AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
Featured topic and speakers
What career has the highest burnout rate? Burnout among physicians, residents and medical students is one of the most pressing problems in medicine. However, medical faculty are also showing signs of burnout. Joining to discuss the current state of educator well-being and what can be done to address it is Charlene Dewey, MD, MEd, MACP, director of the Center for Professional Health and chair of the Faculty Wellness Committee at Vanderbilt University Medical Center. AMA Chief Experience Officer Todd Unger hosts.
- Find more resources on how to treat physician burnout.
- Download AMA's "Educator Well-Being in Academic Medicine," a solutions-focused guide to improving educator well-being.
- Learn more about the AMA Organizational Biopsy assessment tool (PDF).
- Watch our latest episodes on improving physician satisfaction and fixing clinical burnout:
- AMA Organizational Well-Being Assessment with Mark Greenawald, MD (Virginia Tech Carilion School of Medicine).
- Mini Z burnout survey with Gerard Clancy, MD (University of Iowa Carver College of Medicine).
- Medical student and resident burnout with Lotte Dyrbye, MD (University of Colorado School of Medicine).
- Health care burnout trends with physician experts from The Icahn School of Medicine at Mount Sinai in New York City & Dana-Farber Cancer Institute.
- Chief Wellness Officers and COVID-19 pandemic burnout with Tait Shanafelt, MD (Stanford University School of Medicine).
- The AMA is your powerful ally in patient care. Join now.
Speaker
- Charlene Dewey, MD, MEd, MACP, director, Center for Professional Health; chair, Faculty Wellness Committee, Vanderbilt University Medical Center
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Burnout is one of the most pressing issues in medicine, affecting everyone from physicians to residents and medical students. Today we're discussing the well-being of the medical educators who train them.
With me to discuss this on the heels of Women in Medicine Month is an inspiring woman physician leader, certified coach and physician wellness expert. Dr. Charlene Dewey is the director of the Center for Professional Health, and chair of the Faculty Wellness Committee at Vanderbilt University Medical Center in Nashville, Tennessee. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Dewey, welcome.
Dr. Dewey: Thank you, Todd. Thank you to everyone who's allowed these kind of discussions to take place, especially the AMA. It's so necessary, and definitely appreciated.
Unger: Well, you've studied and taught burnout extensively over the years, including among medical educators. How do you think educators are feeling right now? And how does it compare to the general trend of burnout that we're seeing across medicine?
Dr. Dewey: The quick answer is I think they're exhausted. I think they're overwhelmed. And what we're seeing, unfortunately, after the pandemic, of course, is that the pandemic is not done—nor is the effects and the burnout on the health care provider or the medical educator.
Unger: That's very interesting. What do you think are some of the key factors that are contributing to burnout among educators?
Dr. Dewey: One of the things that we in medical education have is that never ending "to do" list. There's one project, there's another committee project, there's another this, another that. And these things just kind of keep perpetuating itself—but in a good way, because you're getting things done. You're accomplishing things, but that to do list never goes away.
In fact, I was just coaching a young female physician about this yesterday when she feels like her to do list isn't going down. And it doesn't necessarily go down in academic medicine. We tend to have thing after thing after thing after thing, and therefore it feels like it's a never-ending list.
There's also that blurred in the boundaries of when you're done with your work and when you're not done with your work. How do you integrate work-life balance together when you have so many things to do and you're still doing some of those things at home? Those boundaries start to get blurred.
So definitely for medical educators in academic medicine, we see that they're feeling overwhelmed and exhausted with everything that's gone on—the changes they've had to made to make pretty quickly in the pandemic, through the pandemic, and now on the tail end of the pandemic, still trying to adjust. And that's a hard place to be for any human being where the flux and the change is almost a daily routine.
Unger: How do you think that's different for medical educators versus other folks out there that maybe they've gone back to work in the office? What is it about this particular situation? Is there a catch up problem now that students are back on location, or what is it?
Dr. Dewey: I think it's multifactorial that there are multiple things you have to do with students, or with learners, residents, trainees, in general. Versus your own career path, versus service to the institution, versus service to the community, which is your patient care. So there's these multiple hats that the academic physician has to wear. And all of those things has their own pressing needs to it.
Unger: Do you find any particular differences—let's say along gender lines, for instance?
Dr. Dewey: Along gender lines? We certainly have some evidence—the Shanafelt articles, the AMA assessments—that, in general, women tend to bear most of the home-related responsibilities to childcare. And that seems to certainly add another layer of stress and challenge for the female academic physician, where they are maybe also responsible for childcare, childcare pickup, get the cupcakes for the after school game, things like that that just add one more layer of things on to do list.
Not to mention that study that came out that Dr. Shanafelt did in 2021. I think it was published in 2022. Most physicians who responded to that survey actually were women, and they definitely highlighted that work-life integration and the childcare responsibilities were significant.
Also in the AMA paper, what we actually saw in that one, we saw a little bit in which male resident physicians actually had a little bit higher satisfaction at work compared to females. And yet there was almost a 1 to 1 ratio in that study of male to females. And then females also experienced higher levels of work stress and burnout.
Unger: Now, we talk a lot about burnout, of course, and well-being at the AMA. I would say most of the focus is on physicians, and sometimes students and residents, obviously. But that issue is often overlooked when it comes to medical educators. What do you think is an important first step that institutions can take to improve the well-being of their faculty?
