Match Day for medical students was March 16, the day they found out if they earned a residency position and, if so, where they would be completing the next step of their clinical training.
In many ways, the years of sacrifice, late nights, debt and struggle all come down to this moment. Yet, at the same time they are realizing their dreams, physicians in training are entering a culture that is replete with men and women questioning their calling to medicine.
As with any busy professional, burnout can have a significant impact on job performance and mental health. Yet given the stakes, burnout is especially prevalent and important to understand in the medical field. A recent study suggests at least a third of physicians are at risk of severe burnout, but it’s important to understand why in order to turn the tide.
As physicians ourselves, we live and witness the reality of burnout in our practices—both personally and gleaned from commiseration with our colleagues. A recent article by nephrologist Amy Williams calls for systematic and institutional changes to address this modern plague of mental and physical exhaustion.
Physician burnout is defined as “a long-term stress reaction characterized by depersonalization, including cynical or negative attitudes toward patients, emotional exhaustion, a feeling of decreased personal achievement and a lack of empathy for patients.” Research shows this is an increasing issue for physicians, impacting all specialties, and a pervasive problem. And, institutions are finally recognizing this and applying scientific solutions.
But, the real problem is in the medical culture that tells us to take care of our patients and their families before ourselves. This extends to all clinicians, not just physicians. And it’s understandable. After all, for many of us, it often is a matter of life and death.
Physicians and researchers have identified interventions to cope with and prevent physician burnout. Hospitals and academic centers now offer wellness programs, yoga, physician workrooms, meditation and mindfulness. Unfortunately, they become an additional item on a to-do list rather than a replacement for existing job responsibilities.
While these may help decrease stress, the real problems on a systems level, such as decreasing clerical burden, allowing for a work-home balance, and changing the cultural expectations of the ideal physician, are harder to acknowledge and address.
Yet, even this does not tell the whole story. A scientific approach will not address what is in essence a failure of allowing physicians to practice the art of medicine. The purpose of our calling has been broken. And, in order to repair this for this generation of physicians and ones to come, we need to revisit how to practice medicine and find joy as physicians.
As medical students, we relied on Stedman’s Medical Dictionary, and physician is defined as “a doctor; a person who has been educated, trained, and licensed to practice the art and science of medicine.”
Years of hard work and sacrifice are required to learn the science of medicine. This typically involves four years of college, four years of medical school, three to eight years of additional training, and a multitude of standardized tests to earn licenses as well as board certifications. These tests and rites of passage communicate the competency to practice medicine.
But how physicians learn the art of medicine is harder to define, yet it is the foundation of what sustains them over time. It involves understanding people and their vulnerabilities, having empathy, communication effectively, being exposed to storytelling and narrative about illness and suffering, sharing your own failures and successes, and finally wanting to be a part of this often messy and grey arena of caring for patients.
Physician and writer Rachel Remen described that “our power to heal is far less limited than our power to cure. Healing is not a relationship between an expert and a problem … it is a relationship between human beings.”
Most importantly, practicing the art of medicine must then be modeled by other physicians to teach the next generation. We learn the art of sitting with parents as their child dies or telling them that their child has a lifelong illness. We spend our days considering how to best help children and families and how to guide them when things go wrong. We consider how to best be with patients during times of uncertainty. These relationships and moments are at the heart of our calling to medicine.
The calling to medicine is intimately linked to the art of medicine and it is this art that the medical profession must reclaim.
In fact, the debate about burnout may be the beginning of a renaissance in medicine, where physicians reconsider how the art that feeds the joy of their calling is practiced. Where they consider innovative models of care that allow them to be financially solvent but also establish meaningful healing relationships with patients, families and colleagues. But to do so, the culture of medicine may need to change faster than it historically has done to prevent extinction.
This is particularly challenging in a medical culture that primarily values efficiency, visit numbers, productivity metrics and outcomes measures. What it does not measure or account for is the dearth of time and space to think and to talk about patients, the connection with colleagues that is required to optimize care, and the inspiration required to innovate and to consider better ways to care for our patients.
To be sure, those metrics are required to keep the business of medicine thriving in uncertain times. But they are not the measures that motivate physicians to continue to practice medicine or inspire future generations to listen to the voice of calling.
Personally, we have revisited our own stories to understand why we felt medicine was a calling and actively reconnected the art of medicine to our daily life. This may be through working in patient advocacy, writing, getting involved to make a difference, and assuming control in our day to day clinical activities. To take back control means putting ourselves in positions where we can effect change. Yes, this may not be direct patient care and not what we signed up to do but sadly, it is what we have to do if we are to ever recreate a system where the art is valued as much as the science.
Consider the words of poet Adrienne Rich as she described the experience of Marie Curie in Power:
…She died a famous woman denying
her wounds came from the same source as her power.
As physicians, our wounds of burnout can accumulate and we can deny them. Or we can name them, harness them, and with our collective power call for the foundation of a new culture in medicine that allows for the space, connection and inspiration required for physicians and all clinicians to be healers.