What we talk about when we talk about physician burnout
Why hospital executives need to stop using the phrase “physician burnout” and why it should matter to investors.
I saw a headline the other day on a healthcare industry site that asked pointedly, “Is your hospital struggling with physician burnout?” I have the answer: no.
So-called “physician burnout” does not exist. Allow me to explain.
“Physician burnout” was first coined in the 1970s by a psychologist named Herbert J. Freudenberger, to describe a condition anyone in the medical field will recognize. It’s a sort of exhaustion, both physical and mental, characterized by “malaise, fatigue, frustration, cynicism, and inefficacy.” Use of the term to describe this experience has persisted in our industry over the last fifty years — and increasingly urgently as the COVID-19 pandemic has strained our healthcare system and the people working within it to the breaking point.
There is no doubt that people in the medical and healthcare fields experience very particular and overwhelming stressors unique to the industry. I’ve been working in the healthcare system since 1999 and I’ve seen my fair share of physicians and hospital staff ground down by their work.
But language matters. Saying “physician burnout” perpetuates the framework of an old culture of blame that continues to exist in healthcare, an approach that presents every error as the fault of an individual instead of as a shortcoming of the system. We are slowly shifting away from this old culture within hospitals as we move to analyze complications and near misses from a systems perspective, but we have yet to apply the same shift when discussing “physician burnout” symptoms, which are an expression of our broken healthcare system.
No matter how sympathetic we are to healthcare workers when we talk about burnout, the phrasing implies a failing or inadequateness in the worker, rather than the system.
I know that this may come across as abstractly semantic. And I might even agree with that assessment, were the consequences of the framing above not so dire. The words we use to describe the problems we’re trying to solve influence our posture, or mental and emotional mindset, as we approach them. Our language affects how we see, judge, and react to things — and the way we describe physician burnout unfairly places the physician at the causal center of the experience.
Think of what “burnout” literally means. You’re likely imagining a candle that has burned its way through its wax and has no wick left to fuel the flame. There was not sufficient wick, because the candle itself was insufficient. It has burned out, and cannot be repaired.
But this framing completely ignores the flame that lit the wick in the first place. Correspondingly, “physician burnout” ignores the framework in which and of which the described person is operating. Just as it’s the fire that’s burning the candle, it’s this framework that burns through physicians. Physicians do not burn out; they fuel a consuming system.
Surgeons are among the most resilient people on the planet. They have to be. The job requires staying alert and focused for upwards of 30 hours at a time; it requires witnessing trauma and death daily. But resilience isn’t actually even relevant. If someone drowns in a pool with no ladder, we wouldn’t say he wasn’t a strong enough swimmer.
When headlines — and hospital CEOs, and media, and everyday folks — use “physician burnout,” they adopt and reinforce a posture that dehumanizes the very people to whom they’re ostensibly sympathetic. It’s counterproductive to see depleted physicians as broken cogs in a larger machine. Instead, we should be asking how we can improve the machine so that it doesn’t destroy its constituent parts.
It’s not physician burnout, it’s system burnout at scale. We have reached the end of the lifespan of a system that forces failure from its components.
Additionally, and no less harmfully, so-called physician burnout is a misnomer in that the experience is hardly unique to physicians. Nearly everyone who works in a broken hospital system will experience “burnout” at some point or another. From the service workers in the cafeteria to the head surgeon: in a toxic environment, no one is immune to the fallout.
Indeed, likely, everyone who has visited a hospital recently can relate a story that evidences a breakdown between the organization itself and the individuals responsible for delivering care.
I’m not alone in chafing at the term “physician burnout.” Other physicians have characterized this phenomenon as a “moral injury” that is inflicted on them by the industry. I like this expression because it more accurately captures the feelings of objectification and dehumanization that result from trying to function in a situation where they are treated like fuel.
Our healthcare system as it exists today is lazily, mostly accidentally, abusive to the people who comprise it. The system prioritizes efficiency above humanity, preferring to consider itself a machine made up of inanimate parts. Many get into this industry to help people, but are so easily swept up in the momentum of healthcare-as-a-business that they drift into a position where they forget that doctors and hospital workers are, themselves, people.
Using more precise language to describe this problem means we can more effectively approach solving it. Or, more accurately: it means we can more effectively approach healing the moral injury. And while hospitals nationwide have established corporate wellness programs, pressured their doctors into learning mindfulness practices, and enacted more flexible scheduling, any doctor will tell you that the most effective way to treat a symptom is to cure the responsible disease. Healing and preventing further physician burnout has necessarily got to result from an inside-out approach. This will take addressing harm (with accurate language), building community, and restoring trust in leadership.
Allowing doctors and nurses more autonomy, more determination over both their own careers and the hospital as a whole is what it will take to build more trust in leadership and heal the broken system.
As the expression goes, rot starts from the top. Medical leadership has got to be more empathetic — and, vitally, more courageous. It takes courage to reassess priorities in any for-profit industry; in the multi-billion dollar industry of healthcare, it would be literally revolutionary.
From a traditional business perspective, it doesn’t seem to make financial sense to replace all MBAs in hospital leadership with those who have taken the Hippocratic oath. But increasing representation of physicians among hospital boards would infuse empathy and people-focused care into all hospital operations. When everyone in a system feels looked after and advocated for by that system, trust is second-nature. The ultimate result of doing this would be happier, healthier, more compassionately cared-for patients, and the end result of that is good for business.
