by Martina Schulte, MD
Featured in the July-August 2019 Colorado Medicine Colorado Medicine.
Somewhere in the decision to become a doctor is a conscious or subconscious understanding of signing on for hard things. Dealing with complexity, challenges, painful conversations, and life-and-death issues are “knowns” about becoming a doctor. On some level, we accept these as inherent with the calling, and many of us even find great meaning and connection doing these hard parts of the job. These are inherent stresses that come with caring for patients, and inherent rewards are often tied to them. Beyond the inherent stresses are added ones. Examples of added stresses include productivity, EMR requirements, workflow and staffing issues, poor management or leadership, and subtle examples of not being valued. Added rewards include income, benefits, prestige, privileges, teamwork and recognition. Thomas Lee, MD, and Deirdre E. Mylod, PhD, provide a succinct and helpful description of these stresses and rewards in an article published in March 2019.1
Inherent stresses/inherent rewards
Interestingly, trying to decrease the impact of inherent stresses by avoiding these hard parts of our work can decrease the inherent rewards we feel from connecting and assisting during challenging times. The inherent rewards of physician work include meaning, ability to help and heal, appreciation from patients, and sometimes practice improvement and leadership in clinical care. The overall goal is not to decrease the inherent stresses and thereby decrease some of the inherent rewards, but to maximize them. Instead of shying away from inherent stress, creating a space to experience it and share it with peers helps to raise one’s awareness of the experience and can add to pride in one’s work, or add to one’s sense of meaning.2
Health care organizations and medical societies are recognizing the importance of promoting time for collegial support gatherings and socialization. Additionally, the inherent stress of physician work that involves witnessing suffering and trauma dictates that more be done to assist physicians in processing and expressing the pain and challenges of these times. Increasingly, organizations are adopting peer-to-peer support programs to formalize this collegial support for each other at times of heightened stress from trauma and loss. Prototypes exist for these programs including the peer support program by Jo Shapiro, MD, at Harvard and Johns Hopkins’ “RISE: Resilience in Stressful Events.”
The bottom line is that inherent stress is part of our work as physicians and embracing it in a healthy way needs to involve regular, supportive and collegial relationships where sharing the experiences and caring with each other in difficult times is the expected norm. Connecting with and supporting each other help optimize the meaning and inherent reward that comes with doing our life’s work.
Added stresses/added rewards
On top of inherent stresses are the added ones that we know well in our daily work. And there are added rewards, such as income, prestige, privileges, recognition and teamwork. But, unlike the connection between inherent stresses and rewards, added stresses are not connected to added rewards.
For example, more of the added reward of income does not take away the challenges and, dare I say, frustration, anger or irritation of the time drain that often is the EMR. To mitigate added stress, individuals, practices and organizations need to commit focused attention on reducing work demands that are not connected to improving patient care. Interventions by practices and organizations are now happening, centered on improving efficiency and decreasing burdensome documenting and paperwork. Organizational approaches to addressing these stresses are many3 and some are discussed more in this issue.
Though inherent stress of our physician work is often tied to the inherent reward, this does not mean nothing can be done to assist physicians in processing and managing these stresses more effectively. Much of this involves enhancing relationships and community. And, as added reward is not tied to added stress, added stress should be dealt with directly by initiating ways to lessen the work demands that comprise it.
- Lee TH & Mylod DE. Deconstructing burnout to define a positive path forward. JAMA Intern Med. 2019;179(3):429-430. doi:10.1001/jamainternmed.2018.8247.
- West CP, Dyrbye LN, Rabatin JT, et al. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med. 2014;174(4):527-533. doi:10.1001/jamainternmed.2013.14387.
- Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92(1):129-146.