APMA News - July/August 2020 - A2

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JULY/AUGUST 2020 / ISSUE 65

PHYSICIAN BURNOUT IS AMONG US
By Calvin J. Rushing, DPM

Almost two years ago, I began what would become the ﬁrst formal pilot study on physician burnout for doctors of podiatric
medicine ("Perceptions of Burnout, Personal Achievement, and Anxiety Among US Podiatric Medicine and Surgery
Residents: A Cross-Sectional Analysis"). My coauthors and I thought at the time that the rate of burnout for resident
DPMs would be lower than that of our MD/DO resident counterparts. The results were quite the opposite; nearly
50 percent reported severe burnout, low personal achievement, and moderate to severe anxiety levels. I was shocked.

ure, the years we put into becoming physicians are rife with
stress and indecision. The sheer amount of material gleaned
during medical school is inconceivable to those outside of
health care, and each semester brings with it the pressure to perform
on test after test after test. After receiving our degrees, and setting
out to share our passion with others, the grueling hours of residency
and the toll it brings-both physically and mentally-set in. The learning curve is steep, and any lurking egos quickly temper among more
senior attendings.
As first-year residents, in the midst of all the stress we begin, rather
subconsciously, to develop and form our perceptions of what constitutes a "great doctor" or "great surgeon." These ideas are based
largely on observations of upper residents and senior attendings. Such
attributes may include intellect, clinical acumen, superior dexterity,
and the ability to make few mistakes under high-stress scenarios, with
little to no sleep. Once internalized, these perceptions help form the
foundation for how we may later perceive our own personal achievement. So, how exactly do we burn out?
The truth is that no one fully understands the process. What we
do know is that physician burnout, commonly described as a triad
consisting of emotional exhaustion, depersonalization, and low selfperceived personal
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achievement, is a
complex multifacto@APMA
rial process that
/APMAmembers
appears to be affect/TheAPMA
ed by interpersonal
/company/apma-official
relationships, as well
as work setting/envi@official_apma
ronment, creating a
EDITOR Will Scott; wpscott@apma.org
milieu of stress and
DESIGN Suzanne Kleinwaks Design
dysfunction.
For
residents
specifiAPMA gratefully acknowledges the
cally, we know that
support of PICA, a ProAssurance
as the gap between
Company, founding sponsor of the
Young Physicians' Program.
what is perceived to

be ideal and reality widens (for whatever the reason), a dissociation
effect sets in as the brain attempts to "check out" to mitigate effects
on one's self-esteem. Left unaddressed, however, defense mechanisms eventually erode, even among the most stoic; burnout sets in.
A key take-away to remember in the burnout discussion is that no
one goes directly from "normal" to burned out overnight. And that's
how we beat it. To be candid, when I initially conducted the study as
a third-year resident, burnout was almost inconceivable to me personally. I rarely slept and spent most of my nights studying, reading, and
writing after 12-15-hour days; I was full of energy and excitement as I
entered the hospital each morning. But years later as a fellow, burnout
almost blindsided me in spite of all my awareness.
If there's one thing I'm certain of now, it's that physician burnout is
out there; more discussion, more awareness, and more research are
needed. The veil of stoicism is so popular these days, but thankfully,
APMA is spearheading the effort against physician burnout among
DPMs with resources available at www.apma.org/wellbeing.

http://www.apma.org/wellbeing

APMA News - July/August 2020

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