Is Our Healthcare System As Resilient As Its Doctors?
As a physician in the Covid-19 era, I’ve been thinking a lot about resilience and burnout. The messaging that most doctors receive is that resilience and burnout are on two sides of the productivity spectrum. Resilient physicians don’t experience burnout and those who do likely aren’t that resilient. This narrative isn’t just dangerous, it’s scientifically untrue. Physicians can be incredibly resilient and still experience burnout. In light of recent reports documenting the pandemic’s mental health impact on physicians, I spoke to two thought leaders in the field of burnout about how the messaging around burnout and resilience can be reframed.
Resilience is a Key Element in Our Toolkit
In a 2020 study on burnout done by the Mayo Clinic, physicians were found to be some of most resilient workers in the American workforce. “That makes sense because you need resilience to make it through medical training and into clinical practice,” says Dr. Colin West, MD, PhD, a Mayo Clinic physician and lead researcher of the study. “The idea that people can get through medical training and into clinical practice without having resilience doesn’t make sense. As doctors, we need resilience as a part of our toolkit because we have an obligation in our profession to be in the best shape, mentally, for our patients. This helps us deliver optimal care. It’s like an athlete who brings good training into their work.” Overall, West’s study found a link between resilience and burnout: the higher the resilience, the lower the likelihood of burnout. But even among the most resilient doctors, 30% had still experienced burnout. According to West, “Resilience is important, but we also need to recognize that resilience alone isn’t enough to prevent burnout.”
Resilience Alone Isn’t Enough to Prevent Burnout
West’s study was done in part to address the false notion that resilience is all that’s needed to prevent physician burnout. “Very commonly, when we talk about physician stress, the first solutions [implemented by organizations] are improved stress management and resilience training for physicians. But these solutions feel like victim blaming, putting all the responsibility on the physician to improve how they function within their environment without giving the environment any onus to improve itself,” said West. He continued, “The system needs to adapt to meet our needs. We can’t put people in toxic work environments and think they’ll be fine with them. We must address the healthcare environment as well.” When asked how resilience training by medical institutions may be perceived by physicians during the pandemic, West said, “Physicians are bringing every tool out of our resilience skillset to bear already. Asking physicians to be even more resilient during this time risks being tone deaf.” According to West, instead of asking physicians to become more resilient, institutions must work to create a more resilient medical system that better supports its workers.
Resilience is a Structural Issue That Needs Systems-Based Understanding
One physician who has worked to create a more resilient medical system is Dr. Christine Sinsky, MD, the American Medical Association’s Vice President of Professional Satisfaction. Sinsky wholeheartedly agreed with West’s sharp critique of the existing medical system. “We spend $100 billion dollars every year researching new treatments and tests, yet we only spend a fraction of that to discover optimal delivery models to deploy those tests and treatments. We need a systems-based understanding of resilience. Our goal should be to create resilient organizations that protect and support the people within.” Sinsky feels hopeful that these strategies can be implemented, “I’m optimistic that these are solvable issues. They haven’t had the financial attention that tests and treatments have had, but there is emerging science around understanding how organizations can be structured to support the individual.”
Creating Resilient Organizations to Support Individual Resilience
Sinsky is working to train medical leadership at various institutions in creating and scaling resilient organizations. “There are concrete ways to do this,” she said, “At the system, institutional, and national levels there must be a mindset of shared accountability. There is a business case for physician well-being.” Sinsky offered measures such as making physician well-being a value in the organization, training hospital CEOs in human-centered leadership methods, and designating an internal team to de-implement policies. She explained, “The idea that sounded like a good idea at the conference table? Make sure it doesn’t make clinical practice worse. Clinicians’ days filled with good ideas that have made clinical practice worse.” When it comes to supporting physicians during the pandemic, Sinsky added, “During crisis, if there are no interventions by an organization, it’s more likely that physicians will experience burnout. But if there’s a set of interventions, such as “stress first aid” (psychosocial support, transparent communication, regulatory relief) there’s a chance for coping, recovery, and later perhaps even thriving. We must continue to message the concept of shared accountability of the leadership at all levels.” As it turns out, it’s actually the US healthcare system, and not its physicians, that needs the much-anticipated training in resilience.
This story was published in Forbes on Feb 8, 2020.
