“Eat when you can, sleep when you can, pee when you can, and don’t mess with the pancreas.” Every surgeon trainee knows this phrase. It’s the mantra passed down through generations of surgeons trying to survive the earliest years.
It’s also symbolic of how the US medical system rewards behavior that leads to burnout.
Even more alarming is that female doctors are 1.6 times more likely than male doctors to die by suicide.
Women everywhere are particularly vulnerable to burnout, which is defined as emotional exhaustion, cynicism, and a low sense of accomplishment. One study shows that women experience more depressive symptoms during their first year of physician training.
Another study evaluating why women leave the surgical field identifies several key reasons: the impact of pregnancy, childbirth, and child-rearing; an insufficient number of female role models; sexism and discrimination; sexual harassment and assault; and poor mental health.
As female physicians, we weren’t surprised by these findings. Many of us have experienced it personally, or know female colleagues who have dealt with discrimination, bullying, overt sexism, and institutional roadblocks.
One colleague told us that when she was in training, nine months pregnant, and in the middle of finishing a surgery—after a 12-hour day in the operating room—a janitor remarked that she had better maternity benefits than the surgeon.
We know many female physicians who have been forced to breast pump in secluded medical supply closets because they aren’t given offices, and many hospitals don’t have lactation rooms. Other female doctors noted that despite their best efforts, such as “dressing the part” and introducing themselves as “doctor,” they often have to remind patients that they are, in fact, the physician in the room. In fact, another colleague reported that despite making a point to wear a badge that read “DOCTOR” in inch-tall red letters, she was asked by a medical student to clean his patient’s vomit.
Women physicians are frustrated, and justifiably so. They are less likely to get patient referrals than men in the same specialty, and at the end of the year women bring home, on average, $105,000 less than their male counterparts.
These disadvantages, and many more, have caused untold numbers of female physicians to experience burnout or other mental health conditions.
This is especially problematic because all physicians have limited protections for their privacy if and when they seek mental help. Numerous state medical licensure boards violate the Americans with Disabilities Act by asking physicians every few years to reveal whether they have ever endured a mental illness.
Women are particularly likely to struggle with mental health problems. One in nine women in the US experiences postpartum depression. While physicians with postpartum depression may not be impaired from performing their professional duties, many opt to avoid counseling or pay out of pocket for counseling out of fear that seeking help might result in discrimination when applying for medical licensure, hospital privileges, or malpractice insurance.
Young, entry-level women physicians are most at risk. They have an average of $190,000 in medical school debt, are often too young to have developed good coping mechanisms, and are of childbearing age. They have the least amount of schedule flexibility, usually cannot afford to pay out of pocket for mental health care treatments, and are trained to think that asking for help demonstrates weakness.
Physician burnout doesn’t just affect doctors—it is detrimental to the entire health system, and everyone who uses it. Burnout costs the U.S. health care industry $17 billion each year. The American Medical Association reports that each physician lost to burnout costs the system $500,000 to $1 million.
Researchers have shown that burnout is associated with a two-fold increase in unsafe patient care, unprofessional behavior, and low patient satisfaction. In fact, patients treated by burned out intensive care physicians have higher mortality rates.
Fixing burnout has historically been cast on the individual and focused on improving “self care.” This further isolates doctors who are overwhelmed. Upon hearing that it’s up to the individual physician to solve burnout, a colleague joked, “Are you saying if I yoga harder, this will fix the problem?” No. Burnout is a systemic issue that requires large, system-wide changes.
Hospital leadership and the medical community need to recognize the issues unique to women. Each state should take steps to change medical board licensure systems to protect the privacy of physicians who are responsible enough to seek mental health services. Medical training should include practical education about burnout detection and prevention, and the importance of peer support. Residency training programs need to build systems that support family leave policies that are in line with state and federal allowances. We have to create a society where physicians who ask for help are not given a scarlet letter.
Learning from professions with far less burnout encourages us to curb burnout by giving physicians more control over schedules and empowerment within a bureaucratic system. Women physicians, who already manage a disproportionate amount of home duties and child rearing, are primed to benefit from increased control of their own work hours.
Jim Morrison, of The Doors, said, “You can’t burn out if you’re not on fire.” Women doctors have been “on fire” for years, operating at a high level and even exceeding male peers, to the point of emotional and mental exhaustion. It’s time to stop the burnout.