A new study sheds light on which physicians are most likely to feel the brunt of burnout — and they might not be the MDs you'd expect.
In 2011 and 2012, study authors surveyed medical students, residents/fellows and early career physicians, along with an age-matched sample of the general U.S. population. The surveys measured burnout, symptoms of depression and suicidal ideation, quality of life and fatigue.
The findings? Well, at each stage, burnout was more prevalent among physicians than their peers in the general population. (Not much of a surprise there.) But physicians in the earlier stages of their careers were more likely to report burnout than those more advanced. Specifically, being a medical student increased the odds of depressive symptoms (compared to the general population) and being a resident/fellow was associated with increased odds of burnout. Early career physicians had the lowest odds of high fatigue.
The results may surprise some, since age and experience is so often correlated with energy and enthusiasm. Journalists know this well. The cub reporter fresh out of J-school is expected to be optimistic and eager, if a tad naïve, while the seasoned editor is painted as the curmudgeon. This is the inherent dynamic of many rookie-vet dyads, but it may not consistently extend to the hospital. Medical students face higher odds of "depressive symptoms" when they don't yet have the MD after their name.
If you think back to your college days — cramming for final exams, pulling all-nighters — you might have very well reported some symptoms of burnout, too. Exhaustion is an easy thing to claim, and it's easy to pour tired-fatigued-exhausted-burnt out into one big bucket. But a closer look at what burnout entails reminds us of how different it is from the fatigue after a long night of studying.
According to Psychology Today, burnout is a state of chronic stress that results in physical and emotional exhaustion, feelings of cynicism and detachment, and a sense of ineffectiveness and lack of accomplishment. Combined, you are left with a physician or physician-in-training who cannot successfully function on a professional level.
So why are medical students facing higher odds of depressive symptoms, and residents higher odds of burnout, than early career physicians? Something systemic is occurring, and it might have to do with expectations versus the new reality of healthcare.
Richard Gunderman, MD, PhD, is a professor and chair of the radiology department at Indiana University in Bloomington. He penned a column on this topic for The Atlantic, noting that burnout isn't the result of some catastrophic exam, long call shift or poor clinical evaluation. Rather, "it's the sum total of hundreds of thousands of tiny betrayals of purpose, each on so minute it hardly attracts notice."
He delves into some examples here:
When they see a patient treated poorly, encounter a fellow student who is struggling with confusion and discouragement, or deep in a maze of tests and grades find themselves beginning to lose sight of the goals that brought them into medicine in the first place, they do not merely knuckle down and redouble their efforts. Instead they take such matters into their hearts, muse over them, and find themselves questioning whether medicine is what they really want to do with their lives.
This is somewhat "soft" language for business-minded readers, but maybe it's time to start dismissing insight like this as fluffy or overly sentimental. Emotional intelligence has become a prominent term in healthcare's lexicon today, but it only seems to go as far as it's convenient.
Physician burnout is a huge, sweeping issue affecting thousands across the country — that's one way to look at it. But emotionally intelligent leaders don't see it that way. Rather, they will approach the problem by doing small things with great compassion. Next time you see a medical student or resident, remember that they may need more encouragement than you think.