First Posted at Common Sense Family Doctor on 11/14/2012
Although they probably came as little surprise to physicians who practice primary care, the results of a national survey of physician burnout in the Archives of Internal Medicine earlier this year made headlines in The New York Times and The Atlantic. This study found that 1) physicians are more likely to experience symptoms of burnout than similarly educated workers in the U.S. general population; and 2) physicians on the front lines of care access – family physicians, general internists, and emergency medicine physicians – had the highest rates of burnout.
A Curbside Consultation in the November 1st issue of American Family Physician discussed the distinct but closely related problem of demoralization in a family physician who serves as the part-time medical director for a financially troubled clinic for children with developmental disorders. This physician was forced to accept layoffs of several key staff members without a corresponding decrease in workload:
She recognized the great need of these children and families, and had talked with other staff and administration about additional programs she wanted to develop. She now would have to say good-bye to coworkers and abandon her hopes for a larger and more robust program. She realized that the remaining staff, herself included, would have to work harder, and that she would have less time to spend with patients, the part of the work she found most fulfilling. Patients who needed the most help would, in fact, get less help. … Over the next week, she became dejected and sad.
Demoralization is a state of hopelessness and helplessness that is akin to, but separable from, depression. It is associated with a sense of subjective incompetence, the belief that a person is unable to express his or her values and achieve his or her goals. Demoralization has an existential dimension that is associated with the affected person’s experienced losses. … Moving past demoralization involves remoralization, or the renewal of one’s personal values and the activities that stem from these values. … However, if not addressed, persistent feelings of demoralization are likely to result in or contribute to burnout.