I recently took another survey confirming the obvious: As a resident, I am horribly burnt out. I sat, along with a half-dozen health care providers and bemoaned our current states. What, if anything, can we do about this? The typical answers came up: sleep more, increase our commitment to enjoyable activities outside of work. Oddly enough, there was little talk about the daily work itself, and how the medical culture helps or exacerbates burnout. Maybe the unit of measurement is wrong? I thought. What if burnout is not my problem, but a collective problem? What if, instead of diagnosing me, we could diagnose burnout collectively: in my primary care clinic, residency class, or inpatient service?
Physician burnout has increasingly become recognized as a major problem in healthcare. Some reports cite burnout as up to 75 percent in residents and up to 46 percent in practicing primary care physicians. Similar to diseases in medicine, burnout is framed as a problem within individuals, which can be fixed by outside means. I believe this model has it backwards: At the root, burnout starts within toxic workplaces and relationships. How might we diagnose the collective burnout in our medical communities, and what can we do about it? Below is a quick checklist to think about your level of team burnout.
1. Is your team valued and publically appreciated? In the same way individuals can become depersonalized, and become “cogs in the wheel,” hospital teams can also undergo collective depersonalization. Here’s an example. The referral coordinator office may process hundreds of referrals for medical tests, yet only hear from patients or providers when there is a problem. No amount of mindfulness could increase the satisfaction of the referral coordinator: What is needed is structural and interpersonal changes. Some ideas include an institutional commitment to recognizing the coordinator’s work, and increasing face-time with providers and patients.
2. Is your team consuming wildly different amounts of coffee? This is a rough way of asking the more serious question, “How equal is the distribution of emotional/cognitive amongst the team?” In medical, teams are typically organized hierarchically, often to the detriment of productivity and emotional health. For example, an intern may arrive on the wards at 6 a.m. daily, while the resident arrives at 8 a.m., and the attending at 9 a.m. The intern is drinking 5 cups of coffee per day to stay awake, while the NP and second-year resident chat about their research projects. It is tempting to blame the intern: He is burnt out and needs help. But in fact, the team is suffering from emotional exhaustion: an inability to find collective purpose to their work. Again, no amount of relaxation work can help the intern; what is needed is to engage the team in becoming more collaborative.
3. Can each team member define what collective success looks like? Despite the lip-service paid to “team-based care,” my experience has been that most clinicians define success individually, in terms of individual patients helped, notes completed, or consults ordered. The typical narrative in the burnout literature is that if clinicians can feel like they are accomplishing more, they will be less burned out. What this leaves out is aligning clinician work with larger team goals. For example, a resident primary care clinic may identify the goal of reducing the rate of smoking by 50% percent among hypertensive patients, or creating a system to reduce the administrative burden of disability forms. Such collective solutions address structural problems of large bureaucratic systems, instead of locating the problem in the residents psyche.
The next time I’m offered a survey on burnout, I will politely decline. Instead, I’ll make one copy, sit around a table with my team, and ask collectively, “Are we burnt out? What can we do about it?”
Tom Peteet is an internal medicine resident.
