There are multiple statistical trends among medical students and resident physicians that are worrisome – the most poignant of which is the fact that doctors, including medical students and resident physicians, have the highest suicide rate of any profession. In this post, we’ll cover burnout, a common precursor to depression and suicide, in medical trainees. We’ll go over what burnout is, what causes burnout, and how you can reduce your own risk of burning out.
What is Burnout & Why Should I Care?
Burnout can be described as a physical or mental collapse caused by overwork or stress, often relating to caregiving activities or work. It is thought to be derived from three distinct elements, including emotional exhaustion, depersonalization, and reduced sense of personal accomplishment. Keep those three elements in mind, as we’ll be referring to them throughout this video.
Burnout is everyone’s business. Burnout has reached epidemic levels, in some studies exceeding 50% of medical trainees or doctors in practice. It’s not exclusive to just medical students and residents, but rather workers in all industries. In this video, we’ll be focusing on the data regarding burnout in medical trainees and doctors. This, too, is everyone’s business, as burnout contributes to an increased risk of medical errors, depression, and adverse effects on patient safety. You don’t want your doctor burned out.
What Causes Burnout?
There are several theories on what causes burnout, the most convincing of which is the Job Demands-Resources Model. In its simplest terms, the Jobs Demands-Resources Model states that high job demands lead to exhaustion, and low resources lead to cynicism and feelings of low personal efficacy.
Overall, chronic exposure to stress is the main risk factor. It’s no surprise, then, that medical students and residents in particular are subject to extraordinarily high rates of burnout. It’s common for medical trainees to be deprived of sleep, have a high workload, relatively low salaries, and several responsibilities in their workplace. Yet there are other tremendous but often overlooked stressors in this profession, including the great responsibility for the health of other people, dealing with sick people, pain, patients, and their families.
In a 2018 meta-analysis and systematic review by Rodrigues and colleagues, it was found that residents in surgical, like general surgery and ortho, and urgent specialties, like anesthesiology and OBGYN, demonstrated significantly higher rates of burnout.
Interestingly, students who are single are significantly more emotionally exhausted than classmates in relationships. This doesn’t mean to run out and get into a relationship pronto, but it does highlight the importance of social support in warding off burnout.
If you look at the rates of burnout over the past few decades, there has been a consistent and steady rise. After scouring the literature and trends in medical training, I would attribute this to three main factors:
1 | Increasing Competitiveness
Over the past 10 years, medical school has become significantly more competitive, with a significant rise in the number of applicants, but not enough new positions in medical school to accommodate the increase. In such a landscape, pre-med and medical students are subject to ever increasing levels of stress.
2 | Modern Medicine & The Computer
Dr. Atul Gawande wrote an excellent piece in The New Yorker about how technological changes in medicine have contributed to burnout. In short, increasing requirements for computer documentation are highly correlated with burnout, which is why neurosurgeons are less likely to be burned out than emergency physicians – they just spend less time documenting. Additionally, decreasing physician autonomy is a major factor, as outlined by the Jobs Demand-Resources Model.
3 | More Female Physicians
Having more equal representation by both men and women in medicine is no doubt a good thing. There are more female physicians now than ever before. In fact, 2017 marked the first year where there were more women than men enrolled in medical schools.
It is important to note, however, that the literature has consistently demonstrated that women are more likely than men to experience burnout, and the increasing rates of women in medicine is one of many factors contributing to increasing rates of burnout over the years. This is obviously not a judgement in any way, but rather an objective reporting of the data.
By understanding differences in burnout pattern causes and behaviors between men and women, we become better equipped to solve a multifaceted and complex issue. For example, as reported by the AMA, burned out female physicians are more likely to sleep, eat junk food, or binge eat than their male counterparts. The 2018 Medscape Physician Burnout & Depression Report noted that women rank family and romantic relationships as top factors contributing to burnout, whereas for men, finances was number one. Further examination of the patterns in burnout between men and women is necessary in order to best address and overcome this complex issue.
How Do We Address Burnout?
