To fortify our understanding of burnout among residents, we have to widen the list of themes we consider, a leading scholar told a gathering of physicians from across the medical continuum. Learn what guidance he had to offer.
A broader conversation
The conventional focus on the work and learning environments, though important, is not enough to address burnout in residents, said DeWitt Baldwin, MD, senior scholar in residence at the Accreditation Council for Graduate Medical Education (ACGME).
In his remarks to the council’s first Symposium on Physician Well-being—part of the ACGME’s larger effort to transform residency to foster wellness—Dr. Baldwin encouraged consideration of the socio-economic setting in which residents work, the moral-ethical environment and the personal characteristics that individuals bring to the job.
Standing in the way of the search for solutions is a culture that holds onto the stigma that surrounds mental and emotional health issues, he said.
“The culture of medicine still entertains the view that persons who cannot cope or err or fail or are weak have violated the traditional norms of the physician as a strong, independent, self-sufficient perfectionist who does not and should not need help,” he said.
“Absurdly, seeking therapy or even help from a wellness program may be seen [as] a weakness or failure,” he said, and it is sometimes looked on as something that could interfere with licensure and employment opportunities.
Casting the net
While the profession works to shed outdated attitudes, Dr. Baldwin said, it must cast a wider net to weigh more facets of resident well-being, including:
- Moral-ethical factors: Toxic and unprofessional learning environments prevent engagement and quash the youthful idealism and enthusiasm that students often bring to the table.
- Individual factors: Examination of burnout must take into account the motivations, temperament, capability, education and health of individual trainees. This can include considering childhood maltreatment trainees may have suffered, and how it can give rise to such conditions as depression and post-traumatic stress disorder.
- Social-economic setting: Residents work in conditions that differ widely in terms of the medical needs of the community and patient safety, factors that can influence burnout.
Changing the fundamentals
The call to renew and refocus efforts to prevent burnout is loud and strong. Thomas Nasca, MD, CEO of the ACGME, opened the symposium with some sobering statistics. Close to 400 physicians take their own lives each year, he said, while other suicides most likely go unreported.
“The pain that this scourge is heaping on our profession … is unbearable at times,” he said, and suicide only represents “the tip of the iceberg,” with other forms of distress below the surface. Dr. Nasca called on physicians as a whole to reimagine the campaign against burnout.
“We can’t just stand by and wring our hands and then walk out the door and go back to doing what we usually do,” he said.
As urgent as the call for action may be, Dr. Baldwin said, there are miles to go in the fight to overturn fundamental factors in medical education that stand in the way. One obstacle is the low priority burnout sometimes holds.
“Wellness and well-being just don’t pay,” he said. “It takes too long. It’s neither glamorous nor dramatic, and there’s little sense of slaying the dragon.”
Change means confronting what he called an antiquated, assembly-line education model that dehumanizes trainees and undercuts their well-being.
“We need to take from them the task of having to gain their well-being,” Dr. Baldwin said. “We should be providing it for them.”
Continuing the conversation
The ACGME hosted a webinar, “Combating burnout, promoting physician well-being: Building blocks for a healthy learning environment in GME,” with speakers Lyuba Konopasel, MD, and Carol Bernstein, MD. ,The ACGME also will be holding its next Symposium on Physician Well-Being this fall. Learn more: Access resources and videos from the 2015 symposium.
