Physician burnout has received a lot of well-deserved attention lately. Characterized by emotional exhaustion and professional frustration, it’s tied to an array of adverse consequences, from physician suicide to poor patient outcomes. Organizations are waking up to the need to measure its prevalence and ameliorate its impact.

There seems to be two broad schools of thought about the causes — and by extension, the fixes — of physician burnout.

The first focuses on the inner life of the physician. Yes, the demands of medical practice are high, but if doctors were a little more “zen” about things, then life would be better for them and the people around them — including their patients. There is a substantial cottage industry peddling retreats, wellness classes, yoga and more to help physicians find inner peace in our tumultuous times.

The second school of thought focuses on the externalities of physician practice. Increasing demands for productivity, economic stress, loss of control over scheduling and higher “hassle-factors” associated with EMRs and regulations that have made medical practice harder and less rewarding. Burnout is just the natural reaction of sane, well-adjusted, intelligent people put into an insane environment.

Here’s what I think. I believe that the life of practicing physicians is often difficult, but that doesn’t seem to me sufficient to explain what is going on. Medical practice has always been demanding of physicians’ time and emotional energy. But I also don’t believe that physicians of today are weaker or whinier than their predecessors. So what’s going on?

I think that the root of burnout is the transformation of medical practice from a solitary craft to an industrial process. This has led to two related consequences: The first is that the current generation of mature physicians suffers from a “bait and switch.” The world they signed up for when they began their medical training is not the world they inhabit professionally. The second is a widespread belief among physicians that we have lost our professional autonomy, and thus burnout is a manifestation of profound loss.

Here’s my assessment and plan: I don’t think that “old world” is coming back, and I don’t believe physicians have or should surrender their professional autonomy. Rather, physicians can and should shape the world that takes its place, by asserting their collective professional autonomy to design systems of care that work better for physicians and their patients.

Ira Nash is a cardiologist who blogs at Auscultation.

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