Psychiatric Views on the Daily News - Episode 198
The 18 hours a day, 7 days a week doctor lifestyle is over. But it’s not the cause of the burnout epidemic…
PSYCHIATRIC VIEWS ON THE DAILY NEWS
In a recent column on burnout from September 19, “Medical Business as Usual is Increasingly Unhealthy,” I discussed the myth that a focus on physician wellness activities will significantly reduce our burnout epidemic. A reasonable assumption, but not true. There are other such current myths about burnout. Here’s another one.
MDQuip often posts quotes related to physicians. On September 27th, it posted one from Dr Martin H. Fisher:
“A doctor must work 18 hours a day and 7 days a week. If you cannot console yourself to this, get out of the profession.”
I am not sure of the original date of this quote, but it was probably many, many years ago when it was a common expectation for physicians to work those sort of hours. Nowadays, you often hear that such long hours are a cause of our current epidemic of physician burnout.
However, burnout has only been rising significantly in the last 2 decades as for-profit managed care businesses took over control of medicine.1 Long hours may have caused stress and problems with work-life balance in the past, but not burnout. That is caused by a different factor, as clearly conveyed in A Piece of My Mind article in the September 27th, 2022 issue of JAMA.2 As its young physician author wrote:
“Although I was prepared for the inefficiencies and long hours, what overwhelmed me was the experience of working within a system that actively prevented me from providing the care that patients needed.”
What these kinds of medical systems do is to put too many obstacles in our way to heal as we can. Most probably, the rise of burnout in other work settings and parenting is also being caused by systemic obstacles.
To the contrary: we physicians prided ourselves for taking care of patients no matter the long hours of availability. Our core ethical principle is that patients come first. That combination did not cause burnout or moral injury, but rather satisfaction, as long as we felt the system was supportive of our work.
Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.
1. LoboPrabhu S, Summers RF, Moffic HS, eds. Combating Physician Burnout: A Guide for Psychiatrists. American Psychiatric Publishing; 2019.
2. Archer CA. Expanding moral injury: why resilience training won’t fix it. JAMA. 2022;328(12):1199-1200.