Many physicians should see a doctor. They are irritable, tired, despondent, unsatisfied with work, and avoiding responsibilities. They report physical symptoms: headaches, GI upset and poor sleep.
Experts say doctors are burned out:
- Half of doctors burned out – Forbes
- Burnout increasing in doctors – Washington Post
- 10 signs you’re burning out – Forbes
- Job burnout: how to spot it and take action – Mayo Clinic
Abuse, Not Burnout
But one doctor calls BS on burnout. Dr. Pamela Wible, ‘America’s Leading Voice for Ideal Medical Care’, says,
“Please stop using the word burnout. You are not burned out. You’ve been abused. Let’s get the diagnosis right.”
“…medical students and physicians are collapsing because they are suffering from acute on chronic abuse.”
And she wrote a best-selling book: Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind
Despite her outrageous book cover, Dr. Wible makes a solid point. Victims of abuse often report symptoms like burnout.
Symptoms rarely indicate one disease. Fatigue, mood swings and stomach aches can mean almost anything. High calcium causes stomach aches, muscle cramps, and psychosis. But we do not say patients have stomach, muscle or mental problems when their calcium is high. They have a calcium problem.
Diagnosis
Many doctors show signs of burnout. But could it be abuse? If doctors are suffering abuse, not burnout, then calling doctors burned out just blames the victims.
Doctors often serve and recharge by practicing medicine in a developing country. No doctors ever tell how happy they are to return home to catch up on the latest legislation, regulation, and tick-boxing requirements of medicare.
Doctors recover from their symptoms of ‘burnout’ soon after escaping abuse. They go on to work even longer hours with energy and joy once freed to do so.
Waking Up
Disillusionment is good. It hurts to lose a dream, to realize what we thought was true is not. But life under an illusion cannot be full and rich. Dreams feel bizarre.
Many doctors talk about delaying gratification until middle age. The dream of being a doctor pushed them through 24 years of school. It promised relief when they finally got out of debt; finally got out of working night shifts; finally became financially independent; finally started a family.
Gambling on the dream, many doctors lived far below the poverty line, long past medical school. But most grew tired of frugality sometime in residency, in their late 20s and early 30s. At that age, debt works so much easier than pinching every dollar.
So after years of being poor – really poor by every measure of poverty in Canada – doctors finally start earning a decent income. Something almost as good as a school principal.
At this point, they usually take on even more debt. They buy a house and build their practice. The Wealthy Barber
Sometime in their late 40s or early 50s, doctors expect to arrive, to be debt-free, to loosen up a little and enjoy life. But depending on how many kids (and spouses) they have, doctors often end up delaying this dream, too.
Over the last year, doctors tell me that they find it harder to make a living. Not maintain their posh lifestyle. To make a living. Just when doctors thought work would get easier, they have to find new jobs, work overtime, and downsize their middle class lifestyle and expenses.
Doctors are frustrated. And with good reason. Even if doctors were earning huge incomes, which many do not, 10 years of heavily taxed earnings, after 35 years of poverty and debt, hardly balance out.
Treatment
Recovery starts with facts. It starts with the right diagnosis. Recovery will never come by telling doctors to maintain better mental health, or to get more exercise. It certainly won’t come from the common response, “Well, you chose to become a doctor!”
Recovery starts when doctors wake up from the dream. They need to find other doctors who feel the same. Thousands of doctors are waking up to understand, in a personal way, that they cannot run a business when government has too much power and control.
This is not just a rant about political theory. It’s a reflection on current events. This will happen again, no matter what truce doctors may sign. Government will get desperate, again, and treat doctors like they have no civil rights.
Will doctors make the right diagnosis? When will they call this abuse, not burnout, and get on with treatment?
Nice. Would be interesting to run with the finding that doctors who practice abroad find greater satisfaction, even if busier, and see where that goes.
Great suggestion, John. I will keep watch for articles or data on it. Thanks again for commenting!
It’s vague on who and what is delivering the abuse. Iso it patients? Other doctors? Medicare? PGME training? Loan collectors?
This is a great question, Judith.
Even in cases where we assume the source of abuse is obvious, e.g., bullying, it often requires a culture that allows bullying for the abuse to continue. As I was thinking of how to answer this, I remembered a documentary on abuse of new recruits in the military. Abuse came from all quarters; it grew in a culture of abuse. But even this example is too crisp.
I think that, right now in Ontario, doctors feel abused by the whole system. If we add up the hundreds (thousands?) of pages of legislation, statutes and regulations governing medicine, plus the bureaucratic performance expectations, plus the number of regulators that can drop in at any time, plus the arbitrary unilateral actions, plus the clawbacks, and the whole environment of uncertainty, doctors feel under attack. They feel attacked because they are. The system feels oppressive. You’d have to work inside it to fully understand. Colleagues who have experience working in the old Soviet healthcare system find many similarities to the structure of our current approach. In fact, if you are really interested, you could read ‘Soviet Health Services: A Historical and Comparative Study’ by H Gordon, 1974; fascinating.
