Burnout in rheumatology: The importance of searching for joy
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This month’s cover story on rheumatology and burnout brings to the fore numerous issues and challenges for our profession for both physicians and advanced practitioners.
The discussion is spot-on in my opinion as to the contributing causes, but unfortunately there are no simple solutions.
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What I did take away from our discussants, however, is a growing sense that our national discontent is gradually coming to a head at every level, from the embattled solo practitioner, to small and large group practices, to the employees of major centers and academic institutions. For most of us who picked our jobs in the recent or remote past, things have likely changed from what we originally aspired to, or what we have previously experienced years and decades ago.
I will also assert that, in general, while our current treatments have vastly improved, the changes regarding how we interact and care for our patients are in many ways not for the better.
Does anyone spend more time with their patients now than in years past? Answer: No. Does anyone perform less administrative tasks and regulatory lather and blather than in the past 5 or 10 — or more — years? Answer: No. Are there many among us who believe that the electronic medical record has been optimized for fast, efficient and personalized health care delivery rather than being a billing and coding machine that has burdened us with a continuous flow of meaningless tasks, which pile up in real time faster than lake effect snow on the shores of Lake Erie? Answer: Definitely no.
If you accept that these observations are at least partially true, then let me share with you what I tell young practitioners to look for as they search for their first job.
First, set your priorities. If it is money, then at least the measurement is easy (ie, salary) but you have to pay for that. In an era of venture capital-acquired practices (which rheumatology is just now entering), cash is king, so to speak, so be willing to sacrifice considerably in terms of time, educational opportunities and medical humanism. Some settings are likely better than others so be aware.
If you are looking for lifestyle — ie, no hospital, 4-day work weeks and location — then go find it. There will be costs in terms of time, efficiency and productivity as well, for nothing is free.
If you are looking for an academic practice setting, make sure it really is one in practice — and not in name only. In general, there will be a financial trade-off but that must come in return with some time for reflection, education and investigation in a formula that is right for you. Furthermore, make sure your productivity will be measured in some definable way. Merely being associated with a university or academic center is no guarantee that every practitioner is treated similarly across the system.
Over and above, perhaps the most important advice I offer is to go there and see how it is done. Talk to those who are involved and assess what kind of people you will be working with. Are they happy? Do they genuinely like each other? Do they have each other’s backs? I am amazed that this most human dimension is so often ignored as applicants try to buff themselves to their potential future employers. A well run and happy group is an asset worth searching for, because when your work is joy it is no longer work.
Of course, past performance does not guarantee future returns. Places change and so do people. With so much being said about burnout it is hard not to be cynical about potential solutions, but I feel we undersell the personal and oversell the impersonal. Don’t forget to look for the setting that, in your own mind and values, will fill you with the most joy. That’s my take. What’s yours? Please share your thoughts with me at calabrl@ccf.org or at rheumatology@healio.com.
- For more information:
- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
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