Physician Burnout: The Role of Lifestyle Medicine

For example, the area of physician wellness has increasingly been viewed as a key component of helping physicians deal with professional stresses.

In the current issue of American Journal of Lifestyle Medicine (AJLM), we are pleased to publish 2 articles related to the increasing problem of physician and other health care professionals’ burnout. The issue of burnout has become a very important topic throughout all of health care. Numerous articles have appeared about this issue both for physicians and other members of the health care team over the past 5 years. The coronavirus disease 2019 (COVID-19) epidemic may have made matters even worse, particularly for frontline physicians and nurses.¹ However, paradoxically, these selfless and courageous workers have also been lauded for immediately rising to the challenge of the epidemic, despite the overwhelming workload and potential dangers that could contribute to burnout.

As both articles in the current issue of AJLM point out, burnout is not a concept that has only emerged over the past few years. It has been around since at least the late 1960s. It is interesting to note that burnout was being described as far back as the 1960s and 1970s. It has been speculated that these decades were another period of time when the idealism of young people clashed with barriers and circumstances that surrounded them—most prominently in that period of time, the Vietnam War.

At its root, burnout results from a clash between the ideals that people possess, including what many of them have described as a “calling” to enter the medical field, and frustration from what they actually experience.

Even though burnout seems very prevalent (some estimates have concluded that 40%-50% of physicians are experiencing at least some components of burnout),² there are some hopeful signs as well. For example, the area of physician wellness has increasingly been viewed as a key component of helping physicians deal with professional stresses. However, I believe that the concept of physician “wellness” is not broad enough. The multiple pillars of lifestyle medicine can play an even more important and comprehensive role moving forward. Thus, it is very important that lifestyle medicine practitioners play a proactive role in the area of physician and other health care worker burnout.

Burnout has been described as a combination of emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment. It must be emphasized that most research in the area of burnout has concluded that burnout is not something that occurs overnight. It is also important to understand that there is some overlap between what has been described as “burnout” and depression and anxiety.

Numerous constructs have been proffered to try to understand what causes burnout. I was particularly intrigued by the framework articulated by Hartzband and Groopman in an article in the New England Journal titled “Physician burnout, interrupted.”³ In this article, Hartzband and Groopman quote important work by Gagné and Deci,⁴ who are experts in the area of organizational psychology. These psychologists make a distinction between “intrinsic” motivation and “extrinsic” motivation. In the area of intrinsic motivation, doctors, nurses, and other health care professionals traditionally have viewed their work as a calling and often enter the field with a high level of altruism in addition to an interest in human biology. Thus, they are highly “intrinsically” motivated. Extrinsic motivation, as the name suggests, comes from factors outside of the individual.

Often, paradoxically, efforts to improve the medical system have inadvertently attempted to create extrinsic motivators without realizing that these efforts can actually erode or destroy intrinsic motivation. As Hartzband and Groopman³ point out, this can lead to “amotivation”—in other words, burnout. A classic example of this is the electronic medical record (EMR). The EMR was intended to make the practice of medicine more efficient, but as many physicians have experienced, it has actually often created barriers between physicians and their patients and resulted in an enormous amount of extra paperwork, leading to the syndrome that has been described as “pajama charting” in the evenings, which can significantly erode into what had previously been reserved for personal and family time.

It is largely in the area of intrinsic motivation where lifestyle medicine can play a profoundly important role. In fact, many people who enter the field of lifestyle medicine do so because they have experienced that mainstream medicine has become unfulfilling. Indeed, many of the pillars of lifestyle medicine can play significant roles in combatting burnout. For example, increased physical activity, healthy nutrition, stress reduction, and sleep hygiene can all play very important roles in helping physicians maintain their own well-being and lower the risk of burnout. Positive psychology, which has become more important in the area of lifestyle medicine in the past few years, can also play an important role.

It is clear that the issue of physician burnout is complicated, with no simple answers. In fact, a major systematic review and meta-analysis of physician burnout⁵ has shown that the most promising mechanisms for ameliorating burnout involve both individual approaches as well as changes in the external environment.

It is very important that leaders in lifestyle medicine, in particular, emphasize that physician burnout is a critically important area to be addressed. The techniques of lifestyle medicine should be applied not only to our patients, but also to ourselves. This is especially true of medical students and residents and other individuals in training or early in their medical careers who have been shown to experience very high levels of burnout. Other frontline physicians such as primary care physicians, emergency room physicians, and as Romito et al⁶ point out in their article, anesthesiologists have also been shown to have high levels of burnout.

We have appropriately focused much interest in the area of lifestyle medicine on lowering the risk of chronic diseases in our patients through positive lifestyle behaviors and habits. It is time to emphasize that these same habits and practices play a very important role in promoting both emotional and physical well-being and lowering the risk of burnout among lifestyle medicine physicians. I hope that the current issue of AJLM will sound a clarion call to apply the principles of lifestyle medicine throughout the medical and health care community to enhance the underlying joy and satisfaction we all can experience in medicine and reduce the risk of burnout.

James M. Rippe, MD
Editor-in-Chief, AJLM
Professor of Medicine
University of Massachusetts Medical School