Healing the Clinicians: Risk Stratifications of Burnout and Declaration of Self-Advocacy

Introduction

Burnout among clinicians is a topic that has often been met with animus, yet clinicians must be aware of it to proactively manage it in the best way possible. Whether you work as a resident trainee, an early-career provider, or a veteran practitioner, the risk stratifications of burnout, which threaten the very fabric of healthcare, must be implemented to avoid any implicit complications.  

Breaking Down Burnout

Burnout is a multifaceted phenomenon characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. Medscape(1) in 2023, which surveyed 9,226 physicians in over 29 specialties between July and October, discovered that 49% of physicians said they were burned out.  

Stage of Resident Trainees

As indicated by a presentation in 2019 from Holly J. Humphrey, MD, MACP, the President of the Josiah Macy Jr. Foundation(2), at the National Academy of Medicine Action Collaborative, burnout is often rooted in the intense pressures of medical education on resident trainees, including long hours, lack of autonomy, and a high stakes learning environment. These conditions can erode emotional well-being and create a sense of disconnection from patients, peers, and selves.

Stage of Early Career Clinicians

Designated Institutional Official of New York Presbyterian Hospital, Lyuba Konopasek, MD(3), who oversees graduate medical education at both the Columbia and Weill Cornell campuses, expressed how early-career clinicians face a broad spectrum of stressors, including the demands of establishing a practice, financial pressures from educational debt, and balancing work-life integration. At this stage, burnout frequently manifests as chronic stress and fatigue, compounded by a perceived lack of control over their workload and professional trajectory.

Stage of Veteran Clinicians

Furthermore, Konopasek(3) discusses how veteran clinicians experience burnout resulting from a culmination of years of systemic challenges, including administrative burdens, evolving patient expectations, and the strain of adapting to rapid advancements in healthcare technologies. For this group, depersonalization is shown through cynicism or emotional detachment, reflecting the toll of sustained professional strain over the decades.  

Resolving Conflicts of Interest, or just Attempting to?

Addressing burnout can only be effective for all clinicians if tailored strategies for these varied experiences are utilized.  

Fear of a Lack of Quality in Care

According to Humphrey(2), one significant challenge arises from the conflict between financial remuneration and a clinician’s intrinsic passion for patient care. The pressure to maintain high patient volumes for economic viability often overshadows the time and attention physicians wish to dedicate to each patient, creating moral distress.

Struggles of Work-Family Balance

Konopasek(3) adds that work-family balance is one of the most detrimental aspects of practice that can lead to burnout. When clinicians bring home patient charts and work extensively after hours, they sacrifice time with their families and are less likely to pursue personal interests outside the workplace. This generates a blurred boundary between work and home life, intensifying the work stress and spiraling themselves away from the edge of asylum.

Uncertainty of Emerging Technologies

The paradox of artificial intelligence (AI) is new but often overlooked when regarding the regeneration of burnout. Konopasek(3) suggests that while AI offers efficiencies in diagnostics and therapeutics, it frequently undercuts the perceived artistry and elegance of human-centered care, dehumanizing clinicians who feel undervalued. This is further aggravated by the considerable time it takes to adapt to these modern technologies, creating a new terror of impairment.

Burdens of Budget Cuts

One last significant objective that Konopasek(3) discusses is that when resources are limited or removed, challenges arise in the ability to provide optimal care. Misalignments like this require systemic changes in a pre-existing overwhelmed healthcare system to restore balance and well-being.

Consequences

Vulnerability to Substance Abuse

The distressing consequences of burnout among clinicians extend far beyond the workplace, significantly impacting professional sustainability. UC Davis School of Medicine’s Dr. Maggie Rea, Director of Student Wellness, and Dr. Uma Anand, Counseling Psychologist(4), both perceive that many clinicians self-question how to find the strength to move on the helix of burnout. This chronic emotional exhaustion often leads to a sense of pervasive inadequacy, opening the pathway to any potential escape in substance abuse. Substance abuse is a frequent coping mechanism for physicians under relentless stress. “Preventing Physician Suicides,” updated on September 16, 2024(5), by the American Medical Association (AMA), reveals that substance abuse concerns reveal the demanding nature of our profession. Couple this with non-trustworthy supporting systems lead to clinicians self-medicating with alcohol, prescription medications, or other illicit drugs. This behavior not only jeopardizes their health but also compromises patient safety.(1)

Irreversible Aftershock

The most alarming resonance of burnout is any clinician's suicide compounded by the stigma surrounding mental health in the medical community. AMA’s study, “Preventing Physician Suicides”(5), also noted male clinicians are at 1.41 times higher and female clinicians are at 2.27 times higher risk of implementing any successful suicide compared to the general population. These outcomes underscore the urgent need for systemic interventions that prioritize clinician well-being, reduce stigma, and promote mental health resources within healthcare systems.

