I am not currently experiencing burnout.
I am grateful for this. I do think I have been there or at least burnout-adjacent in the past (figuring out how to deal with PMDD around winter 2019; possibly spring 2022). I was listening to a podcast this morning (this one: Beyond the To Do List: Chris Bailey on How a Calm Mind Increases Productivity) and learned two things about burnout that are not new — but were new to me.
FIRST: Maslach, of Maslach’s Burnout Inventory, a commonly referenced scale in the physician wellness world (and I’m sure many others)? Maslach is Christina Maslach. A woman! Due to my own patriarchal influences, I had long assumed otherwise. Dr. Christina Maslach is still on faculty at Berkeley. Now I want to delve into her original work.
SECOND: I learned about the 6 factors that can increase risk of burnout, and every single of them made complete sense. I had heard them vaguely before, but not for a while and it just hit me how a) medicine is really primed to facilitate burnout and b) why women are even more at risk. Here are Dr. Maslach’s 6 factors:
WORKLOAD: This is clearly an issue in medicine, especially as staff shortages worsen. Likely worse in various pockets and specialties where shortage are more pronounced. In my specialty, booking >6m out is common. Larger entities are financially motivated to push providers right to the brink of what is tolerable especially as operational costs increase.
Woman also often have a whole pile of ‘workload’ waiting for them at home that disproportionally falls to them. So, double whammy . . . even if your charts are done, the kid admin/cleanup may not be so the overall workload is too high. Personally, I am very lucky in this realm. I feel my workload is manageable in the clinical world, and have someone else doing a good portion of the household work (maybe not the admin, but a lot of the food prep, laundry, and general cleaning up + lots of driving). I know not everyone is able to have this, including those with equally heavy workloads during the day.
CONTROL: Control of the schedule, control of the day, etc. Things like not being able to take a PL day without months of notice can be frustrating — this definitely relates to autonomy and control. Getting “push” notifications (HELLO EPIC CHAT) about non-urgent things is a particularly grating loss of control (to me, anyway!). And call — well, that’s an utter loss of autonomy. (Not saying it’s not necessary or that the work isn’t worthwhile! But it is accepting a temporary loss of autonomy. Call means that you’ve made an agreement to essentially say “yes of course” to anything handed to you during a certain period. And that is hard.)
On an outpatient day, I also can’t control anything about what any patient expects from me — even if what I am recommending is in accordance with guidelines and what they want may not be. Once again, I feel lucky in that most interactions are positive, and that I do not have call all that often. But man – there are plenty of challenges to control in medicine.
(And in parenting. Parenting babies is a huge loss of autonomy and control. It gets gradually better with time, but then morphs/flips into difficult feelings about controlling our kids’ behaviors . . .)
REWARD: Hmm. I can’t complain in the tangible compensation realm. But sometimes I do not feel like what I do gets noticed in any way shape or form. For example, call is a TON of emotional labor. It would be awesome to have someone say at the end — “awesome job. That was really hard, but you did it.” (I do often get that from you guys, which is amazing – but what about those who don’t have blogs?).
I think most medical systems and practices could do more to acknowledge periods of hard work and accomplishment across the board. There are some things happening here, but there could be more.
And at least traditionally, this can be a major struggle on the home front, too.
COMMUNITY: I am happy to say that I truly like my colleagues! I enjoy working with basically everyone at our office and have many colleagues I can truly call friends. There have historically been some spaces where I feel less comfortable/welcome, in part because I am female and on what is probably considered a ‘lower tier’ specialty (less competitive, lower paying, non-procedural).
This is again where I think women with young children struggle. Between pumping and having to rush home and generally being exhausted, it can be harder to make new connections. Early motherhood can be so isolating.
FAIRNESS: So even though I have to acknowledge that physicians are compensated pretty well, the discrepancies between men and women are well-known, and they sting. Also, as a lower paid specialty sometimes I have to wonder – why is what I do over 3x less valuable than that of, say, an orthopedic surgeon when the training took almost as long (admittedly, it was less intense). Why are pediatric subspecialists paid so much less than their adult counterparts?
(On the home front, fairness issues are obvious — see Eve Rodsky’s aptly named book!)
VALUES: Well. This one is tough. But I will say there are certain things I do at work that feel more aligned with values than others. Sometimes what parents or patients want and what is safe/responsible/evidence-based are not in sync, and it can feel like a losing proposition because trying to practice safe and responsible medicine + fulfilling patient/family desires can be at odds. Not to get into specifics, but some days I have come home feeling like I didn’t do much that felt truly good. Those days can feel demoralizing.
At home, values come into play as well as we make all kinds of choices for our own kids and often question them along the way.
All this is not to say “woe is me” (AT ALL) or even “woe is being a woman in medicine.” First of all, I feel very lucky that many of the above do not apply to me currently (or if they do, to an acceptable/minimal extent). Second, I want to acknowledge that this is not unique to medicine or even health care overall. I think MANY career paths and lifestyles probably invoke similar challenges — it’s just that being a mother and a physician is the particular path I have taken, and the lens through which I see these 6 factors coming into play. A similar list could probably be adapted to those who are teachers, those who work in tech, those in other corporate environments, and really an infinite number of other things.
At least in identifying these factors, maybe I (we) can get ahead of things if burnout rears its ugly head again.
And, in completely unrelated news (and characteristic theshubox fashion), here are some V-day pix!! We had a fantastic treasure hunt this morning — a tradition passed on from my dad that will hopefully continue across generations 🙂
The prize was (as always) boxes of See’s candies. The hiding place this year was the oven.