Why Burn Out? A Personal and Professional Journey

Clinicians are perceived to be at increased risk these days for professional burnout, a condition that is frequently attributed to low reimbursement relative to plumbers, lawyers, and CEOs; frustration with paperwork; medical liability; and a loss of personal autonomy brought about by managed care. Medical staff lounge conversations are regular distribution points for such wisdom, and not even patients in exam rooms find sanctuary from such complaints. What's going on here? Are the doomsayers—“Will the last doctor turn out the lights when they leave...?” —right? Is the reputed burnout epidemic attributable to purely external factors, or might there be some ownership of the problem at a personal level as well? Although I have performed no formal research on the question, I have been interested in the issue for some time now.

I frequently have an opportunity to travel and serve as faculty for quality improvement collaboratives involving chronic care. I have asked participants from coast to coast the following question: “Do you love your work?” Generally, they respond overwhelmingly that they do love their jobs. Asking the same question in your average medical staff lounge would likely produce a different response. Why the discrepancy?

In the following attempt to address this question, I will draw on my experiences as a patient, a clinician, and a teacher, because each role provides an opportunity to come to the same conclusion: it is self-efficacy in our daily lives that determines our general level of satisfaction as individuals and clinicians. Let me explain, starting with my own experiences as a patient and then with my experiences as a physician.

As I stared at the ceiling over a Thanksgiving weekend in the early 1980s, I was overwhelmed by a series of disturbing possibilities: blindness, heart attacks, amputations, kidney failure—the end of life as I knew …