I am naturally a problem solver, and I share this characteristic with most of my fellow physicians. When I felt burned out at one point in my career, I was certain that a literature search would help me solve the problem by giving me answers I could use to make my burnout a thing of the past.
My research, within the academic literature and information on the web, led to some disheartening conclusions. While we have good definitions for burnout, we also have a very poor understanding of what exactly causes it. We do know some risk factors for burnout and that it is at an all-time high. The results of my search, however, were nebulous at best. Even worse, much of the conversation is framed around making physicians, already incredibly resilient people, even more resilient. The burden of solving burnout has been laid on problem-solving doctors.
After this research and my own challenges with burnout, I have instead come to believe that resolving burnout is about subtraction, not addition. Instead of adding more beneficial chores for ourselves, we need to subtract the things which distract from our mission of helping our vulnerable patients as they seek health and combat illness.
Health care administrators, like most physicians I think, sincerely want to improve burnout. They hear daily about staffing and provider shortages and know firsthand that there are no easy solutions. The amount of help they can provide, unfortunately, is limited. Administrators can develop good culture, open communication, and hire adequate support staff, but they cannot fix the larger regulatory and clinical staffing environment. They cannot change the fact that our health care system errs more on satisfying payors than treating patients.
We must have realistic expectations. Being a physician is hard work, and not every aspect of work as a doctor will have a positive emotional impact. Yet we can all agree that the balance of what fills the bucket and what depletes it is off. There are some signs that those in power are starting to get it. Surgeon General Vivek Murthy has spoken about making physician burnout a priority. But when we finally get the stakeholders interested in burnout, the solutions must be about subtracting burdens and not giving us more “wellness” to engage in.
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