Academic Medicine Open Forum

This article raised a new point that had not occurred to me before: many clinicians dislike the term “burnout” because it implies that they themselves are the problem (i.e., they couldn’t handle the pressure) rather than acknowledging the immense toll of external factors beyond their control.

https://www.linkedin.com/feed/update/urn:li:activity:6966411249140035584 

How do you feel about the term “burnout”? Does this resonate with you? What would you suggest instead?

------------------------------
Stephanie Weiner
Director, Digital Strategy & Engagement
Association of American Medical Colleges
------------------------------

I don't have a good suggestion for a replacement word, but I do think that the overuse of the term "burnout" and the general responses to addressing the phenomenon have been problematic.  The fact that Dr. Glaucomflecken has generated millions of views on his comedic video portrayals on burnout, wellness, and resiliency training is not an accident (e.g., https://www.youtube.com/shorts/MUVzRs3E5g4). 

The issue isn't simply the lack of acknowledgement of multiple external factors outside ones control -- it's that the institutional responses have typically focused on individually based "interventions" that imply individual blame.  The implied blame extends beyond the idea that people couldn't handle the pressure.  It also conveys the idea that if only the individual got more sleep, had better work-life balance, exercised regularly, ate healthfully, and engaged in mindfulness meditation (among other things) that they would be "resilient" and their "burnout" would magically disappear.  

Responses of health care organizations and the health care delivery system, in general, have typically avoided addressing the systemic issues that contribute to burnout for multiple members of the health care team.  Short-staffing, poor usability of electronic health record systems, insurance pre-authorizations, regulatory related documentation requirements (e.g. from CMS and Joint Commission), and a host of other challenges remain unaddressed.  Constant references to clinicians as "providers" contributes to the sense that we are viewed as interchangeable Lego pieces.  An excessive focus on productivity and RVU benchmarks fuels greater workloads over time as everyone is aiming to be above the median RVU numbers (or higher for bonuses).  The negative impacts on clinicians and on patient care are considerable and further add to burnout when clinicians feel unable to spend time with their patients and give them optimal care.  

A final problem with the current approach to burnout is that it can lead depression to be dismissed as understandable burnout, and thus to go unidentified and untreated (https://pubmed.ncbi.nlm.nih.gov/31314066/). This is particularly true given the persistent stigmas against psychiatric illness and the frequent difficulty in accessing care. 

Again, I don't presume to have a simple solution but if some of the overarching contributors could be addressed at an institutional or national level, I think it would be preferable to the current individual-focused efforts.

------------------------------
Laura Fochtmann
Distinguished Service Professor
Stony Brook University

Opinions are my own.
------------------------------

Original Message:
Sent: 08-22-2022 08:58
From: Stephanie Weiner
Subject: Question of the Week: How do you feel about the term "burnout"?

This article raised a new point that had not occurred to me before: many clinicians dislike the term "burnout" because it implies that they themselves are the problem (i.e., they couldn't handle the pressure) rather than acknowledging the immense toll of external factors beyond their control.

https://www.linkedin.com/feed/update/urn:li:activity:6966411249140035584 

How do you feel about the term "burnout"? Does this resonate with you? What would you suggest instead?

------------------------------
Stephanie Weiner
Director, Digital Strategy & Engagement
Association of American Medical Colleges
------------------------------

I think you have really articulated this well, Laura (and my wife and I follow Dr. Glaucomflecken - I've been wanting to reference him here for a while now - so thank you for doing so). 

there is no easy answer, as you note. It's complex and will need a lot more thought. But,  perhaps we can find ways to discuss these larger issues in forums like this and find opportunities to collaborate collectively to help create the change that's needed. Or at least make steps towards it. 

Thank you so much for such a thoughtful response and stay well! 

------------------------------
Penny Schnarrs
Virtual Communities Program Manager
Association of American Medical Colleges
------------------------------

Original Message:
Sent: 08-28-2022 19:07
From: Laura Fochtmann
Subject: Question of the Week: How do you feel about the term "burnout"?

I don't have a good suggestion for a replacement word, but I do think that the overuse of the term "burnout" and the general responses to addressing the phenomenon have been problematic.  The fact that Dr. Glaucomflecken has generated millions of views on his comedic video portrayals on burnout, wellness, and resiliency training is not an accident (e.g., https://www.youtube.com/shorts/MUVzRs3E5g4). 

