Doctors are responsible for the physical and mental well-being of everyone else, while their own health is widely overlooked. What’s even stranger is that it is widely overlooked within the medical community as well, especially in Asian countries.
In this article, we explore the what, why, and how of physician burnout.
Physician burnout is often described as ‘running on an empty tank’. Extremely apt, because when a car’s fuel tank is empty it stops functioning, but as a healthcare professional - that is usually not an option.
Burnout has been defined by CP West et al. as ‘A work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment.’
Burnout is described by the ICD-11 as:
It creeps in gradually, and usually without the victim realizing it until it slowly erodes through their life, and if not addressed can have serious consequences.
The consequences of burnout are physical, mental, social and professional.
Mental: Anger, irritability, apathy, detachment, helplessness, loss of motivation and self-esteem.
Social: Isolation, negative changes in interpersonal relationships, detachment from others.
Physical: Change in appetite and sleep patterns, fatigue, exhaustion, decreased immunity, mental illnesses such as depression and anxiety disorders.
Professional: Procrastination, decreased cognitive performance, reduced quality of patient care, decreased productivity, loss of desire to work, depersonalization towards patients.
Chronic stress might be the obvious cause for it, but it isn’t enough to stop there. That is an easy answer, and one often met by ‘you chose this’ or ‘that’s just how medicine is’.
But, what is causing this burnout? What are the finer points to this chronic stress? Which of them can be managed? Perhaps it might help to take notes from countries facing relatively lower burnout rates than ours, such as the UK and Germany - even if all of their solutions are not directly transferable.
The most widely cited reasons for burnout in India have been:
India has no cap for the number of hours a doctor can be made to work, including no mandatory days off or fixed night duty hours. Moreover, the time spent on work-related matters and studying even at home is disproportionately high, leaving no time for personal life.
The system of hierarchical reverence in India penetrates deep into the field of medicine. Leadership skills based on mutual respect and professional courtesy are not adequately practiced, with no guidelines for the same and no consequences for the opposite. The difference in autonomy to express opinions between India and other countries is stark.
Moreover, there is often a lack of clarity of roles and responsibilities and no accountability for being asked to perform excessive work.
The ever-growing, misplaced distrust towards doctors and the constant swinging between deifying them to anger for when they don’t deliver to those expectations has been a rising cause of concern for doctors.
India has one of the world’s worst doctor-patient ratios with the number of MBBS and MD/MS seats not increasing proportionately.
There is once again a massive gap between the number of doctors graduating MBBS and the number of specialty seats available to them, leaving a large number competing endlessly each year.
Despite public perception, doctors in India do not earn well, especially if their per-hourly earnings are looked at.
Most doctors throughout their 20s are heavily dependent on their families or spouses as most academic and non-academic junior doctor positions do not pay living wages - heavily disproportionate to the skill and working hours expected.
Even senior doctors must work several times more than their counterparts in other professions to earn the same.
This varies from place to place with some being better than others. A handle on the ragging culture has been attained in most universities. However, the hours spent on outdated teaching methods like long non-interactive lectures, the severe lack of days off and holidays even while in college, and the rote learning methods still required to pass examinations in India create conditions facilitating burnout starting much before even earning the title of doctor.
There are, however, steps that can be taken to reduce their impact - starting with educating more doctors on physician burnout.
The lack of awareness of physician burnout, the stigma faced, and the potential loss of opportunities faced due to lack of acknowledgment of the condition by employers must be corrected. Education and awareness on physician burnout and mental health must be formally or informally taught.
Talking about it and addressing the issue starts vital conversations that can eventually lead to change in terms of laws and policies, as well as a general change in work environments.
Burnout management must involve two things:
Laws and policies addressing workplace safety for doctors, low income, the weak doctor-patient ratio, and the gap between the number of undergraduate and postgraduate positions available must be collaboratively and comprehensively addressed by the medical community and non-medical policymakers.
Better hospital working conditions, mandated days off, fixed hours for junior and senior doctors, an emphasis on hospital-specific leadership skills for doctors and management could go a long way in improving work environments and increasing productivity and goodwill.
Lastly, on an individual level, it would be pertinent for every doctor to take responsibility for the mental well-being of their juniors, their departments, their workplace, and each other. Caring for each other extends to mutual respect for each other - colleagues or juniors, better rota divisions to ensure at least 1 day off in a week or two are ensured, more autonomy for expressing opinions, professionalism, and courteousness in all interactions, and a positive learning environment. Self-care has no space in an environment that isn’t allowing it.
Physician burnout is a systemic problem and cannot be addressed in a ‘survival of the fittest’ manner. That is good for neither doctors, their patients nor their hospitals. Policy changes, workplace changes, and individual changes are all essential to tackle it.