Support, empathy, system changes vital to battling burnout

In my guest column in the September 2023 issue, I wrote about the importance of recognizing burnout as an occupational phenomenon. It is neither a moral failing nor a completely unexpected consequence in disorganized, time-pressured workplaces that often lack community and human-centeredness. I'm from a generation where those before me talked about the work sustaining itself, but based on the feedback I received on my last column, it is too often not the case for physicians now. The feedback also suggests that not enough people hear often enough that burnout is not their fault.

I am concerned for everyone affected by burnout because people deserve to feel valued at work and feel that they do meaningful work. I am also concerned because burnout can negatively affect patient safety, patient perceptions of their care, and care quality. If we are going to say we are people who care about outcomes, we must acknowledge and address the causes of burnout. In my last article I wrote about starting by asking people what they need and proceeding from there. There are starting points that are meaningful because they reflect the lived experiences of physicians who may not feel supported in being able to provide the care patients need, and who are at risk for the moral distress that can result when we are not able to provide the care that we know patients deserve.

It is important to provide support to physicians and learners in the ways they and their patients need it. With this in mind, it can be helpful to consider teaching (and learning) communication skills to reduce burnout, especially about potentially difficult topics, such as palliative care and substance use disorders. Knowing that moral distress can result from being asked to make moral compromises, such as in the quality of care that can be provided, we can work to improve accessibility of interpreters and accessibility of evidence-based care so that we are not being put in a position where substandard care is risked. And since we know that some colleagues and learners experience the same workplace differently due to personal and group characteristics, we can work to adopt robust antiharassment and discrimination policies and take a strong stance against workplace violence.

These examples also illustrate how physicians' and patients' well-being are interrelated, despite being often misconstrued as at odds. With this frame, it can be easier to advocate for better workplaces and learning environments so that patients can get the care they deserve while we are taking care of our colleagues and learners. Some innovative ways we can sustain each other while doing this work include inspiring practices such as starting small group discussions, joining story slams, and hosting patient memorial services.

If you are fired up reading this and want to take bold action but are unsure where to start, I encourage you to consider checking out some of the ways ACP can help you be an advocate. There is a toolkit on pressing for prior authorization reform, another on addressing rising violence against health care workers, and also the Legislative Action Center, which makes it easy for you to improve access to care, advocate for reducing administrative burden, and more. Or, if you have noticed that you are being judged on performance metrics that aren't under your control or don't address a meaningful clinical issue, consider sharing evidence reviews of performance measures and calling for a time out until a more appropriate measure can be developed, piloted, and seamlessly implemented. If this feels impossible, please know that thanks in part to ACP Advocacy, in recent years CMS has reduced the number of performance measures by over a quarter, along with documentation requirements.

While we are considering gaining new knowledge and skills and also reducing administrative burden, I hope we always remember to take care of each other. I'm concerned for my early career colleagues who on average bear a heavier burden of educational debt, have had a much higher proportion of their professional careers disrupted by COVID-19 (including the aspects that drove so much moral injury during the worst of the pandemic), and work for large employers where they often feel they do not have agency. I'm also concerned that their generational work ethic is more often questioned when they try to set manageable work-life boundaries or when they choose nonclinical roles or side gigs. We of all generations chose medicine for similar reasons. If some are choosing to cut back, retire early, or otherwise diversify their work, we should question not each other's dedication but why the work doesn't sustain itself for them—and then work to ensure that it does.