Comprehensive Approaches to Clinicians’ Self-Advocacy

The AMA instrumented 8 Steps to Envisioning and Implementing Well-Being Initiatives(6) on November 26, 2024, to outline a detailed and effective well-being program. It includes components such as leadership commitment, resource allocation, and clinician-centered interventions.

Resolving the Documentation Burden for Work-Life Balance

According to AMA’s Pearl of the Week: Reduce Documentation Burden(7) on November 12, 2024, one area of focus is reducing the electronic medical records (EMR) burden, which consumes significant amounts of time and detractions from patient care. Although it is easier said than done, efforts to alleviate clinicians' administrative responsibilities will place a therapeutic potential on prioritizing clinicians’ work-life balance.

Additionally, AMA’s 2021-2022 study, Physician Survey Shows Medicine’s Toll on Personal Relationships(8), indicates that having a high impact of work on personal relationships provokes 13.59 times the odds for clinicians to present at least one symptom of burnout. One viable solution is to offer outlets with flexible scheduling and accessible/confidential mental health resources.

State and Federal Oversights

The AMA’s November 24, 2024, article, "How the AMA is Fighting and Winning for Physicians at the State Level (9)," reemphasized the need to advocate for well-rounded policy changes at both a state and federal level to orchestrate awareness of initiatives in self-advocacy.

Conclusion

In my opinion, burnout is not a disease; instead, it is a signal for immunity. Promoting self-advocacy throughout a clinician’s career, starting from resident trainees, could lessen or prevent burnout so clinicians can demonstrate resilience and deliver integrity-driven results. Preservation is a selfless act that clinicians should use to flourish. Through honest self-recognition and self-communication, clinicians could bridge Optimal Patient Safety with the Truth of Healthcare: autonomy in health and transparency in care.  

References

1. Medscape, 2024 Physician Burnout & Depression Report, Advisory Board, January 31, 2024, https://www.advisory.com/daily-briefing/2024/01/31/physician-burnout?utm_source=chatgpt.com.  
2. Accreditation Council for Graduate Medical Education. Changing the Culture: Returning Humanity to the Healing Professions. https://dl.acgme.org/courses/changing-the-culture-returning-humanity-to-the-healing-professions.  
3. Accreditation Council for Graduate Medical Education. Combating Burnout, Promoting Physician Well-Being: Building Blocks for a Healthy Learning Environment in GME. https://dl.acgme.org/courses/combating-burn-out-promoting-physician-well-being-building-blocks-for-a-healthy-learning-environment-in-gme.  
4. Accreditation Council for Graduate Medical Education. Substance Abuse Among Physicians. https://dl.acgme.org/courses/substance-abuse-among-physicians.  
5. American Medical Association. Preventing Physician Suicide. https://www.ama-assn.org/practice-management/physician-health/preventing-physician-suicide.
6. American Medical Association. 8 Steps to Envisioning and Implementing Well-Being Initiatives. https://www.ama-assn.org/practice-management/physician-health/8-steps-envisioning-and-implementing-well-being-initiatives.
7. American Medical Association. Pearl of the Week: Reduce Documentation Burden. https://www.ama-assn.org/practice-management/sustainability/pearl-week-reduce-documentation-burden.
8. American Medical Association. Physician Survey Shows Medicine’s Toll on Personal Relationships. https://www.ama-assn.org/practice-management/physician-health/physician-survey-shows-medicine-s-toll-personal-relationships.  
9. American Medical Association. How the AMA is Fighting and Winning for Physicians at the State Level. https://www.ama-assn.org/practice-management/scope-practice/how-ama-fighting-and-winning-physicians-state-level.