Burnout: It’s not burnout, it’s moral injury.

Today I opened my email and found two emails about this topic. One of the more engaging shared a ZDogg post. Medical students introduced me to this bald-headed, internal medicine doc who has another career as a stand-up comedian for medical audiences.  His riff is the dysfunctional healthcare system and his you tube videos have quite a following.

Earlier this March he picked up on an article equating burn out to moral injury. A plastic surgeon and psychiatrist wrote an opinion piece. In brief, moral injury was first used to describe soldiers’ responses to their actions in war—exhaustion, cynicism and decreased productivity. The doctor duo point out that physician burnout includes the same symptoms. What is being called burnout in physicians is really moral injury. The moral injury in health care is being unable to provide high-quality care and healing in the context of health care. Watch ZDogg perform.

I can relate. The current pressures of productivity, electronic health record dysfunction, and the prior authorizations, make practicing pretty tough, especially if you don’t have a functioning support team.

But I would argue that physicians are not the only group suffering from moral injury. Nurses and other health professionals are afflicted as well. We enter a service career to help people. The current business-oriented and profit-driven health care environment makes it very difficult. Nurses--I am using the term broadly to include RNs, LPNs and medical assistants--have impossible numbers of patients to care for in the hospital and nursing home. I watched the MAs scurry from one demanding patient to another when I visited my sister in the nursing home last week. My physical therapist friends complain about spending more time on documentation than on patient care. I could go on.

The doctor-duo conclude: Navigating an ethical path among such intensely competing drivers is emotionally and morally exhausting. Unless major planning and re-engineering of health care occurs which allows health care professionals to meet the needs of patients and not the demands of business and for-profit organizations we are doomed.

We received a subtle warning last week. On March 15th medical students in their final year learned where they would spend the next 3 to 7 years. The computer matches the wish list of the student with the wish list of different residency programs and the results are announced in mid-March every year. It is a party at medical schools around the US. For many wishes were granted. For others tears were shed. Residencies learn who has chosen their programs and we learn how many family medicine, surgery, gynecology and other specialists will be trained.

Unfortunately, this year the number of US medical students choosing family medicine dipped. Not by a lot, but it should serve as a warning. Students are not stupid. Who wants to go into a career where practicing doctors are struggling, exhausted, and cynical? Although we talk about burn out in all the specialties, primary care bears the burden of the business-oriented environment because of the many hours of patient contact in the outpatient setting. Who wants a specialty whose value is de-emphasized by other doctors and whose needs are side-lined by administrators because FM does not bring in the big bucks? i.e. procedures and surgeries. In other countries primary care is king. But in the US, 12% of medical students choose family medicine. We need at least 25%. Let this serve as a call to action. Major change is needed. Tweaking around the edges won’t work. Health care for profit is not serving our needs as healers and definitely not meeting the needs of our patients.