Burnout. Unable to do anything when everything is out of control.
Burnout, often described as an experience of emotional exhaustion, demoralization, depersonalization, and a lost sense of personal accomplishment and achievement, has become a growing concern in these past few years. Burnout in this case doesn’t just affect the person, but it affects everybody even remotely related to them, but especially in the case of the physician, this sense of hopelessness and futility can pervade through colleagues, other healthcare providers, and most importantly, the patient themselves. With lower quality of patient care, accidents can happen and mistakes may be overlooked, that can eventually compound together into a greater problem at the root. In a study between burnout and work-life balance rates between 2011 and 2014, it was found that from about 6,700 physicians, 54.5% reported symptoms of burnout, about 10% more in just those past three years and that the highest rates came from the frontline physicians in primary care, family medicine and emergency medicine.
*This will probably be a series of posts where I discuss various factors in burnout and physican mental problems. Disclaimer, that I am an undergraduate student and while I don’t personally face these issues yet or myself, this is an issue that resounds very strongly with me.
Overlooked by many, a common misconception of medicine is that it leads to cushy and stable lifestyle with no problems at all, a nice big house, expensive luxury car, and more. But that is far from it, instead medicine is hard, stressful, and demanding at times, and I always tell my friends that if they’re pursuing medicine for the paycheck, they’re going to be in for a rude awakening. Sure, doctors might have a nice salary and all, but at what cost? Some people are able to graduate from college with just a bachelors or even a master’s and make upwards to $60-70k in a year, and depending on the field, there may be a steady and consistent pay raise contingent on experience and other factors. But whereas most people just do 4-5 years of college, doctors in the United States have to do another 4-years of medical school, most likely racking more than twice the debt from their undergraduate years as scholarships and financial aid are more scarce. Speaking from my own case, I was very fortunate to have received a very generous scholarship package here at my undergrad institution, which actually was a major factor for me in coming out to Chicago, but I know that most people aren’t as fortunate with student loan debt. Just thinking back to some statistics that I heard to learn for my Student Ambassador job with the Office of Undergraduate Admissions, the average class of 2016 graduate has about $37,000 in student loan debt, and even then that could take a few years to pay off depending on how much they’re willing to repay back. The craziness is that just a few years ago, the debt was still around $28,000 which is frightening because of the rate of increase for each year.
Another thing to consider is that not a majority of undergraduate students have to take loans out, and when I last checked only about 33% of the undergraduates had to apply for loans or had any help of financial aid and grants. Now, that’s just for undergraduate student loan debt… unfortunately medical school isn’t nearly the same or generous with financial aid and grants. Although there are loan repayments and other deferment programs, that can usually pigeonhole you into doing a certain specialization or working in a rural area, things that might not be people’s cup of tea. When I was doing my initial research at the debt, costs, and loan repayment statistics for medical school, I stumbled across this AAMC Fact Card from October 2015 and I was a little more than shocked. Even at a public medical school, just for the four years of medical school, the average debt that graduates of the class of 2015 were facing was $180,000.
As opposed to the 33% of undergraduate students that had outstanding loans and payments, about 78% of medical school graduates were faced with any form of outstanding payments, once again, $180,000 is on the low end of the spectrum. Now in the four years of medical school, most people have been earning an income with a job, most likely received a promotion, raises, or even moved onto another company that offered a more competitive salary and income. So not only do you have to deal with the crippling debt that you faced as you walked across the stage during your undergraduate commencement, but now you have the next four years thinking about how much more debt you’re accruing as well as the POTENTIAL loss of income, if you had done something else, like Investment Banking or whatever. After those four years of medical school, now you become a resident and finally start receiving a sizable income… oh wait, no you don’t. Referencing the above fact card again, it shows that the estimated median for first year residents is $52,200. When asking recently graduated friends of mine, I’ve been told that just fresh out of college, they’re already receiving around $55,000 if not more (once again, contingent on the field and job) … and these residents are finally getting that pittance of a salary after an additional 4 years of medical school. Now, I’m not trying to say that having student debt is a cause to mental problems and physician burnout, but I believe it is a linked factor, and although the physical aspect of money is fleeting, it truly is the “crushing” and “crippling” debt that have these newly minted doctors picking up extra shifts, working extra hours, and doing everything that they can to make some more money. I’m not saying that I’ll be exempt, but hopefully, in that time (fingers crossed) I’ll be more self-aware of that situation. Burnout can reflect an inability to recover the drive and energy that you once had, and more importantly, it makes it difficult to have a healthy work-life balance, especially in some specialties of medicine (coughcoughEmergencyMedicinecough).
Like I mentioned before, burnout doesn’t only affect that one person but everybody around them as well. From an anecdotal standpoint, it’s hard to garner much from my dad. My dad grew up in a time of tight-lipped quietness, clamped down emotional outbursts, and not given to outward displays of affection. Growing up and even now, I don’t really know how he feels, but I just feel so broken whenever he would walk in through the door after a long day at work, driving between hospitals, with a stack of papers in one hand, and an obviously heavy bag in the other. But whenever I saw him, he didn’t have to say anything, I could just see in him how tired and exhausted he was. I guess I picked up the stoic characteristic trait from my dad, because I always hold back from just running up to him and giving him a hug. This man is my hero, and as cliché as that sounds, his love of family, honesty and hard work is awe-inspiring and he’s been a primary factor for me in pursuing medicine. But it’s difficult, he doesn’t talk about the troubles that he faces and he will usually try to hide his emotions. I don’t know if he’s felt burned out before, and in truth, it’s that lack of understanding that affects me the most. I would assume with most people, they won’t go around just declaring that they feel they are mentally weak and unstable, that they are feeling down, incapable, and exhausted. People look up to doctors for strength and as a foundation of reliability, so to display signs of weakness is looked down upon. So in the efforts to maintain their facades, everyone around them feels a sense of dread that they can’t put their fingers on. People feel and know that there is something off, but they can’t discern what it exactly is that is wrong.
As of now, that’s all I really have to say and right about how debt can be a significant factor in burnout. Although I talked about it in a medical standpoint, debt in relation to burnout can honestly be applied to any kind of career, it’s just about the magnitude and severity of it. As someone that gets a job right out of college, the only debt that they really have to worry about are undergraduate debts. But maybe someone that does years of further education to get a PhD, will have much more in debts, and perhaps might not receive much more of a payraise than if they had received a bachelors. It’s about the opportunity cost and whether or not that person can justify the cost of education and pursuing what they want to pursue as opposed to the physical aspects of life, i.e money. It sounds like a simple decision, but when you face it headon, I can understand why it feels like such an oppressive and crippling system.