Physicians are ‘perfectly constructed’ to burn out

AUSTIN, Texas — The intrinsic personality traits of the physician lay the foundation for burnout, according to an expert speaking at GI Outlook. The internal drive for perfection, lifetime rewards for overwork and need to surpass outside markers for success can quickly push a physician past a healthy mental state.

“Physicians are perfectly constructed to be burnt out,” Daniel O’Connell, PhD, a clinical psychologist, consultant to The Institute for Healthcare Communication and faculty for the Foundation for Medical Excellence, said during his presentation. “If I were to create a program to burn out a smart professional, medicine would be the program, which does not mean you are the problem. It means you have to understand you were constructed and trained to be the ideal tool to be burnt out. Which means you have to take more responsibility for yourself.”

O’Connell explained that physicians equate how hard they work with love and satisfaction.

“Work is placed in an exalted position. For many of you, work was placed in an exalted position in preschool. Some of you were voted most likely to succeed in preschool and first grade and second grade,” he said. “Work was exalted above all other things and then you come into the practice and work is again exalted. If there’s competitiveness in the group, then the one who works the hardest is a form of royalty. This is neurotic, but no one will know because they’ve been in this ... someone has to help them to realize this is not normal.”

Speaking at a practice management conference, O’Connell called on the physician leaders and practice administrators to “have courageous conversations” where those that have reached a level of burn out can recognize it and work toward solutions.

“We have physicians we have to save from themselves,” he said. “People can often not see the problem they’re in. We have to help them.”

Where the system has failed physicians, O’Connell said, is when the meaningful work that brought that initial satisfaction, passion and love got confused with the highest paid work.

“If you lose the meaning of work, the extrinsic reinforcers start to take over,” he said. “To use financial incentives for things that should be intrinsically rewarding will almost certainly become corrosive.”

This corrosion is easily seen in the burnout rates among physicians, especially women, O’Connell said. Female physicians have a higher rate of burnout and report suicidal idealization three times more often than their male counterparts.

“I’d like us to recognize how the organizations we construct, how individually inside ourselves and societal dynamics contribute to the problem, which is production pressure leading to burnout,” he said.

With that in mind, O’Connell presented five challenges for physicians:

1. Reflect on your own psychology – perhaps with the help of a mental health practitioner – and how it has made you the ideal tool to be burned out by a profession.

2. Rethink income expectations in a way to allow more flexibility for yourself, your family and your practice or institution. Be honest with yourself, your family and your practice.

3. Exert more meaningful or effective influence over your work situation. Don’t just complain without forging a path to improvement, either organizational or personal.

4. Allow your workload to decrease by training and authorizing others (staff and mid-level providers) to do more clinical tasks.

5. Think, communicate and negotiate in a way that does not over-personalize issues. Focus on interests, options, fairness and acceptance of alternatives.

“You’re doctors, and you cannot delegate to other forces the path of your life,” he said. “People as highly trained and intelligent as physicians should feel like they have more choices, not fewer. They should not feel like slaves. They should feel like intelligent people shaping their lives.” – by Katrina Altersitz

Reference: O’Connell D. Lighting the Flame on Physician Burnout. Presented at: GI Outlook; Austin, Texas; August 10-12, 2018.