The Burnout Triad
Physician burnout remains a crisis within the medical community. As the report released earlier this year, A Crisis in Health Care: A Call to Action on Physician Burnout, stated: “We believe that physician burnout is a public health crisis, an assessment that has been echoed by others in both major medical journals and in the lay press. A primary impact of burnout is on physicians’ mental health, but it is clear that one can’t have a high performing health care system if physicians working within it are not well.”
The situation is similar elsewhere, including here in Canada. In the fall of 2018, the Canadian Medical Association released the results of their National Physician Health Survey concluding “areas of concern, such as burnout, depression and lifetime suicidal ideation, with rates being higher among residents than physicians and higher among women than men.”
Burnout remains something that we, Colin and Sara, remain constantly aware of, and as such, have been working through the concept of “the burnout triad”. In our opinion, despite the multifactorial nature of burnout, we consider 3 main contributors - loss of autonomy, control and flexibility - and all other factors are either directly or indirectly related to them.
For instance, looking at some of the key drivers of physician burnout:
complexity of medicine
human suffering, often in the face of limited resources
culture of medicine
Now, take scheduling and vacation as an example of this 3 pronged framework. In this example, let’s say you work in a hospital-based setting full-time. Due to diversified interests or a myriad of other possible personal reasons, you decide that reducing your hours to part-time would currently suit your needs much better. You may even start to like the practice of medicine again. You bring your request to your department head and it’s denied. You feel completed deflated. Your sense of autonomy is eroded; you feel you have little control over your work circumstances; and you perceive no flexibility over how you practice medicine. Unfortunately, this scenario is not all that imagined, and in turn, is a significant contributor to burnout.
To continue with our example above, we once again refer to the landmark study out of the Mayo Clinic titled Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout by Drs. Tait Shanafelt and John Noseworthy. In the article, they state: “organizations should seek to provide physicians greater flexibility in when and how they work.” And although not always easy or seemingly possible, “organizations should seek to make this option available to the greatest extent possible.”
Physician burnout is complicated but at the same time it doesn't necessarily have to be. If we start to conceptualize some of the key factors or true game changers, perhaps we can see more tangible solutions. Onward we go…
“Find the autonomy in your work. Autonomy is key to feeling good about the work you do, no matter what kind of work it is.” ~ Jean Chatzky