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Labor Day thoughts on increasing dermatologist burnout

DII small banner By Warren R. Heymann, MD
Sept. 5, 2016

“Love and work…work and love. That’s all there is” – Sigmund Freud

Today you probably received an email from Dermatology Times entitled “Tips for taking advantage of Labor Day 2016.” A recent Mayo Clinic study was quoted, noting that between 2011 and 2014, dermatologists had the largest increase in burnout of any specialty (from 32% to 57%), listed as seventh in satisfaction with work-life balance. Just a few years earlier, dermatology was second, following preventive/occupational/environmental medicine (1).

“Doctors, you need a day off!” the author Ben Schwartz declared. The recommended tips included: 1) Getting outside (I took a bike ride today); 2) Take a tech break (I picked up my cell phone every 10 minutes instead of 5 — not quite what he meant, but better than usual); 3) Take a staycation/long weekend (we were at our home in Brigantine, but left early because of the impending Hermine, that never came to pass); 4) Catch up on sleep (I got a few more winks); 5) Read a book (I finally got to Being Mortal — I’ll report on that in the future); 6) Spend quality time with family and friends (Ronnie and I had a delightful lunch in Princeton with my oldest friends from childhood); 7) Learn a new skill (nothing to report here!) 8) Volunteer (Great idea — I should consider that).

These are all fabulous ideas, however, they are not antidotes to the root causes of burnout. What if I despised my work? In a matter of hours, I would be facing the same situations that made me want to escape on my bike. While the current buzzwords are “work-life balance,” thinking in that context implies that they are two separate realms, when realistically, they are still intertwined, with the satisfaction of each domain influencing the other. I have always envied the person who says “When I leave the office, I leave it all behind.” I have never been able to do that. It would be a rare person who fought bitterly with their spouse the night before, only to completely forget about it the next morning.
The following is the abstract of a brilliant commentary by McKenna et al (1) exploring the causes of physician burnout with offering solutions, rather than just (important) escape valves such as those listed in Dermatology Times.

Awareness of the risks of burnout, depression, learner mistreatment, and suboptimal learning environments is increasing in academic medicine. A growing wellness and resilience movement has emerged in response to these disturbing trends; however, efforts to address threats to physician resilience have often emphasized strategies to improve life outside of work, with less attention paid to the role of belonging and connection at work. In this Commentary the authors propose that connection to colleagues, patients, and profession is fundamental to medical learners’ resilience, highlighting “social resilience” as a key factor in overall well-being. They outline three specific forces that drive disconnection in medical education: the impact of shift work, the impact of the electronic medical record, and the impact of “work–life balance.” Finally, the authors propose ways to overcome these forces in order to build meaningful connection and enhanced resilience in a new era of medicine.

The key to resilience, and ultimately love of one’s work, is engagement, with a prioritization of the need for human connection and belonging. This can be accomplished by assuring that there is protected time to learn (and think!), sharing stories about what matters most (this may differ for residents compared to faculty), and appropriate mentoring.
I wholeheartedly agree with their conclusion that “we should focus less on the competition between work and life and more on making our work a functional and enjoyable part of our lives. To do so, we might draw upon the feelings we first channeled into our medical school personal statements to remember how medicine brings us together to share in the privilege of caring for others. This is where connection, and resilience, begins.”

1. Shanafelt TD, et al. Burnout and satisfaction with work–life balance among US physicians relative to the general US population. Arch Intern Med 2012;172: 1377–1385.
2. McKenna KM, et al. The missing link: Connection is the key to resilience in medical education. Academic Medicine 2016; 91: 1197-9.

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