It’s Not Too Early for Medical Students to Think About Physician Burnout

It's common knowledge that medical training is anything but a vacation, but many medical students enter the field believing that their hard work will make a difference in patients' lives. What they might not anticipate is something called physician burnout, which may be more prevalent than previously thought.

This is the case despite medical education trends in early patient exposure, as well as work hour changes to try to combat resident fatigue. Recently presented studies, particularly the results of a large, multi-specialty survey of practicing doctors in the Archives of Internal Medicine, indicate that symptoms of burnout among physicians—both residents and more experienced doctors—are surprisingly common.

The widely used Maslach Burnout Inventory, a questionnaire developed from a compendium of 25 years of research, identifies three scales of burnout:


• Depersonalization: Sometimes physicians, when overworked or overburdened, may start to see patients more impersonally, and thus could be less empathetic in their treatment.

• Emotional exhaustion: This might occur when doctors feel overextended by certain aspects of their work.

• Sense of accomplishment: This is a measure of physicians' sense of achievement or fulfillment in their work.

The August 2012 study in Archives surveyed both physicians and working U.S. adults in other fields. It found that 45.8 percent of physicians reported experiencing at least one symptom of burnout. The M.D. and D.O. (doctor of osteopathic medicine) community was significantly less satisfied with the work-life balance than were workers who do not hold medical degrees, the study found.

The suicide rate among male physicians is also 40 percent above the rate for men in general, and 130 percent of the rate for women, according to a 2008 Annals of Internal Medicine study. Among medical students, the study found an approximate rate of suicidal thoughts of 3 to 15 percent.

The Archives authors also noted that physicians, who are in specialties where they tend to be the first point of patient contact—such as family medicine, internal medicine, and emergency medicine—reported the highest rate of burnout. But another study, which compared psychiatry and pediatric residents at a county hospital, found that psychiatry residents reported more burnout than their colleagues in pediatrics.

How can burnout be prevented in medical school and beyond?

• Seek advice now: Medical students, and even residents, may hesitate to seek help due to a stigma about burnout. A 2010 article in Academic Medicine implied that medical students might fear some form of retaliation. The piece referenced a "hidden curriculum" of medical education, in which a strict hierarchy is established. That's often portrayed—albeit a bit more dramatically—in TV shows, but it still occurs to some extent today.

• Inclusion in medical school curricula: The 2010 study suggests that medical schools should make an effort to address this issue in their curricula to prevent burnout from occurring, since it can not only affect the well-being of the clinician, but also patient safety.

Because burnout typically starts in medical school, it would be more beneficial for aspiring physicians to have an intervention as students, according to a study from the Mayo Clinic. The consequences without an intervention, the study states, can be steep. Higher rates of substance abuse and academic dishonesty were reported in surveys of medical students.

The authors suggested that faculty mentors could be more proactive, using their own experiences to try to prevent the stress of a medical education causing a medical student to fall by the wayside. They also recommend that medical schools start peer groups of medical students, so that classmates can share their frustrations and possibly learn coping skills from fellow students.

The decision to study medicine is tough, so it is important to be aware of potential problems that may arise unexpectedly, and to know that many schools provide support for students who are struggling.

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Ibrahim Busnaina, M.D. is a graduate of the University of Pennsylvania School of Medicine and coauthor of "Examkrackers' How to Get Into Medical School." He has been consulting with prospective medical school applicants, with a special focus on minority and other nontraditional candidates, since 2006.

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