Burnout in the Hospital: Why Doctors Are Set Up for Stress

Some experts call physician burn out “inevitable,” given the high-pressure environment in which they must make potentially life-saving, and almost always life-altering, choices on a constant basis. Research shows that up to 40% of U.S. doctors experience emotional, physical, and psychological burnout from their jobs, and the consequences are no different for them than they are for people in other occupations — substance abuse and cutting corners.

In the premiere issue of the journal Burnout Research, which is dedicated to research on the topic, Anthony Montgomery, an associate professor in the Psychology of Work and Organizations in the University of Macedonia in Greece, focused on physician burnout, and argues that the way doctors are trained may set them up for a career of frustrations and high-stress situations. And the consequences may be hurting the care they provide patients.

He says that while doctors interact with people on a daily basis, their training and their worth as physicians are focused almost entirely on their technical capabilities, leaving them with few tools for understanding and navigating social interactions and for collaborating as part of a larger team or organization.

Montgomery argues that most medical students are chosen because of their high test scores, so medical school becomes like an extension of school. They then become residents, thrown into a more social environment in which they are expected to interact with patients, hospital staff and colleagues in ways they may not have expected to or been prepared to do. It’s assumed they have the leadership skills and the proper emotional capacity to guide patients through extremely stressful and often traumatic experiences, but not having the tools to manage these situations can be stressful on the doctors themselves. While burnout among physicians is widespread, some studies have shown surgeons and OBGYNs can be at a particularly high risk.

“The irony is that doctors are the one group of people we don’t want to be stressed, yet we are increasing the possibility for them to make mistakes,” says Montgomery. “Doctors understand that their job is to be the best doctor they can, but [they do] not necessarily [understand] their part in helping the hospital as a whole better serve the community.” In his practice, for example, Montgomery says that his colleagues admitted to learning skills like communication and teamwork on the job, after they left medical school.

And that’s not just a problem for the medical community. The more doctors feel stressed about their jobs, the more they feel burned out and defeated by the health care system, leading to less motivation to improve conditions, both for themselves and for patients. A 2012 study published in Archives of Internal Medicine reported that nearly 1 in 2 U.S. physicians report at least one symptom of burnout, like losing enthusiasm for their work, or growing cynical. Forty percent of doctors reported being unsatisfied with their work-life balance and that they did not have time to devote to their families or their personal lives. And in a 2013 study published in JAMA, the consequences of that burnout started to emerge — only 36% of 2,556 surveyed physicians believed doctors had a major responsibility in reducing health care costs, despite the fact that they prescribe the drugs, tests and procedures that can escalate costs. Other studies also link burnout to poorer quality care and increased rates of medical errors.

What can be done to alleviate some of the pressure on physicians? Montgomery cites revisiting the way doctors are educated in order to arm them with stronger social and leadership skills, as well as some untraditional strategies, including teaching mindfulness. Improving the doctor-patient relationship may also help, so physicians and patients collaborate in their care rather than perpetuate a hierarchical system which neither doctor nor patient finds satisfying. He writes: “The uncomfortable truth is that we may need to reimagine healthcare in a way that views some errors as unavoidable, demystifies the physicians as superheroes, engages real patient participation and steers healthcare professionals away from cultures of self-preservation.” In other words, making health care more satisfying for physicians and patients may be a group effort, and that’s something that doctors aren’t quite used to yet.