Forty-eight million people quit their jobs in 2021.1 During that time, surveys showed that 54% of physicians were planning to make an employment change,2 and 22% of physicians were considering leaving the profession entirely.2,3 If Mississippi physicians hold true to the national statistics, many of you are considering leaving your current position, cutting back your practice, or retiring early.
In the general population, most people leaving their jobs cite toxic work environments and organizational cultures that do not value them as individuals. For physicians considering career changes, they offer similar reasons: insufficient and inefficient tools (i.e. EHRs), lack of autonomy and respect, excessive workload, poor sense of community with peers, and compensation that has not grown with the value of their work.3,4
What differentiates the physician workforce, and the general population, is that many more of us had the experience of occupational distress or full-blown burnout far before the pandemic began. 79% of physicians with burnout report that their symptoms began prior to 2020.4
COVID-19 certainly worsened the numbers, but at over 40% prevalence pre-pandemic, we were already well acquainted with the emotional exhaustion, depersonalization, and feelings of low effectiveness that define the occupational syndrome known as professional burnout.5 The pandemic has simply been the latest straw added to the proverbial camel’s back.
How, then, do we as individual physicians respond to our situation? Is there hope for turning a tide that has been mounting for decades? I suggest that the answer to improving our situation lies, at least in part, in how we value ourselves. This is not to say the economic value, but value that becomes apparent when we examine our thoughts and actions as they relate to our individual flourishing: behaviors like caring for our basic needs, relationships, and aspirations. There is overwhelming evidence that the work environment, from the local job site to the national government regulatory system, is the cause of 80% of physician burnout.6 It may seem contradictory to claim that a personal quality like self-valuation is the key to a systemic problem, but I believe that low levels of self-valuation, selected for and taught to us by the culture of medicine, have kept us from exercising the power we have to lead the necessary change. A mentor of mine often says of physicians: “Nobody is coming to save us. There is no cavalry coming over the hill. We are the cavalry.”
Many organizational wellness programs have suggested implicitly or explicitly that if physicians would just learn to be more resilient, our problems with professional dissatisfaction and burnout would resolve. This line of thinking has never sat well with me, and I’m thankful that physician researchers in this area have done an excellent job debunking it.7 Physicians have substantially more resilience than the general population - it is not a trait we are lacking. But we are lacking in self-valuation.
Last year, Trockel, et. al., published data on how physicians value themselves through their behaviors (not merely what they say, but what they do, and how they think about themselves when they experience difficulty).8 The participants were surveyed on activities like caring for their own health, nutrition, and relationships, as well as whether they exhibited a growth mindset or were instead paralyzingly self-critical when faced with personal setbacks. The physicians surveyed had significantly lower self-valuation scores (SVS) than the general population against whom they were compared. The researchers also found that, for physicians, there was an inverse relationship between self-valuation score (SVS) and the likelihood of burnout. When separated by gender, scores revealed that the association between SVS and burnout fully corrected the gender gap in burnout for women physicians. When corrected for the SVS, the difference between burnout rate in physicians and non-physicians disappeared.
While this study was designed to show association and not causation, my experience and that of many physicians I know gives me evidence that there may well be a causative connection between self-valuation behaviors and burnout. I experienced burnout several years ago, and developing the muscle of self-valuation is what started my process of recovering and then flourishing. In training, we learn to believe that our value is in our sacrifice. Prioritizing our well-being is selfish. We do not take time off when we are unwell, we are strapped for time to exercise, eat well, and nourish our relationships. We learn to be cogs in a giant wheel, one that we dare not slow down – even at the cost of our own lives.9,10 It is the very fact that we are so resilient that has kept us in this cycle for so long.
We must take steps individually and collectively if our profession is to thrive again. Individually, we will need to take the necessary steps to experience joy and fulfillment and serve our patients well. Those steps may take some imagination, the support of colleagues or friends, and time. Collectively, we will need to disrupt the harmful hidden curriculum in medical training and lead change in our local and national healthcare system so that it works for all of us.
With improvement in our wellbeing comes increased capacity to care for the people and the systems we work within. With the healing of burnout, cynicism melts away. When healthy boundaries are in place, there is less resentment, and compassion comes more easily. When we honor our own accomplishments, we naturally seek out new skills and mastery from a place of curiosity and genuine interest. With this growth comes the capacity for leading change, because our value is no longer dependent on maintaining the status quo. These are the characteristics of great physicians. Perhaps it is returning to ourselves rather than leaving medicine that is the true solution to burnout.