"Don't ask me to take resilience training!"

Professional burnout has had a lot of attention recently, both in the medical literature as well as the media.  For example, a recently published survey of U.S. physicians using the Maslach Burnout Inventory, a commonly used instrument to assess burnout, noted that 44% of the physicians surveyed reported at least one symptom of burnout in 2017.  The Maslach Burnout Inventory (MBI) assesses "burnout" based upon the presence of emotional exhaustion, depersonalization, or a sense of a loss of personal accomplishment.  

Importantly, an individal meets criteria for "burnout" when he or she meets threshold criteria in all three categories.  The media has erroneously reported in the past that "nearly half of physicians in the U.S. are burned out" - this is technically not correct, and it would be more accurate to state that "nearly half of the physicians in the U.S. meet at least one criteria for burnout."

There are a number of factors that have been associated with physician burnout.  Dr. Tait Shanafelt, one of the foremost authorities on physican burnout, breaks these factors down into individual factors, work unit factors, organizational factors, and societal factors.  For example, improving diet, exercise, sleep, and mental wellbeing have all been suggested as potential strategies to alleviate individual factors leading to physician burnout.  A number of health care organizations have responded to the growing problem of physician burnout by implementing strategies to improve personal resilience.  While all of these strategies are certainly helpful, by themselves they are not nearly enough.

Some experts have suggested that focusing only on the individual factors that lead to burnout can lead to a sense of blame (for example, see the Harvard Business Review article, "Burnout is about your workplace not your people").  I see their point and tend to agree - focusing on system-level factors are probably more important.  However, solely focusing on system-level factors is insufficient as well.  At the end of the day, eating a balanced diet, getting enough sleep and exercise, and focusing on mental wellbeing are necessary too.

Here's the crux of the issue though.  Resilient individuals are less likely to suffer symptoms of burnout.  The problem is that physicians, as a group, are more resilient than the rest of the population at large.  The journey to become a physician is long and arduous.  It's an intense experience that probably self-selects for personal resilience.  By that token, trying to alleviate physician burnout by improving resilience is probably not going to be that impactful.  Physicians are already resilient enough.  

Health care organizations instead should focus on the system-level factors that drive burnout - decreasing some of the regulatory burdens on physicians, improving the ease of use of the electronic health record, and focusing less on the volume of patients seen and emphasizing the value of the care that is delivered.  Health care organizations would do well to address these system-level issues first.  And perhaps most important of all, don't ask physicians to take resilience training!