Banner by Natalie Cohen

Burnout, Breaks, and Balance

By Alexandra Perazzo

Roaming through Staten Island University Hospital as a meek sophomore in high school, I was eager to watch and learn about the inner workings of the hospital. I scurried around the hallways holding my head high as I did my average volunteer due diligence. Give out water, command directions, offer a hand. “Do you need any help with anything?” Give out water, command directions, offer a hand. “Sorry, I’m a volunteer, I can’t do that.” Give out water, command directions, offer a hand. “I don’t know where that room is but I can find out!” One Wednesday, in my bright mustard-yellow “VOLUNTEER” shirt, I was sitting on a ledge looking out the window at a beautiful scene of the hospital roof, when a doctor in his pristine white coat muttered to the resident trailing behind him, “I never should have gone into medicine.”

Most prospective medical students have been discouraged from their dream career by one person or another. Too much time. Too much money. Poor quality of life. One study found that most doctors are dissatisfied with their job, and more than half would not choose a career in medicine if they could do it over again. These statistics highlight the severity of physician burnout—it’s an epidemic. But the normalization of doctors as rude, narcissistic, tired, and lifeless isn’t fair, and it certainly isn’t normal.

Physician burnout is a commonly experienced disorder associated with negative attitudes, exhaustion, low satisfaction, irritability, and imposter syndrome. Dr. Latrice Akuamoah is a pain management physician and anesthesiologist at the Spine and Pain Institute of New York, in New York City. She confirms that it is very common for doctors to experience symptoms of physician burnout. These symptoms are particularly harmful because of their effects on quality of care and personal justice. Firstly, physician burnout can severely harm a patient physically and emotionally. For example, there are cases of malpractice, reduced patient satisfaction, medical mistakes, and reduced quality of care, that can be attributed to the symptoms of physician burnout. Research conducted at the Stanford University School of Medicine concluded physicians experiencing burnout are over two times as likely to make a medical error, commonly including misdiagnosis, anesthesia/surgical errors, premature discharge, and prescription mistakes.

Additionally, for a profession that makes such a significant contribution to the well-being of society, there should not be such high rates of burnout. Physicians should not be burdened with distress just because the disposition is accepted in the field. The Association of American Medical Colleges estimated that 29% of residents suffer from depression. Why should physicians, who spend most of their life trying to improve the wellbeing of suffering individuals, have to compromise their own well being at the cost of doing their job?

Dr. Akuamoah’s experience with burnout is a state of “ebbs and flows.” She describes having elements of burnout at certain times, but it all comes and goes. Still, she reports being satisfied with her career and thinks medicine is where she should be, as it aligns with her interests closely. Even though burnout has not been particularly taxing on her, she points to a physician’s environment as the major contributor to the severity of burnout, explaining that, “If you’re in a workplace that recognizes your contributions and gives you good feedback, you’re going to feel a lot better going to work every day, even though our job is stressful and challenging”. She also discussed some habits and prevention methods to reduce burnout, such as looking forward to and making time for breaks, traveling, yoga, and going out with her friends. Dr. Akuamoah is well aware of the impact and significance of physician burnout, but she has created an environment and routine that, for her, minimizes the severity of burnout.

Medical student burnout has become just as common as physician burnout, however often stemming from different triggers. The mix of high standards, numerous demands, high stress, and low tolerance for mistakes placed on medical students lead to incidences of fatigue, eating disorders, emotional instability, and even drug use. Education to become a doctor is supposed to be rigorous, but rigor should not insinuate toxicity. Now, take all of these social stressors, and couple them with extremely high tuition costs. After over a decade of schooling, most doctors are drowning in debt, and face burnout and job dissatisfaction. This, too, assumes that our hypothetical student gets admitted to medical school, successfully matched into a residency program, and can acquire a job—all of which are not simple tasks.

One solution that has been growing in popularity for a multitude of reasons is the gap year. Now more than ever, many pre-medical students chose to take a year or more “off” from school to separate their undergraduate education from their medical school education. They often use this time to relax after school, save money, gain clinical experience, or improve their chances of being accepted into medical school. With competition increasing, many students feel they need the extra time to make their application as strong as possible. Also, with the probability of experiencing burnout being so high, students also understand that a year away from school could be beneficial for their mental health; the journey to becoming a physician is not a sprint.

With this being said, the effectiveness of a gap year is highly contested, as it was not nearly as common as it is now to take a gap year a decade ago. Dr. Akuamoah touched on how the number of medical school applicants taking a gap year has gained a lot of traction, stating “It just wasn’t really done when I was training.” Some argue that it is difficult to make the transition back to school (you lose momentum), you waste a year of progress towards your degree, or it’ll look like a vacation year. Dr. Akuamoah argues that a gap year should be taken simply if you want a year to do something different. “Once you’re in medicine, you’re in medicine…I think you should take a year off if that’s what you want to do. If you want to go abroad, work in a different career, or see something new, do that, but don’t be afraid that what you’ve done isn’t good enough or try to protect yourself from burnout.”

Despite the increasing prevalence, coverage, and understanding of burnout, little is being done to actually solve the issue. The New England Journal of Medicine (NEJM) Catalyst reports that 96% of clinicians and executives believe physician burnout is a serious issue, but when asked what is being done in surveys, most respondents reported that there was little to no action. Most suggestions often point to physicians themselves as the problem, telling them to eat better, sleep, or practice mindfulness. But 96% tells us that the individual is not the problem, it’s the tells us that the individual is not the problem, it’s the environment.

Dr. Akuamaoh discussed a phenomenon relating to the “domino effect”, which is where a physician experiencing burnout shows symptoms of stress, tiredness, and irritability, leading to a less supportive environment for their peers. Then, this environment triggers other physicians and health care workers to spiral towards feelings of stress and irritability, and as it goes on, it creates a cycle of burnout and forms a toxic environment. Instead of blaming physicians, systemic changes outlined by NEJM Catalyst, such as limiting intrusive regulations, delegating tasks, lowering workload expectations (increasing sustainable working conditions), and measuring/tracking the well-being of physicians, are ways to actually create actual change.

Additionally, we should listen to physician input, and let them have a voice in the way hospital regulations are put in place. Physicians and other health care workers are integral to care, and therefore should have a say in how care is carried out. Finally, changes should begin to be made in medical school. Some researchers suggest that implementations such as mindfulness training and group discussions should be expected in physician’s training. While learning and growing into a physician, students should also gain the strategies necessary to combat stress and other burnout symptoms.

There is beauty in medicine, and coming together to help better support healthcare workers is a beautiful cause. When I was shadowing at the Spine and Pain Institute of New York, a doctor told me that “Medicine is beautiful and it’s all around us. It is the foundation of everything.” Surrounding students with the notion that being in the medical field is impossibly taxing is neither inspiring nor accurate, and it emphasizes the misconception that being a miserable doctor is the same as being a good one. Students should be energized by their superiors, and feel validated taking on their own path. Balance and breaks are necessary and should not be stigmatized, in order to create a more successful environment and reduce burnout for the entire healthcare community.