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Going upstream: Two takes on clinician burnout

At the Lown Institute, we’ve highlighted the negative effects our dysfunctional health care system has on clinicians as well as patients; how the lack of time with patients, clunky EHR systems, and administrative red tape makes clinicians feel like they are cogs in a machine rather than healers. While most health care institutions recognize that clinician burnout is a widespread problem, there is less agreement on the cause. 

In the past week, two editorials have highlighted systemic issues leading to burnout that are often overlooked in this conversation. In a STAT opinion piece, Northeastern University health policy professor Timothy J. Hoff argues that focusing on burnout caused by external forces (like EHRs or fragmented care) ignores the impact that medical training has on physician health, even before they begin working. 

We should be teaching resilience and emotional intelligence as well as anatomy, and nurturing students’ idealism rather than squashing it. 

In Hoff’s view, medical schools and residency programs are not doing near enough to prepare future physicians for the “rewards and realities of being a doctor,” emphasizing academic achievement at the expense of a well-rounded education. We should be teaching resilience and emotional intelligence as well as anatomy, and nurturing students’ idealism rather than squashing it. 

“We need an educational revolution right now: radical shifts in the content of what medical schools and residency and fellowship programs teach their students, how they evaluate and interact with them, and greater awareness that they have the first and most important responsibility for preventing burnout in doctors,” writes Hoff.

“We need an educational revolution right now!”

Harvard Medical School student Leo Eisenstein agrees that we need to address the upstream factors causing burnout, in an NEJM editorial. In his experience in medical training, Eisenstein has found himself already getting discouraged and disempowered – not by administrative work, but by the harm being inflicted on his patients by socioeconomic forces beyond his control. Clinicians are led to believe have individual agency and power to heal, but then find that the health problems caused by poverty, lack of education, childhood trauma, and marginalization are too much for them to handle alone. No one physician can fix these problems, and thus, can feel like what they’re trying to do is pointless.

“Organizing toward collective action means looking after both our patients and ourselves.”

However, there is a solution, says Eisenstein – collective action. Not only can physicians begin to solve these social problems by organizing and mobilizing their social power, they can feel less powerless about their work as healers. “Organizing toward collective action means looking after both our patients and ourselves,” writes Eisenstein. 

Eisenstein directs his editorial at both clinicians and those who train future clinicians. “If medical schools and residency programs are serious about burnout, they have to teach us about collective action,” Eisenstein writes. Eisenstein and Hoff have similar visions for new medical school curricula, but where Hoff wants to prepare students to work in the current system, Eisenstein wants to prepare students to change the system.  

We can’t solve burnout by dealing with problems as they happen. We have to go upstream to the source.

The term “burnout” encompasses many problems in medicine: lack of work-life balance, overly competitive culture, profit-driven health care, poor training, and frustration with intractable social problems. We can’t solve burnout by dealing with problems as they happen. We have to go upstream to the source, whether it’s medical training, the culture of medicine, or social determinants of health.