Patient issues – demanding, ungrateful, mean patients – will always be part of a service industry. Doctors learn to manage that. Arbitrary, unanticipated unilateral actions by government, along with grand redesigns of medical care rolled out with NO input from the people who provide medical care makes doctors feel abused.
Great question!
Thanks so much for reading and sharing your thoughts.
Best,
Shawn
I wonder if the satisfaction doctors have when working abroad has something to do with greater appreciation from patients there? I really don’t want to blame patients here in Canada, but I often feel that we (and our whole healthcare system) are devalued by people with high expectations, who feel entitled to this ‘free’ healthcare (provided by that rich group of 1 per cemters).
Maybe some of the abuse comes from (some of) the users, with support from the government of course…
Great line of thinking, Soraya.
It is perfectly natural for people to have less patience and more entitled attitudes for things that have always been ‘free’. Only the older generation who lived through tough times, that required great sacrifice, will smile and cooperate with schedule changes, waiting, inconvenience, etc. While we all have responsibility for our actions, I do not think we can blame people for being ungrateful. The system is designed to make them so.
Having provided limited care in other countries, I found it invigorating to diagnose and treat instead of primarily trying to educate and motivate. Medical notes were taken to help me and the next physician who might read them, not to help the regulators or lawyers looking for blood. It was delightful. AND the patients appreciated it for the most part.
Great comments, Soraya. I sure appreciate you taking time to read and comment!
Best regards,
Shawn
Shawn, I think you have belled the cat! Great reflection and I agree with your thesis wholeheartedly. Clay
Thank you, Clay! And thank you for ‘belled the cat’…I’m embarrassed to admit that I had to look it up!
I sure appreciate you reading and taking time to comment.
Best regards,
Shawn
Halfway through medical school, I made the decision to leave. I could not handle the pressure without being an unhealthy person. It was an extraordinarily heart-wrenching choice to make, but I would make it again, ten thousand lifetimes over. I am so much healthier, now.
Wow, Rachel.
Thank you for sharing this. I remember many long conversations with fellow residents wondering if there was life outside of medicine. But we’ve committed to much time to this! You were wise to act on your self awareness. I can imagine the emotional/mental/spiritual battle of making that decision. Very happy to hear you’re on to better, healthier things.
Thanks so much for sharing this!
Warm regards,
Shawn
Hi Shawn..been following docs tweets for some time. Tone is one of frustration with Wynne/Hoskins and …..helplessness. No wonder docs feel overwhelmed. I think it’s time to stop the whining and take control. You’re well educated, highly respected and from my patient point of view….you keep us healthy to enjoy our lives. No small feat in the current healthcare climate in Ontario. Teachers & other public unions are tenacious and never quit until they get what they want. I don’t recommend their tactics but there is clear path they employ to get attention. When we’re depressed exercise is a great diversion, well when docs are depressed, do something about it. Docs underrate their impact because, God forbid they upset their govt bosses. When docs are depressed we patients suffer. As a patient, that’s unacceptable. We wait 12 months for specific surgeries, our quality of life is being jeopardized by Wynnes mismanagement. Doctors can change that, you have the strength, knowledge and commitment to HC. Most importantly your on the right side of the HC debate.
Ah….that feels better.
Don
Very well said, Don, as always!
We sit in an interesting low right now. If government settles, most of the passion for change will evaporate. Docs will grumble and whine but go back to doing what they’ve always done. But if government takes one more action, just a tiny cut, the whole system will blow apart. Doctors will irrupt. They’ve been primed. A critical mass has taken on activism as a second job. One tiny pin-prick from the government should cause the whole stink bomb to blow.
I agree. Whining won’t help. It turns people off. But often the whiners inspire each other. That’s what I’m hoping for.
Again, thanks so much for reading and sharing an inspiring comment!
Best regards,
Shawn
I knew a doctor who never opted in to OHIP. He did all the paperwork and the patient received the cheque which they endorsed and forwarded to him. Funded health care was a matter between the patient and the insurer and had nothing whatsoever to do with the Doctor. I spent many evenings at his dinner table in my youth, not really understanding his point of view but now it’s clear to me. Unfortunately it is also too late.
Great comment, Kathleen. We didn’t know what we gave up by allowing McGuinty to push through The Future of Medicare Act in 2004 that outlawed opting out. No one fought because it was already illegal to bill anything different than the state enforced fees. But the principle still stood. We lost something important when patients never exchange funds for a visit to the doctor. The costs become invisible. It all becomes free. It changes people.
Yes, unfortunately it is too late.
Thanks again for sharing this!
Best regards,
Shawn
During the “capped” years he could not be capped. Which patient do you take the claw backs from? It also wouldn’t work with this global budget they have imposed on you. I find it interesting that in order to be licensed by CPSO you are obligated to enter into a business relationship with the government by obtaining a billing number. It seems to fly in the face or the mission of the College.
