Although many systemic factors universally contribute to both burnout in both male and female physicians, female physicians also tend to experience burnout at disproportionately high rates versus their male counterparts. Burnout, also known as a state of as a “state of physical, mental, and emotional exhaustion,” continues to grow despite being a recognized problem for decades. Burnout is a critical public health risk which not only affects the livelihood of a sizeable portion of our health care force, but also affects patient care and outcomes. AAMC data from 2021 showed that women made up more than one-third (37.1 percent) of the active physician workforce in the United States. Therefore, it is imperative to explore and address the causes of female physician burnout.
As a medical student, I have not experienced all of the burnout that female physicians face. I have, however, experienced the stresses of heavy workloads, long hours, countless exams, and emotionally taxing patient encounters in an educational system that does not teach us how to practically nurture our own well-being. A 2014 study comparing the prevalence of burnout amongst trainee and early career physicians versus similarly aged college graduates pursuing other careers (control group) found increased odds of experiencing/exhibiting depressive symptoms in early career physicians, increased likelihood of being burned out and exhibiting symptoms of depression in medical students.
A review published in 2021 analyzing the relationship between burnout and physician gender consisted of 43 empirical studies between 2010-2019; almost 90 percent of the studies suggest that female physicians experienced a higher likelihood of experiencing burnout compared to male physicians, particularly in the emotional exhaustion dimension. A possible explanation for this is that women may be more likely to be willing to express emotional fatigue, whereas male physicians may cope by feeling suppression and distancing themselves, leading to higher depersonalization levels.
A 2021 rapid review article, which included 47 studies investigating the causes of occupational stress and burnout in health professionals during the COVID-19 pandemic, showed that structural factors (i.e., organizational resources, work-related policies and roles, resource adequacy related to inadequate PPE and staffing shortages, increased workload and inadequate compensation were major drivers of burnout.
Systemic factors contributing to burnout may include high patient loads, no paid time off or benefits, inadequate compensation, and high administrative burden due to EMR systems. Individual factors contributing to burnout in both genders include lack of sleep, unhealthy coping strategies, and lack of self-care and social support. Unique challenges that many women physicians face include infertility, responsibilities in family needs, childbearing, lack of mentorship and leadership opportunities, workplace harassment and discrimination, and inadequate and decreased recognition and pay versus their male counterparts.
In 2017, the Accreditation Council for Graduate Medical Education (ACGME) acknowledged the issue of increasing physician burnout by adding a “well-being” requirement for all residencies — also known as obligated wellness initiatives and burnout mitigation as a contingency for accreditation. However, I have learned from many interactions with both residents and attending physicians that these obligated “wellness initiatives” often did not contribute to their mental, emotional, or physical well-being. For example, one told me they were required to read a book, complete even more online modules, or attend a wellness “retreat” in a campus library. I have heard residents scoffing and chiding these “wellness initiatives” as it is clear they do not actually promote wellness but instead add another task on their already burdened plates.
Workplace-related burnout risk factors include unequal pay, lack of leadership and mentorship opportunities, and heavy patient loads (to name a few.) Health care organizations may implement strategies such as incorporating a clinician voice in policies, administration, operations, diversity and inclusion committees, mentorship programs that prepare younger female physicians in order to take on leadership positions, flexible scheduling (e.g., work from home/telehealth options), compensation reviews and transparent advancement policies, paid time off, and ensuring equitable advancement for opportunities and pay.
Home-related risk factors for burnout include increased house and childcare responsibilities (compared to male counterparts.) Some potential strategies to address these factors include on-site childcare, access to meal prep, house cleaning, and laundry services, assistance with child transportation, and help with sick child care. Personal health-related risk factors include age, existing mental health status, and role in childbearing. Some potential strategies include improved diet and exercise programs with access to gym memberships and nutritionist services, mental health care, improved maternity leave, and lactation support.
Physician burnout is a growing public health risk that can no longer be accepted as the norm. Health care organizations, boards, and CEOs need to understand and implement strategies in order to address the risk factors of female physician burnout, which will benefit both their employees and patient care. I recognize that this problem is complex but cannot be ignored. This matters because although I am a medical student, I will be entering this environment in a year once I graduate and become an MD. It is important to advocate for change that will make the workplace sustainable for women.
Raya Iqbal is a medical student.
