From residency to retirement, medical professionals typically face a tougher work load and longer hours than many other professions. In fact, 40% of Canadian doctors report facing work burnout in their career. This holds true even in a role that provides adequate downtime, as the nature of medicine – balancing patient interactions with administrative work and making decisions that impact a patient’s livelihood – is such that no matter where you are in your career, the job has the potential to be stressful.
This isn’t always a bad thing, since passion and medicine tend to go hand in hand: in a study of why doctors choose medicine, the most common answer was that medicine offered students the opportunity to serve others. For many physicians, medicine is a calling rather than a career, and taking care of your patients comes before other parts of the job – or even your own welfare. However, while passion and a desire to help others are great qualities to have as a doctor, they can easily lead to job burnout – which is bad for both you and your patients.
Tackling work burnout starts with looking at the reasons you’re burned out in the first place – from too much paperwork to around the clock patient needs, here are some of the biggest reasons doctors are burned out at work – and some tips on how to address them.
1. Administrative Workload
Unlike other professions, the administrative side of the job is nonnegotiable – while business leaders might be able to make a ‘love or loathe’ list and eliminate or delegate the parts of the job they don’t like, many tasks in a physician’s day (such as documentation on patient charts, reviewing labs or reports, filling out patient forms, or making referrals/requisitions) must be completed by you. This can not only increase the time you spend in the office, but also decrease the enjoyment you take from your job.
While some provinces have enacted reforms (such as Ontario’s workplace reform law which bans employers from requesting sick notes for short absences) to reduce the amount of paperwork doctors need to complete, the administrative burden is enough that some doctors have questioned whether or not it encroaches on patient safety. Leading the pack for administrative burdens are insurance forms, hospital intake requirements, and worker’s compensation claims – where a delay in administration can mean a serious delay in patient care.
Administrative duties may be here to stay, but there are plenty of ways doctors can spend less time on them. Using all the capabilities of your EMR system is a good place to start – if you’re doing something tedious or repetitive, there’s likely a better solution, and checking to see if there’s a workaround with your vendor, using the EMR provider’s community portal or user hub, asking other doctors in your office or creating a solution yourself will save you time in the future. In addition, many EMRs now integrate information for insurance or hospital intake forms, which could potentially reduce the amount of time spent filling them out.
Beyond your EMR, some other solutions for handling your paperwork are using a dictation system or setting aside a few hours in your day just for tackling administrative duties. If you’re billing on your own then try a smart automation system that makes billing for your time easy and straightforward. In the case of the more onerous insurance or worker’s compensation forms, one doctor surveyed by The Medical Post suggests that the patient book a time with him so they can fill out the form together – eliminating the need to spend your own evening doing paperwork.
2. Taking On Too Much
When it comes to medical practice, most doctor’s chief interest is helping the patient. When the focus is on serving others rather than getting a raise or gunning for a promotion, it’s easy to say ‘yes’ when your answer should be ‘no’ – especially if your ‘no’ means some patients don’t receive your care. Whether it’s joining committees, taking on tricky referrals, working on vacation or even showing up for work on a day where you really should call out sick, it might seem like there’s no reason to put your own needs over the people who need you – and this is something unique from any other profession.
However, even the idea of serving others doesn’t fully explain why doctors take on too much. Studies from the US show that doctors burn out more often than workers in any other stressful service based profession, despite their higher compensation and education (factors that would typically minimize job burnout rates). Unsurprisingly, the physicians at the highest risk for work burnout had the highest sense of personal responsibility.
While some doctors have argued that work life balance is simply impossible in the medical field for this reason, most agree that taking care of your own well-being is equally important. Taking a personal responsibility for your patients is excellent in moderation, but too much can leave you exhausted, burned out, and reduce the quality of care for all your other patients. Choosing your ‘yeses’ wisely can help you to prioritize the care you provide – and maintain your sanity!
3. Organizational Structure
While experts agree that there is no one cause for work burnout, a great deal of the research on the topic shows that the unique structure of the medical organization is a cause. Unlike many typical office or service environments, hospitals, clinics and care centres can be chronically understaffed, overworked, and poorly managed. Healthcare decision makers in provincial legislative bodies are typically not doctors, and provincial decisions about how patient care is to be billed and provided can very often not meet physician’s needs.
Doctors working the highest hourly workweeks are the hardest hit for job burnout and the research suggests that compensation doesn’t minimize the risk, physicians are uniquely prone to burning out. So what is the solution? Some physicians say it’s getting involved in the planning and administration of your organization. Blocking out time in your schedule for yourself or advocating for the hiring of additional staff and administrators (if needed) can help you to not only to provide better care, but also provide a better working environment for other staff. After all, while some causes of doctor burnout (like making life and death decisions or dealing with critical patients) are unavoidable, others (like working long hours in an understaffed ER) can be moderated at the organizational level.
Some researchers suggest that while stressful working conditions for doctors would be verging on illegal in other industries, doctors are expected to not only rise to the occasion, but also be infallible, omnipotent, and resilient – with a failure to do so implying they’re not up to the job. While the provision of medical care is an important and well respected responsibility (one that comes with many years of schooling and an oath) and doctors are often leaders in their communities, studies have shown that it is these ideals of perfectionism which are the root causes of job burnout.
Researcher Alan Card points out cultural expectations “that ‘good doctors’ do not complain, do not show pain, do not shirk work, and, above all, do not ever show signs or symptoms of mental illness, especially depression.” These expectations are not just harmful for doctors, but also for patient health – and living up to the ideals of a ‘good doctor’ is impossible without taking care of your most basic physical and mental health needs. Recognizing work burnout in yourself and others around you (and taking steps to address it) is a crucial first step towards solving the problem.
5. Difficult Patients
More than any other job, doctors have a huge responsibility to the people they care for – including, in some cases, making life or death decisions, losing patients, or explaining medical options to grieving or worried family members. That’s a difficult job even for doctors not working long hours! According to the US research on physician burnout, dealing with difficult or demanding patients, or dealing with patients who require intense hospital stays, is almost as big of a reason for work burnout as long hours.
Remember that you’re a person first – Card suggests thinking of the difficult parts of your work the way you would think of caring for your patients. Some suffering (like recovering from a major surgery) is unavoidable, while some (like managing pain) can and should be avoided. Of the most difficult parts of your job, there will always be painful or heartbreaking moments – but taking on many difficult patients or working exhausting hours on top of this emotional burden is putting undue stress on yourself. Remembering to ask for help if you need it, taking time to spend with friends and family, and creating a balanced workday for yourself will make sure you’re strong enough to deal with tough moments – and this is better for your patients.
While medicine might be a difficult job at times, it can also be exceptionally rewarding. Despite the added risk for job burnout, most physicians in Canada agree that despite the challenges being a doctor can pose, the benefits are worth the cost!