Exactly. That’s probably why McGuinty was so eager to close that final gap. Now government can disallow payments when docs submit bills instead of having to look patients in the eye and deny payments for the bills they submit directly.
The college runs under the shadow of having its leadership removed by government at any point. It has become an arm of government with a patina of ‘self regulation’. It is the college of ‘lawyers and lay-people’ according to someone working on the inside.
I think “abuse” is an attention-getting word, and I agree on the need to clarify what is the abuse and by whom? Is there abuse in the training of physicians?–which is something Dr. Wible also writes about. Is there abuse with the administration of the healthcare system, or is that simply bureaucracy that is present within many fields that leads to frustration, disempowerment, stress and burnout (teaching, for example). Comments here seem to point to national healthcare and entitlement of “free” care (though it is tax-based); however, Dr. Wible writes of a system in a country that does not have national healthcare, which indicates that is not the source of the problem whether it is called abuse, bureaucracy or burnout. Whatever it is called, the focus should be on what can be changed, and should or shouldn’t be changed to prevent not only physician abuse/burnout, but to prevent fraud and abuse of and from providers and suppliers. Not everyone will be able to afford private healthcare…that is not entitlement, it is just economic reality for many. Cost reductions, administrative simplification, legal reforms, and wage equity all play a factor.
Interesting thoughts, D. Thanks for sharing them.
I think abuse steps beyond expected frustration with bureaucracy and the bluntness of policy. The facts point to physician suicide as much higher than comparator groups.
You take a hard swerve left at the end of your note. We can provide universal care, even for those who cannot pay, without a government monopoly. Just look at all the European countries. Also, I’m not sure what you mean by wage equity. Do you want your GP to make the same for seeing you as the surgeon who repairs your ruptured bowel at 3 in the morning? Or do you mean income equity? Do you want your GP who works 60 hours per week during daylight hours to make the same as the trauma surgeon who works 100 hours, mostly at night? Or do you mean everyone should make the same wage per hour and total income regardless of training, hours worked per week, risk, responsibility, etc? Other countries have tried that approach already…
Thanks for taking time to read and comment.
Best,
Shawn
I really, really hope that whatever agreement doctors (via their association) are finally able to come to with the government that they do not ever again trust the government to do the “right, honorable and ethical thing”. Governments are way past that these days and the current Ontario liberals are among the worst. Doctors at any stage in their careers do not deserve this kind of treatment and as a patient, it is extremely maddening to me that the government thinks I am stupid enough to believe that how doctors are being treated and the health care system gutted will have no effect on patients. I think most patients are smart enough to know that if we do not allow new graduates to get on with their careers that we will “run out of doctors” as the older ones retire. We are already short of doctors, so there is no logic at all in this. Not to mention that many will retire earlier than planned (if they can) rather than put up with the bu–sh– any longer. I certainly know people who are already feeling the effects of the cutbacks and I am just hanging on hoping that my own surgery is not cancelled or delayed. I think what makes me the maddest is that Wynne is doing this to doctors and the health care system because she can. There is no one to stop her and she certainly turns a deaf ear to the public.
Doctors have enough stress just doing the demands of their profession. They don’t need the government bullying them, undervaluing them, and jeopardizing their practices.
Very well said, Valerie.
I sure wish everyone else had your insight! You are right: government treats voters as though they were ignorant children; easily distracted by baubles.
This spring should be very interesting. The healthcare ship lists dangerously; it will take very little to sink it.
Thanks again for sharing such a thoughtful comment!
Best
Shawn
Made me feel guilty. I was a well established physician back home. Not very rich but highly respected in the community. moved to Canada, spent 5 years rewriting all exams, training and started practice.
Now after 5 years of practice wants to quit a profession that I wanted to practice till my last breath. Its not medicine that I am practicing in Canada, its buttering the patient, making them happy with whatever they want as its their right. Yes a patient in Canada has all the rights but physician has no rights, no respect. Probably i am more financially sound now but with no satisfaction, no happiness, just an emptiness……
What a powerful comment, Naeem!
I can only imagine how you feel. Canadians in big cities, especially in Southern Ontario, sees MDs very differently than in rural areas and other countries. Over 20 years, I watch attitudes change as the city moves out. Having worked in rural and urban areas at the same time, it feels like practicing in a different country in light of the respect afforded to a ‘doctor’. It’s demoralizing to devote over 20 years to training to be faced with sneering criticism, snide remarks, and accusations of moral corruption.
No doubt, thousands of doctors do not feel what you report and see entitlement as just part of the job. But thousands of doctors share your feelings. Those who share your feelings grow in numbers as the government attacks us. I’d like to see a survey with with a question about your comments. I would not be surprised to see your views approaching majority opinion in many areas and specific clinical specialties.
Again, I appreciate you taking the chance to share these thoughts. Powerful! While it might be small comfort, there is always a community somewhere that will value and respect your services. It just might mean working in a northern or remote area.
Highest regards,
Shawn