The issue isn't simply the lack of acknowledgement of multiple external factors outside ones control -- it's that the institutional responses have typically focused on individually based "interventions" that imply individual blame.  The implied blame extends beyond the idea that people couldn't handle the pressure.  It also conveys the idea that if only the individual got more sleep, had better work-life balance, exercised regularly, ate healthfully, and engaged in mindfulness meditation (among other things) that they would be "resilient" and their "burnout" would magically disappear.  

Responses of health care organizations and the health care delivery system, in general, have typically avoided addressing the systemic issues that contribute to burnout for multiple members of the health care team.  Short-staffing, poor usability of electronic health record systems, insurance pre-authorizations, regulatory related documentation requirements (e.g. from CMS and Joint Commission), and a host of other challenges remain unaddressed.  Constant references to clinicians as "providers" contributes to the sense that we are viewed as interchangeable Lego pieces.  An excessive focus on productivity and RVU benchmarks fuels greater workloads over time as everyone is aiming to be above the median RVU numbers (or higher for bonuses).  The negative impacts on clinicians and on patient care are considerable and further add to burnout when clinicians feel unable to spend time with their patients and give them optimal care.  

A final problem with the current approach to burnout is that it can lead depression to be dismissed as understandable burnout, and thus to go unidentified and untreated (https://pubmed.ncbi.nlm.nih.gov/31314066/). This is particularly true given the persistent stigmas against psychiatric illness and the frequent difficulty in accessing care. 

Again, I don't presume to have a simple solution but if some of the overarching contributors could be addressed at an institutional or national level, I think it would be preferable to the current individual-focused efforts.

------------------------------
Laura Fochtmann
Distinguished Service Professor
Stony Brook University

Opinions are my own.

Original Message:
Sent: 08-22-2022 08:58
From: Stephanie Weiner
Subject: Question of the Week: How do you feel about the term "burnout"?

This article raised a new point that had not occurred to me before: many clinicians dislike the term "burnout" because it implies that they themselves are the problem (i.e., they couldn't handle the pressure) rather than acknowledging the immense toll of external factors beyond their control.

https://www.linkedin.com/feed/update/urn:li:activity:6966411249140035584 

How do you feel about the term "burnout"? Does this resonate with you? What would you suggest instead?

------------------------------
Stephanie Weiner
Director, Digital Strategy & Engagement
Association of American Medical Colleges
------------------------------

Like @Laura Fochtmann I don't love the term, but I don't have a better one. And I agree, we need to shift this to an institutional policy change.

I just got back from a week without access to WiFi, and everyone is telling me how good I look, probably because I couldn't have any work contact, and got solid sleep. Even sabbaticals are work-focused - when you apply for one, you have to outline what projects/ research you plan to do.


The individualizing of the problem/response pretends that the institutional policies are not in need of change. Telling me I need to exercise, but not allowing me the time off for a walk or a trip to the local YMCA, reinforces the idea that we are expected to take our "work assignments" home with us. It's another example of "do more with less," which is only sustainable for a short time.

​​
I would love to see examples of good policies in this area. I can identify some issues, but don't have examples to replace them with positive change. 

-Carolyn

------------------------------
Carolyn Pointer
Assistant Professor
Southern Illinois University School of Medicine

Opinions my own.
------------------------------

Original Message:
Sent: 08-28-2022 19:07
From: Laura Fochtmann
Subject: Question of the Week: How do you feel about the term "burnout"?

I don't have a good suggestion for a replacement word, but I do think that the overuse of the term "burnout" and the general responses to addressing the phenomenon have been problematic.  The fact that Dr. Glaucomflecken has generated millions of views on his comedic video portrayals on burnout, wellness, and resiliency training is not an accident (e.g., https://www.youtube.com/shorts/MUVzRs3E5g4). 

The issue isn't simply the lack of acknowledgement of multiple external factors outside ones control -- it's that the institutional responses have typically focused on individually based "interventions" that imply individual blame.  The implied blame extends beyond the idea that people couldn't handle the pressure.  It also conveys the idea that if only the individual got more sleep, had better work-life balance, exercised regularly, ate healthfully, and engaged in mindfulness meditation (among other things) that they would be "resilient" and their "burnout" would magically disappear.  

