Not long ago I received an email that made my heart sink.
It was from someone I knew in medical school many years ago (too many to say out loud). We lost touch a few years years after I graduated.
The short email read:
“I am owned by the University of ——-, and mired in Primary Care practice. I’ve made a major career mistake.”
My last memories of my friend were of him winning a prestigious award that recognizes the medical student who best exemplifies the ultimate in patient care. He was enthusiastic about his life and was looking forward to a rewarding career in internal medicine.
I gave him a call and he filled me in on the downward spiral that led to this point where he would gladly leave medicine if he only knew how. (He agreed with my writing about his situation here).
He told me about some rough patches during residency, then a practice partnership that went south, followed by the all too common stresses of juggling work and family life, and a time on call when he “lost it” one night in a big way. But what I found most upsetting was when he told me about what he lost.
His job at the university had initially allowed him to teach part-time in addition to seeing patients, and he quickly won several teaching awards. He loved this part of his job and it kept him motivated and engaged. Then he was told he needed to see more patients instead of teaching in order to increase revenue. That was a huge blow. The second blow came when he had to decrease the time he spent with patients. Spending time educating his patients about their disease was really important to him, and one of the reasons he won the award in medical school. Now he never had enough time to practice in a way that was satisfying.
Here was someone who had loved medicine, loved his patients, was a great teacher, and had been thrilled about spending the rest of his life being a doctor. Now, all that seemed lost in a trap of conflicting values.
Is this the path we would chose for our future doctors? To have them burned out and demoralized while their career is still young?
How do we prevent this from happening?
In my last post on the causes of burnout, I said I would be talking about solutions next.
The solution is going to have to happen on an individual as well as an institutional level. It is not enough to tell doctors to get their lives in balance, exercise, eat right, take a stress management course and learn to express their feelings. Clinics, hospitals and universities need to actively promote physician wellness and have it be an integral part of the professional culture. Fortunately, some are already doing this.
Dr. Anderson Spickard, a physician wellness expert, speaks to this model in his article on burnout in JAMA*:
“Preventing burnout, a responsibility of all physicians and of the health care systems and organizations in which they work, entails the explicit promotion of physician well-being. Physicians must be guided from the earliest years of training to cultivate methods of personal renewal, emotional self-awareness, connection with social support systems, and a sense of mastery and meaning in their work. Maintaining these values is the work of a lifetime. It is not incidental to medicine but is at the core of the deepest values of the profession to first, do no harm. Doing no harm begins with one’s self. “
It is estimated that the loss of one primary care physician costs hundreds of thousands of dollars.
However, there really is no way to estimate the cost of losing the love of one’s profession.
It doesn’t have to be this way.
Next blog – practical suggestions for burnout.
*JAMA 2002:288(12)1447-1450 Mid-Career Burnout in Generalists and Specialists Physicians. Spickard et al.
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