How Our Dedication to Service Can Cause Burnout

In my introductory blog, I examined how burnout drew me out of medicine, into education, then back into medicine with a renewed sense of purpose and ambition. While studying for my master’s degree at Brown University, I had an interesting realization: the skills and passions that lead us to medicine can also drive us to burnout.
This is an interesting paradox. In my research, I identified four forces — service, excellence, curative competence, and compassion — that are moral, outstanding traits and yet, if unchecked, can turn our best intentions into harmful emotions.
I’m reminded of Aristotle, a contemporary of Hippocrates, who wrote about the “Golden Mean.” In short, virtue lies between two opposite extremes. For instance, the virtue of ambition is between laziness and greed. Or, in medicine (and in this blog post) there’s service, which falls between selfishness and selflessness. Service means helping and caring for others to one’s utmost abilities while still being realistic.
Like many of you reading this, I entered medicine to heal people. I quickly realized my altruistic vision of helping patients and saving lives often takes a backseat to administrative tasks. A recent Medscape physician survey found that 59 percent of respondents said “too many bureaucratic tasks” as a leading cause of their burnout.
Paperwork for FMLA and disabilities. Filling out forms for prior authorizations. Switching medications not to help our patients, but because of formulary changes. Documentation for the sake of documentation. Or to defend us from future lawsuits or insurance scrutiny. Or to justify our expertise — our years of training — to insurance companies so they’ll fairly reimburse us for the hard work we do for our patients.
The list goes on and on and on.
In fact, it’s gotten to the point that the majority of our time is reserved for these tasks, leaving only 33 percent of our time to share with patients. Spending only half our time engaging patients can cause compassion fatigue, one of the leading factors for burnout. And studies show higher burnout rates means lower patient satisfaction and a 3–10 percent higher risk of a physician making a medical error.
So what’s the solution?
There’s no silver bullet. No magical software package or workflow will alleviate us of all this. Us doctors can be a perfectionistic bunch, which makes searching for that solution a frustrating non-starter. As the saying goes, “The perfect is the enemy of the good.” However, we can make progress.
Consider hiring a physician’s assistant or employing a part-time scribe. While our independence is important to us, there’s no shame in asking for help. We give that advice to our patients, sometimes we forget to tell it to ourselves.
You can also partner with a medical group. These organizations help to relieve administrative burden and create networks of doctors to support each other. There are many to choose from — independent physician associations, clinically integrated networks, managed services organizations — but with a little research, you can find the one that’s best for you.
Finally, let humility lead us; we are here to serve our patients, and sometimes that means doing the grunt work of documentation. We can also adopt team-based documentation strategies, such as enlisting our nurses to fill out HPI templates. Another option is to optimize our EHRs or transition to one that uses smart phrases or orders.
That’s all for now. Be sure to subscribe to inforMD so you don’t miss my next entry on how excellence can paradoxically drive burnout. In the meantime, I encourage you to leave a comment. That’s one small step we can take to building community, which is yet another way we can fight burnout together.