Tired doctor in gloves, respirator and grey uniform sitting on the floor by wall

There are seven industries where people experience to burnout the fastest.

We are being inundated today with the topic of burnout. It is so prevalent in healthcare news, and across many different arenas of healthcare provision.

One cause of the increased numbers being mentioned presently is the pandemic, but it is not the sole reason, and existed way before that. The pandemic has just exacerbated the trend. One must keep in mind that burnout is not limited just to the medical profession. I remember one time talking to a plaintiff’s malpractice attorney, who said “I hate what I do, but I have a family to support!”

Since there is an absence of a generally accepted definition of the syndrome of burnout – not to mention its multifactorial origin, the ever-changing healthcare landscape, and the vagueness and subjectivity of the diagnostic criteria – it is difficult to get a clear and correct overview of the prevalence of burnout in a general population.

According to Rachel Montanez, there are seven industries where people experience burnout the fastest, and they are:

  1. Social work;
  2. Emergency response;
  3. Design;
  4. Business development and sales;
  5. Retail;
  6. Medicine; and
  7. Law and other businesses with large workloads.

These categories come from 2019, which would be pre-pandemic, and more than likely, things have changed, with a higher number of sufferers coming from healthcare. Even with all of these professions being cited, this article will deal with the healthcare arena.

In that arena, things have gotten so intense that, according to Becker’s Hospital Review, on March 3, the American Hospital Association (AHA) urged Congress to address workforce challenges facing healthcare facilities, calling the issue a national emergency. The very next day, Becker’s cited a study led by the American Medical Association (AMA) showing that turnover of primary care physicians results in about $979 million in excess healthcare expenditures annually, for payors. Of that amount, $260 million, or 27 percent, was attributed to burnout-related turnover.  Hence, one can see that burnout has become a pandemic unto itself and the effects are far-reaching.

The study also found that roughly 11,339 primary care physicians were expected to leave their current practices per year, and that physicians with burnout are more than twice as likely to leave their current practices than those without. The study authors concluded that reducing physician burnout could reduce unnecessary healthcare expenditures. Keep in mind that this study is pre-pandemic, but it still doesn’t answer the key question: why is this occurring, and escalating?

The main question to consider is why these physicians and other healthcare professionals burn out. Why is there burnout when the vast majority of these professionals love what they do? Many have gone through prolonged periods of education and training. Why didn’t they burn out then? At times there are other collateral challenges arising, such as alcohol and drug abuse, partly because of the ease of access, and even suicide, caused by the thinking that this is as good as it is going to get.

I am not naïve enough to not acknowledge the internal pressures that erode enthusiasm, as these professionals face them daily, such as:

  • Financial concerns;
  • A fast-paced environment;
  • A highly litigious industry;
  • Boredom from repetition;
  • Complying with protocols, policies, and documentation requirements;
  • Denials and appeals thereof;
  • Emotional and mental pressures of daily experiences;
  • And more.

We help so many patients through the stages of various illnesses, from a GI virus to a terminal fight with cancer to today’s COVID challenges. We would like to believe we have all the answers, all the treatments, but we don’t. It can frustrate us, for it is often not that the involved illness is terminal, but that the knowledge of our treatment of that illness is limited by our present-day knowledge and research. We sometimes reach the point of having no more to offer, and it leaves us with a sense of helplessness. We tell ourselves, “don’t get emotionally involved,” but empathy is the quality that distinguishes us as human beings. As much as we try, you just cannot turn that off.

On Death and Dying, by Elizabeth Kubler-Ross, M.D., is a classic and should be read by every healthcare provider. In the 1969 book, she talks about the five stages of grief and grieving in illness and death:

  • Denial;
  • Anger;
  • Bargaining;
  • Depression; and
  • Acceptance.

We must and do learn, as healthcare providers, to help patients and families navigate through these five stages. They may not be traversed in the order listed, with equal amounts of time spent in each one, but chances are very high that none are missed. But what about us? Our problem is, how do we help ourselves transcend these stages in our own grieving in patient care? You may say we don’t get that emotionally involved and go through these stages, but we do – whether this happens consciously or subconsciously.

This may not be the total “why,” but think about this. Healthcare providers go from patient to patient to patient, situation to situation to situation, every day. It requires changing emotions, changing mental pathways, constantly, without missing a beat. Take, for example, an ED physician who just had a COVID patient arrive and deteriorate right in front of them, expiring after a short period of time, and then has to see a teenager with presumed appendicitis. What a paradigm shift in emotions and thinking this is. That takes an emotional and mental toll, whether acknowledged or not. Doing this day after day after day, without giving ourselves the chance to account for our emotions or feelings, empties our emotional “bank,” eventually leading to “bankruptcy.” They do not get a chance to process their grieving, and, in the long run, this leads to burnout.

Allow ourselves the necessity, as it is not a luxury, to find a way to deal with our emotions. In today’s world, it is called our mental health. We need to find a way to reignite the fire of passion for the practice of medicine, reinspire the love of what we do, and remember why we entered this profession. It’s not as easy as it sounds.

As it says in the Bible, “Physician, heal thyself” (Luke 4:23). According to Rachael Naomi Remen, MD, as she says so well in her book Kitchen Table Wisdom: “It’s not that we don’t care; we care too much.”

Programming Note: Listen to Dr. John Zelem every Tuesday on Talk Ten Tuesdays at 10 Eastern.

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