Responses of health care organizations and the health care delivery system, in general, have typically avoided addressing the systemic issues that contribute to burnout for multiple members of the health care team.  Short-staffing, poor usability of electronic health record systems, insurance pre-authorizations, regulatory related documentation requirements (e.g. from CMS and Joint Commission), and a host of other challenges remain unaddressed.  Constant references to clinicians as "providers" contributes to the sense that we are viewed as interchangeable Lego pieces.  An excessive focus on productivity and RVU benchmarks fuels greater workloads over time as everyone is aiming to be above the median RVU numbers (or higher for bonuses).  The negative impacts on clinicians and on patient care are considerable and further add to burnout when clinicians feel unable to spend time with their patients and give them optimal care.  

A final problem with the current approach to burnout is that it can lead depression to be dismissed as understandable burnout, and thus to go unidentified and untreated (https://pubmed.ncbi.nlm.nih.gov/31314066/). This is particularly true given the persistent stigmas against psychiatric illness and the frequent difficulty in accessing care. 

Again, I don't presume to have a simple solution but if some of the overarching contributors could be addressed at an institutional or national level, I think it would be preferable to the current individual-focused efforts.

------------------------------
Laura Fochtmann
Distinguished Service Professor
Stony Brook University

Opinions are my own.

Original Message:
Sent: 08-22-2022 08:58
From: Stephanie Weiner
Subject: Question of the Week: How do you feel about the term "burnout"?

This article raised a new point that had not occurred to me before: many clinicians dislike the term "burnout" because it implies that they themselves are the problem (i.e., they couldn't handle the pressure) rather than acknowledging the immense toll of external factors beyond their control.

https://www.linkedin.com/feed/update/urn:li:activity:6966411249140035584 

How do you feel about the term "burnout"? Does this resonate with you? What would you suggest instead?

------------------------------
Stephanie Weiner
Director, Digital Strategy & Engagement
Association of American Medical Colleges
------------------------------

Excellent points, all-thanks for raising the question, @Stephanie Weiner!

@Laura Fochtmann, thank you for raising that point about the connotation of the term "providers"-it hadn't occurred to me, and I will now be more mindful about it.

Laura and @Penny Schnarrs, I also appreciate Dr. Glaucomflecken's videos. I just recently started watching them after my wife introduced me to his channel. He does a good job showing where medicine can be better.

Laura and @Carolyn Pointer, I liked your articulations of how problems in the medical workforce are individualized without recognizing institutional and systemic responsibility.

@Eric Weissman and I did some informal research back in 2018 looking at the terms used to talk about clinician well-being and how they've changed year over year. We also looked at groups of terms, such as individual-oriented terms (e.g. stress, burnout, resilience, grit, mental health, well-being, substance-related disorders, and coping) and system-oriented terms (e.g. workload, turnover, social support, retention, attrition, and wellness curriculum). Most individual-oriented terms (and some system-oriented terms) largely put the onus on clinicians themselves, while some system-oriented terms acknowledge the role of systemic factors.

Throughout the whole period of study (2006–2018), individual-oriented terms were much more common than system-oriented terms. The former appeared in 74–90% of the articles in our set; the latter appeared in only 13–23%. It would be interesting to see whether covid has changed anything about how we talk about this.

Eric has done some more recent work in this area, such as with "Grit, Gratitude, Grace and Guidance: Moving Academic Medicine from Crisis to Transformation."

------------------------------
Lee Crowther
Library Specialist
Association of American Medical Colleges
------------------------------

Original Message:
Sent: 08-22-2022 08:58
From: Stephanie Weiner
Subject: Question of the Week: How do you feel about the term "burnout"?

This article raised a new point that had not occurred to me before: many clinicians dislike the term "burnout" because it implies that they themselves are the problem (i.e., they couldn't handle the pressure) rather than acknowledging the immense toll of external factors beyond their control.

https://www.linkedin.com/feed/update/urn:li:activity:6966411249140035584 

How do you feel about the term "burnout"? Does this resonate with you? What would you suggest instead?

------------------------------
Stephanie Weiner
Director, Digital Strategy & Engagement
Association of American Medical Colleges
------------------------------