Dr. Dewey: I think always the first step is to recognize that it is something that is concerning and that we should all be paying attention to. It's too common where I hear someone who contacts me and says, I think I'm at burnout, but my organization doesn't do anything about it. So it's really one of those things that, if we look into the academic setting, they experience all the sources of burnout that Maslach talks about.
In the resident studies, we see that as well. So in the medical educator, it's not going to be any different as far as those sources—maybe in different proportions, but they're going to probably have all of them. So any organization, any academic setting, the first thing we need to do is raise the awareness, talk about it. Get people to understand that how they're feeling might actually be burnout. Or is it over-exhaustion and what can we do to help reduce that?
So if we think about the first thing to do, it's talk about it, it's recognize it. It's making it part of the conversation so that people don't have to retreat into themselves and try and figure out a way to fix it. But the organization and the individual together have to make changes that are going to address burnout. Burnout is generally always multifactorial and not one thing is going to actually solve it for everyone.
So recognize it, talk about it, start taking action. When we find that there are places that has significant sources, and that work overload, that part of not having a clear boundary of when you go home versus when work is done, for the medical educator especially, those things of the responsibility around the learners and the balancing piece. Anything that we can do to put in programs or resources that help reduce any of those burnout sources, then we're going to do better for the people in that organization.
I think leadership is one of the clear ones, as well. The leadership part—the more the leader understands it, recognizes it, sets a culture of acceptance and a tone of we're here to help, we're going to support. You're not somebody who just gets thrown away just because you experience burnout. But we embrace what you have to offer, and we want to help you feel like you are at your best every day. That's the role that an organization should be playing.
Unger: Now you mentioned resident burnout in your comments, and I want to turn to that just for a bit. The AMA's latest residency well-being report shows that more than two out of five residents are feeling burnout. Is this in line with what you're seeing at your institution? Is there a connection between resident burnout and faculty burnout that we're talking about?
Dr. Dewey: I would say I don't know the exact number of burnout for my own institution. But I will say, in general and over the past few decades, we have seen that ratio or proportion, of people at burnout not really change that much—somewhere between 30% to 60% most of the time, as high as 70% in residents. The last AMA paper looked at about 40% or so.
And so it hasn't gotten better. But we've also just been through a significant pandemic. So part of me says I wouldn't expect it to be better right away.
When we went through the pandemic, there was a term called the "pandemic trauma and stress experience." I remember when I talked about that in presentations saying, we don't know what the ripple effect of this is going to be. We don't know how many years it's going to take for us to actually get past the effects of this.
And so I feel like we are still in that ripple effect. I think the evidence that the AMA was able to emphasize, that it was worse than it was in 2021, is on par with what I expect is going to happen. I just don't know when it will actually get better.
Unger: Now we know from our research that the drivers of physician burnout are often at the system level. Now when you think about residents and faculty burnout, and you think about that, same source or are there larger issues in graduate medical education that are a root cause?
Dr. Dewey: I'm going to say same sources, slightly different proportions in a way. In that last AMA paper, in the 2022 results, they actually showed that residents still had difficulty with work overload and sources of not being sufficiently rewarded, and their lack of control over situations, their own schedules. Those things still happen to faculty, but slightly different proportions. I have a little bit more control as a faculty member on my schedule than a resident is going to have on their schedule. same
Sources, slightly different proportions. Same sources with administrative burden and the EHR kind of things. Maybe a little bit higher in physicians, in faculty attending levels, but still present for residents in training.
We actually saw that in the AMA paper as well. That that time that they have to spend doing the administrative burden type tasks might not be quite as high as the physicians, but it's significant enough that it takes away or detracts from the reason they came to the medicine in the first place, which is to take care of patients. So I think the sources are the same in maybe slightly different proportions.
Unger: Dr. Dewey, before we go, I've got one final question for you. From your perspective as a certified wellness coach, what advice do you have for medical educators out there who suspect that they might be experiencing burnout right now?
Dr. Dewey: My first and greatest thing is to let them know they're not alone. There are many of us who have been out there and have experienced burnout. I say for myself it's probably experienced it at least three times.
And the second is knowing that you're not alone also means there are people that can help. And then the third and most important thing, that means when you get help, you can overcome it. It's not a career-ending thing.
As a medical educator, those challenges, we just need sometimes a little bit of focused effort on ourselves and what we're doing within our medical education careers in order to actually prioritize what is most valuable, what's most necessary at this point in time, until we can safely get through the burnout period. Because the self-care piece of this is critical. We don't really see people get out of the burnout without that self-care.
So that piece for medical educators that are always trying to climb that ladder towards success and promotion and things like that, to understand that it's OK to put some pauses at times to allow yourself to just do those things that are really critical for you and for your learners so that you can bring your best self to work. And I think those three things—knowing you're not alone, knowing that there's people out there ready to help and knowing that you'll be successful in getting through it with changes at work and for yourself, but never underestimating how much taking care of yourself should be the priority.
Unger: Dr. Dewey, that is great advice. Thank you so much for joining us today. Reducing physician burnout, including burnout in medical educators, is an important pillar of the AMA Recovery Plan for America's Physicians. You can learn more about our ongoing work at ama-assn.org/recovery.
That's it for today's episode. We'll be back soon with another AMA Update. In the meantime, find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Let's take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
