GRADUATE MEDICAL EDUCATION
David K. Barnes, MD, FACEP
Nicholas Hartman, MD
Katren R. Tyler, MD
Decoding Physician Wellness By David K. Barnes, MD, FACEP, Nicholas Hartman, MD, and Katren R. Tyler, MD This might be the understatement of the year, but residency training is difficult. Those who have completed emergency medicine training undoubtedly recall periods of sleep deprivation, emotional depletion, and lack of time and opportunity to pursue outside passions and interests. Post-graduate training stresses relationships and complicates child bearing and rearing, and requires separation from family and friends, debt accumulation, and acclamation to demanding schedules. No wonder trainees feel helpless.1 The emergency medicine and broader graduate medical education (GME) communities now appreciate the human consequences that the training environment and clinical practice have on physician wellness.2 The World Health Organization defines wellness as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” An evolving concept, wellness is often used interchangeably with the term “well-being”. While several models of wellness exist, each contains a common set of eight dimensions determined to be essential—characteristics, identities, and behaviors that contribute to one’s complete health. Fortunately, a growing wellness effort now exists within the medical community and aims to improve the mental health and professional satisfaction among residents and practicing physicians.3,4 Of all the elements contained within physician wellness, burnout usually dominates the conversation. Burnout—defined as a syndrome of emotional exhaustion, depersonalization, and decreased sense of personal accomplishment—has been a topic of discussion in the medical community since its description by Maslach in the 1980s.5 Physician trainees have consistently been found to possess higher rates of burnout and lower rates of wellness than the general population.6
Unfortunately, physician burnout is on the rise. The AMA and Mayo Clinic surveyed 6,880 physicians across all specialties to “evaluate the prevalence of burnout and physicians’ satisfaction with work-life balance compared to the general U.S. population.” They reported that rates of burnout and professional dissatisfaction rose for every specialty studied from 2011 to 2014. Unsurprisingly, emergency physicians reported the highest rate of burnout in both study periods. Even worse, emergency medicine was the only specialty to exceed a 70% burnout rate.7 Emergency medicine may be unique with its combination of shift work, patient mix, chaotic work environment, and high volume/high acuity, but the circumstances that conspire to cause and contribute to burnout affect all physicians: long work hours, chronic fatigue, difficult patients, administrative barriers to care, loss of autonomy, human suffering, to name just a few.
"It has become increasingly clear that helping residents improve their own well-being and mitigating the circumstances that lead to burnout will be essential in the coming years." 17