We have seen a surge in the last few years in awareness and discussions about physician wellness and burnout. More than 50% of physicians are experiencing symptoms of burnout with some specialties as high as 70% burnout1.
Wellness and burnout are often described together. I like to think of burnout as wellness’s evil twin. Wellness is simple at heart and complex in the details and the details are going to be different for everyone. Burnout, succinctly, is job-associated dysphoria. Burnout’s link to the workplace is key in differentiating burnout from depression.
The personal definition of wellness for an individual physician will change over time. A physician with toddler children will have different definitions of what their wellness looks like compared to those caring for older parents. Disabled physicians will define their personal wellness differently than able-bodied physicians. Men are not the same as women. LGBTQI physicians will have different needs than hetero-normative physicians. It all counts.
Physician wellness is certainly a lot more than exercising regularly, meditating occasionally, sleeping well and eating a healthy diet. #physicianwellness is a common tag on social media with great photos of exciting activities, but really only scrapes the surface of what wellness means. Assumptions about physician wellness often include being physically able, generally healthy, with reasonable disposable income and without significant encroachments on your time beyond your work and your non-work life. Physicians with disabilities, serious medical or psychiatric illnesses, significant at-home responsibilities such as medical complex children or older relatives may not have the luxury of these assumptions. Importantly, the individual physician is often held responsible for these physical and mostly personal aspects of wellness, often amounting to a kind of victim blaming.
Resilience is a term that is also often used in association with wellness. Resilience is the ability to bounce back from difficulties, and also the ability to spring back into shape. Resilience is a learned skill and also a lost skill. The process of medical training is pretty much the definition of delayed gratification and deferred decisions about your self. You lose your good habits to comply with the burdens of training. The freshman 15 turns into the PGY1 30. You spend 4 years of medical school and at least 3 years of residency doing what someone else is telling you to do. You think there is a perfect time to start a family (news flash – no perfect time exists). You lose some of your protective social supports with long distance moves, shift work and call schedules.
On the plus side, you can learn to be more resilient. One of the advantages of personal resiliency in physician wellness is that this mostly under your control. When you sleep and how much. Exercise. Diet. You get to control that. You don’t get to control which electronic medical record the institution choses. But in the context that the more control of your life you have the happier you are, seize control where you can.
Physicians are individuals and physician wellness will look a little bit different for all of us. But broadly, work that is valued, and compensated; ability to pursue professional passions; time to engage in nonclinical interests; a schedule over which we have some control. Institutions willing to engage in developing a culture of wellness and maintaining skills
Physicians and other academics do a lot of uncompensated work in the academic environment. In many respects, how uncompensated work affects your professional fulfillment depends upon other drivers of your time. How many clinical hours are you working? Are you a shift worker and do you work weekends and holidays? Are you regularly on call? Does the electronic medical record occupy your evening? Do you have any additional compensated time to follow your clinical interests? What are the burdens of publication in your academic series?
Buffers against physician burnout
A buffer against physician burnout is the presence of meaningful social connections in the workplace. Physicians in many clinical environments are socially isolated from each other. Doctors lounges have disappeared, time pressures have increased and we spend a lot of time interacting with screens. Social connections improve resilience.
Mentoring, especially peer or near-peer mentoring provides an opportunity for social connections. The reciprocity of the mentoring process protects and sustains the mentoring relationship. Both the mentor and the mentee or protégé are getting something meaningful from the interaction. Sometimes, it is acting a project mentor for a specific project. It might be coaching in specific skills, or reading through the departmental compensation plan.
Team mentoring is particularly useful in offering some of the skills that might sometimes be offered by a life coach. Increasingly, we recognize that a single person cannot be an uber-mentor, and a mentoring team offers benefits and protects against mentor and mentee missteps2,3. Mentoring can be broadly grouped as traditional mentoring, coaching, sponsorship and connectors4. In practice environments with limited ability to make direct in real life connections – branch out to other departments, other institutions and social media. Social media offers a lot to individual physicians in terms of connections with like-minded providers. Recent campaigns included #ILookLikeASurgeon, #FeminEM, #GirlMedTwitter, #FOAMed. Don’t underestimate the power of mixing work and play with book clubs, running groups, networking at conferences. Mentors can help you protect your time and your resources, guide you in new directions, and provide sponsorship.
A physician can be burnt out and recover. But to be well, you will need to figure out what drives you, what motivates you, how you relax and how you recharge. No one can do this work but you, but it is easier with a friend.
- Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic proceedings. 2015;90(12):1600-1613.
- Vaughn V, Saint S, Chopra V. Mentee Missteps: Tales From the Academic Trenches. Jama. 2017;317(5):475-476.
- Chopra V, Edelson DP, Saint S. A PIECE OF MY MIND. Mentorship Malpractice. Jama. 2016;315(14):1453-1454.
- Chopra V, Arora VM, Saint S. Will You Be My Mentor?-Four Archetypes to Help Mentees Succeed in Academic Medicine. JAMA internal medicine. 2018;178(2):175-176.