{"id":2830,"date":"2020-04-30T15:00:25","date_gmt":"2020-04-30T19:00:25","guid":{"rendered":"https:\/\/blogs.nejm.org\/general-medicine\/?p=2830"},"modified":"2020-04-30T15:00:25","modified_gmt":"2020-04-30T19:00:25","slug":"why-is-burnout-still-occurring-even-with-work-hour-restrictions","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2020\/04\/why-is-burnout-still-occurring-even-with-work-hour-restrictions\/","title":{"rendered":"Why Is Burnout Still Occurring, Even with Work-Hour Restrictions?"},"content":{"rendered":"
\"Dr.<\/a>

Dr. Orlovich is a Chief Resident of Wellness at Stanford University<\/p><\/div>\n

\u201cDaniel, this guy is one… sick\u2026 puppy,\u201d he stated emphatically, drawing out the last three words.\u00a0<\/span><\/p>\n

I put my phone down and turned my chair away from the computer. He had my attention. Not because I haven\u2019t taken care of any sick patients before, but because this statement was coming <\/span>from him.<\/span><\/i><\/p>\n

I\u2019m sure your hospital has someone like him (or her), too. A physician who stays up to date on the current literature yet has enough experience to know the previous guidelines and recommendations. One who really has \u2018seen it all\u2019 and remembers when the old wing of the hospital was new. A colleague who others curbside to glean insight, which he\u00a0gladly shares. And of course, the highest compliment of all \u2014 someone who is trusted to take care of other physicians\u2019 family members.\u00a0<\/span><\/p>\n

His tanned face leaned in as he told me about this patient who was getting ready to go to surgery. <\/span>Looking down at his beige and hunter green hiking boots, it dawns on me \u2014 I\u2019m in a moment. <\/span>This<\/span><\/i> type of patient, <\/span>this<\/span><\/i> type of case, <\/span>this<\/span><\/i> type of responsibility with someone of his caliber could only make me a better physician.\u00a0<\/span><\/p>\n

But then something happened. The case got pushed back. A few hours later, it was pushed back again. Pretty soon it was morning. The patient didn\u2019t go to surgery that night.<\/span><\/p>\n

\u201c<\/span>What could have happened?<\/span><\/i>\u201d I thought to myself, as I stopped by Starbucks. I was looking to indulge in a little more caffeine to make up for the lost learning opportunity. <\/span>Just then my phone vibrated: \u201cCASE TO GO LATER THIS AFTERNOON,\u201d the page read. <\/span>And, the case finally did go that afternoon. And also long into the night.\u00a0<\/span><\/p>\n

The Connection with Resident Burnout<\/b><\/h2>\n

What does this story have to do with resident burnout? When it was all said and done, I was at the hospital much longer than the ACGME recommended limit. And, despite this, I felt <\/span>less<\/span><\/i> burned out, rather than more burned out.<\/span><\/p>\n

Resident burnout is more than hours worked. In the situation above, I clearly went beyond the arbitrary hour limit. That artificial number, in the midst of a complex, large, and imperfect system, was crossed. But to focus solely on a number fails to take into account other important drivers of resident burnout.\u00a0\u00a0<\/span><\/p>\n

To be clear, hours worked <\/span>is <\/span><\/i>an important factor. And this piece is not about the \u201chours worked\u201d debate. It\u2019s easy to point out when something is excessive. It is harder to define when something is right. Of course, hours worked is an easy metric to track, but it provides an incomplete assessment.\u00a0<\/span><\/p>\n

Solely focusing on hours worked drives a wedge between those who trained before and those who trained after work-hour restrictions. I completely understand that some of those who trained before the limits have trouble understanding how hours have gone <\/span>down,<\/span><\/i> but resident burnout currently is at epidemic levels. There is no doubt that the training system has improved, yet we are still mired in a suboptimal environment.\u00a0<\/span><\/p>\n

\"Four<\/a>

Four Domains of Burnout: Physical, Mental, Emotional, Moral<\/p><\/div>\n

Four Domains of Burnout<\/b><\/h2>\n

To obtain a more complete understanding, I conceptualize the drivers of resident burnout into four categories – physical, mental, emotional, and moral. By framing the conversation strictly around hours worked, only the physical domain is addressed and the others are neglected.\u00a0<\/span><\/p>\n

The other domains:<\/span><\/h3>\n

 <\/p>\n

 <\/p>\n

Mental: <\/b>E.g., How does my mind keep up with the pace of the day?<\/span><\/p>\n