In order to address burnout, we must look at both preventative and therapeutic interventions. How do we reduce the risk of it happening, and if it has happened, what can we do about it? Similarly, we must examine how individuals can best deal with burnout, and what we need to change on a systemic level to reverse the trend of increasing burnout over the last several decades.
On an individual level, there are 4 main pieces of actionable advice:
1 | Social Support
The most consistent finding throughout the scientific literature is that social support reduces burnout. Women seem to be better at this, seeking professional help for burnout on average 31% of the time compared to men at 24%.
My advice to you is two-fold: first, seek professional help if you believe you are burned out, depressed, or suicidal. Second, seek the support from your friends, family, and colleagues. I advise doing a shared activity where you can speak at ease and with relative privacy, such as during a hike, a relaxed sport, or grabbing a meal or coffee.
2 | Sleep
Sleep duration is negatively correlated with burnout, meaning the more you sleep, the less likely you are to be burned out. Unfortunately, if you’re burned out, your sleep quality is likely to suffer. We have other posts going over the best ways to optimize your sleep, with actionable advice on improving sleep hygiene and consistently waking up significantly more refreshed. Link in the description below.
3 | Optimize Your Day to Day Life
Life optimization is the name of the game here at Med School Insiders. In creating a future generation of happier, healthier, and more effective doctors, we understand that your personal and professional lives are not siloed apart, but rather are closely intertwined.
Optimizing your sleep, productivity, and overall efficiency is going to go a long way. However, there are frequently overlooked aspects that deserve highlight. First, shorten your commute. When I was in plastic surgery residency, I paid a premium to live near the hospital. This reduced my commute drastically and also allowed me to cycle to and from work. Ultimately, this meant more time for sleep, and I was able to get cardio twice daily, automatically.
Other ways you can buy yourself more time include ordering takeout instead of cooking yourself, getting a housecleaning service, or using ride-sharing services like Uber or Lyft rather than driving. Maintaining healthy habits such as proper nutrition and regular exercise will also go a long way in sustaining this intense lifestyle and warding off burn out.
4 | Vacations – Not as Helpful as you Think
Now, an important point about vacations. Contrary to popular belief, they may not be as helpful as you think. The reduction in burnout symptoms is short lived, lasting on average less than 3 weeks. Plus, we want sustainable fixes, and vacations are relatively infrequent if you work in the medical profession.
Now onto the systemic causes. Ultimately, burnout is more of a systemic issue than a personal issue. While we must all take responsibility and mitigate it in our own lives, the fact that burnout among medical students, residents, and attending physicians has been consistently rising for decades points to a systemic cause.
More and more medical schools and residency programs are pushing wellness programs to address this growing issue. While these programs may have good intentions, their utility and ultimate benefit is questionable. A major point of contention is the fact that these programs push an undertone that burnout is the responsibility of the medical student or resident – a failure of individuals to properly self-care, sleep, and mitigate stress.
Rather, we need to urge our programs and institutions to make meaningful changes. Facilitating social support, sleep, and autonomy are areas that, based on the scientific literature, would be beneficial to this growing issue.
Burnout has been strongly correlated with suicidal ideation, even after controlling for depression. This is something I care deeply about, as I’ve lost friends, colleagues, and classmates to suicide. Nothing was being done about it, and suicides were being swept under the rug. So I decided to do something about it.
Together with a team of other medical students and residents passionate about this issue, we have started an initiative to raise awareness and help fund proposals in reducing medical student and resident physician burnout, depression, and suicide. It’s called the #SaveOurDoctors Grant. If you too refuse to sit idle in this epidemic, this is your chance to take a stance. There are three ways for your to help: first, submit a video on the submission page outlining your own proposal and enter for a chance to win. Second, blast #SaveOurDoctors on your social media accounts. And third, donate to the cause. Fully 100% of all proceeds go toward the grant and addressing this issue. I’ve personally put $1,000 from my own pocket into this, but if you’re willing to donate even $5, that too will go a long way.
Thank you for reading. I hope this post has helped you understand burn out and provided you with actionable advice. If you too are passionate about doing something, please get involved with the #SaveOurDoctors movement. Thank you for your support.