‘Burnout is a poison’: Depersonalization, business-of-medicine issues undermine care
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WASHINGTON — Addressing burnout in rheumatology will require attention to personal exhaustion and depersonalization, as well as systemic business-of-medicine issues, according to a speaker at ACR Convergence 2024.
Leonard H. Calabrese, DO, professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, RJ Fasenmyer chair of clinical immunology at the Cleveland Clinic, and chief medical editor of Healio Rheumatology, told attendees that although efforts are being made to “recruit, train, and sustain” rheumatology professionals, these providers, at nearly every level and geographic region, are reporting increasing rates of burnout.
“Burnout is a poison to every element in this equation,” he said.
Sources for this seemingly ever-present exhaustion range from the personal to the systemic, according to Calabrese.
On the personal side, providers often feel emotional exhaustion.
“The existential battery is draining,” Calabrese said.
This can lead to depersonalization, where providers become detached in their response to others.
“This is poison for empathy,” Calabrese said, stressing how a lack of empathy can be consequential for all physicians. “Empathy is one of the strongest tools in our toolbox.”
Physicians can also feel a low sense of accomplishment.
“If you are doing all of the things you dreamed of, but you are not making it and falling behind on the treadmill, it leads to burnout,” Calabrese said.
Regarding systemic issues, Calabrese argued that the business of medicine has led to a loss of autonomy for many physicians. He highlighted a refrain from those involved in the financial aspects of health care practices, who demand that providers see more patients, in a shorter amount of time, yet still improve outcomes and satisfaction.
“We know what the right thing to do is, the right medicine, but we are blocked from doing that,” Calabrese said. “It is in conflict with the covenant of care. We have a problem and we need to address this.”
Although he acknowledged that burnout is a “cultural phenomenon” observed in myriad professions and industries, Calabrese stated that its presence in medicine can have catastrophic consequences if left unchecked.
“The surgeon general points out that burnout in medicine has some primacy,” he said. “If the medical community is burned out, it has a direct impact on the health and well-being of the population.”
The issue is of particular concern in rheumatology. Calabrese noted that, in a study of more than 37,000 health care providers who were asked questions relating to burnout, 39% reported an intention to change professions.
Rheumatologists were strongly represented in this group.
“We are in the upper third of burned-out groups,” Calabrese said.
“Rheumatology has a manpower problem,” he added. “But, remember, rheumatology is a village.”
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Calabrese L. Burnout in Rheumatology. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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