbial canary in the coal mine that alerts miners to the need for course correction, physician burnout provides an early indicator of health system dysfunction in time for decision-makers to change course and avoid health system failures. In this issue of Mayo Clinic Proceedings, Sinsky et al1 report that physicians may be exiting their careers in medicine faster than they enter; their intentions to withdraw are highly correlated with burnout (odds ratio [OR] 5.8). Also in this issue, Shanafelt et al2 advocate to proactively monitor and manage professional burnout and wellbeing in individuals as a way to avert crises.
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      • In Reply—Physician Burnout: A Leading Indicator of Health Performance and “Head-Down” Mentality in Medical Education—I and II
        Mayo Clinic ProceedingsVol. 93Issue 4
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          I agree with Drs Peck and Viswanath, that residents should be transitioning into their careers “invigorated and excited.” The fact that most physicians are experiencing burnout, and it is particularly high among residents, indicates a need for course correction. I concur with the logic that it is best to treat the root cause rather than its adverse effects. As I indicated in my editorial, the evidence suggests that the work and workplace stressors are the predominant drivers of physician burnout and the ensuing withdrawal from clinical practice, which frustrates our ability to provide the population with access to affordable high-quality patient-centered care.
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