Coping with health system dysfunction 

By Dimitrios Tsatiris, MD, Northeast Ohio Medical University 

Many healthcare professionals experience burnout at some point in their career. It’s important to remember that this doesn’t indicate a lack of resilience. A cross-sectional study of over 5,400 physicians showed that even the most resilient suffer from high rates of burnout.   

Some suffer from burnout because a career in medicine didn’t turn out as expected. Becoming a healthcare professional was a calling to help people overcome ailments and live their best lives. Unfortunately, on a daily basis, clinicians contend with countless systemic factors that prevent them from manifesting their calling.   

Clinicians make tremendous sacrifices to become physicians. Extending their education by a decade after college saddles many with significant student loans. There are countless nights and weekends studying for exams and taking call. Many feel they have to skip meals, sleep, exercise, bathroom breaks, family, and social gatherings to serve patients. 

And of course, healthcare professionals don’t have the luxury of practicing medicine in ideal settings. Far from it. Countless systemic factors interfere with the ability to best care for patients. Increased administrative, clinical, and documentation requirements, a loss of clinical autonomy, denials of care from insurance companies, persisting gender and racial inequalities, and a fear of being sued stretch many clinicians beyond their limit.  

Furthermore, the corporatization of healthcare has tarnished medicine. By adopting business metrics to maximize revenue, hospital administrators put clinicians in an impossible moral conundrum. Conforming to productivity benchmarks interferes with the ability to best care for patients.  

The systemic factors plaguing medicine are the primary reason countless physicians suffer. It’s imperative that hospital leadership, insurance companies, the pharmaceutical industry, and governing bodies implement policies to address these factors. In theory, policy changes would eventually trickle down to physicians working in the trenches and improve patient care. 

But we can’t wait passively for a top-down approach to improve the landscape of medicine. The U.S. spends more on healthcare than other high-income nations. Yet, this spending hasn’t translated to better quality of care as the U.S. has the lowest life expectancy of this group (2). In addition, a review published in JAMA estimated the cost of waste to range between $760 billion and $935 billion, which represents almost 25% of total healthcare spending (3). These inefficiencies indicate that we can’t simply hope that this bloated and fragmented system will evolve into a more organized, efficient, and humane establishment that prioritizes patient care and physician wellness. We need to take the necessary steps to rise above a broken healthcare system. Here are three tips to do so:  

1. Set boundaries. 

Advocating for yourself can be difficult when you fear it can result in repercussions. Such an emotional response is understandable considering the hierarchical structure of medicine.   

Working harder to keep up with increasing demands isn’t a viable long-term strategy. This only gets you stuck in a vicious cycle of learned behavior in which people grow accustomed to expecting more productivity out of you. In other words, the more you give, the more others expect you to give.  

 Saying “No” is unavoidable. If you never say “No” to your employer, then you’ll end up saying “No” to yourself and loved ones. 

2. Make yourself a priority.  

 Self-care may sound simple but it’s hard to practice. Medicine promotes traits that aren’t congruent with practicing self-care such as stoicism, self-reliance, and self-sacrifice.  

The way physicians vacation further supports this notion. A cross-sectional study of over 3,000 U.S physicians found that 59.6% took three weeks of vacation or less in a given year and 70.4% worked while on vacation. Both patterns were associated with higher rates of burnout. 

Changing the culture of medicine starts by making yourself a priority. It’s ok to take care of your needs. You’re a human, not a machine. Self-care is essential to serve others at the highest level.  

3. Tame your perfectionism.  

Medicine selects for and reinforces perfectionism for understandable reasons. In many clinical scenarios, the slightest deviation from perfection can have devastating clinical outcomes. The truth is that perfectionism is a recipe for suffering. It’s associated with mental health difficulties. It can also negatively impact your closest relationships. It is even a risk factor for burnout and imposter syndrome. Perfectionists fall for the all-or-nothing trap. They either view themselves as perfect or complete failures. This mindset sets you for an unattainable standard and isn’t congruent with personal growth. How can you expect yourself to be perfect when medicine is imperfect in diagnosing and treating different conditions? Instead of trying to be perfect, strive to be outstanding. Do your very best while accepting imperfections as opportunities for personal growth.  

For further tips, check out my recently published book, “Physician Burnout,” on how to rise above the systemic factors plaguing medicine. 

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This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.