The Journal of the Arkansas Medical Society Med Journal Aug 2019 Final 2 | Page 5

COMMENTARY
Issam Makhoul, MD
Is Physician Burnout a
Self-Inflicted Wound?
F
rozen in his chair and
exhausted, staring at his
computer and dreading
the rest of his evening that will
stretch way into the night to finish
charting, making phone calls, and
signing the stacks of forms that
his assistant has left for him, Dr.
Clarity feels that nothing is clear in
his life anymore. Fifteen years ago, when
he signed up for medical school, he thought that
he would be making a difference in the lives of
every patient he sees. Even though every patient
gets out with their prescriptions in hand and their
paperwork signed on time, he feels that he barely
knows them and they barely know him. He feels
fake, like an impostor. Dr. Clarity is suffering from
the most dangerous epidemic that the medical
profession has seen in its history: burnout.
The number of physicians with at least one
symptom of burnout (emotional exhaustion,
feelings of cynicism, detachment from work, and
a sense of low personal accomplishment) was
an alarming 54% in 2014. In 2018, it reached a
record high of 78%, based on the 2018 Survey
of America’s Physicians conducted by Merritt
Hawkins for the Physicians Foundation. 1 The
majority of physicians are working at full capacity
or are overextended (80%), and the majority of
them are employed by a hospital or an organization
(the number of independent physicians in the U. S.
dropped from 48.5% in 2012 to 31% in 2018).
Forty-six percent (46%) consider changing their
career paths, and 49% would not recommend the
profession to their children.
Attempts at diagnosing the root cause of
the problem led some to blame the physicians.
Hence, solutions were proposed to increase their
resilience and improve their well-being – getting
more sleep, changing their diet, doing yoga and
mindfulness exercises – and several companies
were formed to administer these recipes. What
we can see from the burnout trends is that these
solutions were no more than a bandage and could
not even scratch the surface.
It is fair to say that burnout is a byproduct of
the modern transformation of medicine. Indeed,
organizational and environmental factors are the
main causes for burnout. Due to the introduction
of technology requiring huge investments in every
aspect of medicine, the fragmentation of medical
practice into an enormous number of subspecial-
ties, and the large demand for health care, the
profession changed from being a calling or a mis-
sion to being a business where profit became a
major impetus. This was associated with the rise
of a large, bureaucratic army of health adminis-
trators that increased by 3,200% between 1975
and 2010 compared to a modest growth of 150%
for the population of physicians. The growth of
the health administration was a cause and con-
sequence of the increased complexity of the
regulations and reimbursement rules. Administra-
tive costs went up along with the cost of medical
equipment and drugs. The time consumed to ful-
fill the bureaucratic tasks imposed on physicians
started occupying an increased percentage of their
day, leading to long work hours. The modernization
of medicine culminated in the universal adoption
of electronic health records (EHR), which became
a problem by itself. It is estimated that every phy-
sician spends up to 23% of his or her time docu-
menting in the EHR.
Many accuse physicians of
having been passive during this
transformation and not standing
up enough for their profession to
preserve its soul.
The global effect of this change is a loss
of autonomy and control, with slow erosion of
respect and self-respect. If this trend continues,
the physicians – who used to be special individuals
endowed with healing power and shrouded by a
halo of respect for their dedication, skills, altruism
and sense of service – may become completely
alienated parts in a large factory, a part of an
assembly line where productivity is the metric by
which they are assessed. Many accuse physicians
of having been passive during this transformation
and not standing up enough for their profession to
preserve its soul.
The next horizon is the introduction of artifi-
cial intelligence (AI) into medicine. This revolution
is coming and is unstoppable, in my opinion. And
here again, physicians will be facing a more fun-
damental change in their identity and role. Look-
ing at the fields that will be overtaken by AI, it is
likely that physicians will practice medicine in two
or three decades in a completely different way
than now. Many of the cognitive processes that
physicians used to spend years to acquire will be
relegated to AI platforms and will surpass human
abilities. The only solution to the current epidemic
of physician alienation and burnout is that physi-
cians confront this upcoming revolution head on
and thereby direct it to a place where it will have
at its center the well-being of patients and physi-
cians.
Physician burnout is not a self-inflicted
wound. It is one of the unintended consequences
of huge societal and professional changes that
happened despite physicians’ will or awareness.
Its reversal, however, depends on their aware-
ness of its underpinnings and coalescing with
their peers and society as a whole to recreate a
humanistic medicine for our time.
https://physiciansfoundation.org/wp-content/
uploads/2018/09/physicians-survey-results-
final-2018.pdf
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