The prevention and cure of physician burnout.

Abstract

To the editor, Rachel Remen's essay about the importance of personal meaning as it relates to job satisfaction and health care professionalism was timely and well written. Her formula (roughly stated: Personal meaning = Commitment = Professionalism = Service and soul) for the relationship of personal meaning to health care delivery and “the soul” of medicine is valid and easily appreciated.1 Studies such as The Physician Burnout Project2 demonstrate that burnout is related to the destruction of personal meaning for physicians concerning the care they deliver. Also, the number of physicians in clinical practice who burn out continues to be high. Preliminary results from another study underway show that in the managed care era, the burnout phenomenon begins early and is also a threat for residents and physicians with academic practices (D Campbell, unpublished data). Most burnout seems to be related to early exposure to the restrictive effects of capitation and managed care on academic practice. The question remains: As the major cause for the loss of the “soul of medicine,” how do we prevent and cure physician burnout? One view is that the prevention of burnout begins when parents instill the sense of value of and desire for personal meaning through service-related endeavors. Certainly, the medical school application process should involve effective screening measures to select future physicians who are best suited to be happy and content in a service industry. Similar screening should occur during the application process for residency training. An unavoidable fact of specialization is that different specialties will demand and result in different lifestyles. It is wrong for us to hide or avoid discussing this fundamental truth with medical students when they consider what specialty to enter. We must be honest with our students and ourselves—not only is the “Big-Bucks” era of medical practice over, but also dwelling on its memory is responsible for much of the economic frustration in the current health care marketplace. If we select caregivers who are emotionally prepared to place financial considerations and economic productivity second to clinical effectiveness, we will be well on our way to preventing most burnout and restoring medicine's soul. Treating burnout is another matter. Like depression, in many ways, burnout can be difficult to diagnose. Many physicians are unaware of the disease until they are in its end stages. I did not realize I was burned out until after I was cured. The cure came accidentally with the opportunity to return to full-time academics. When I left behind case-by-case concerns about capitation and managed care and a “successful” private practice, I was, once again, experiencing the daily joy and enthusiasm for clinical practice that was present in my early years. It then struck me—I had been burning out for a long time. We all can't—and shouldn't—return to salaried academic medicine. Placing financial concerns on the back burner is difficult for many young physicians, who have large education debts to pay, families to raise, and a managed care industry in which to work. They begin to practice and quickly find themselves on an economic treadmill that continues for many years. If for no other reason than to allow them off this treadmill of clinical practice to help prevent and cure burnout, it is essential that medical education and residency training in the United States receive better economic support. As Americans embrace the concept of universal access to and economic support for a minimum standard of health care provision, so too should Americans chosen to be providers of health care be assured support for their medical education and specialty training. The benefits of universalism to health care delivery are equally applicable to medical education. This assurance and effective recruitment and screening should allow health care professionals to concentrate on providing more meaningful service, which will, according to Remen's social equation, enhance their personal meaning (the soul of medicine) and cure physician burnout.