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Dr. Colin P. West on how he came to study physician burnout


“I think there's a mindset out there that you have to have experienced a particular mental health crisis or some other major sort of breaking point event in your medical career. That's not actually my story,” says Colin P. West, MD, PhD.

In this installment of “Begin Your Journey,” Colin P. West, MD, PhD, talks with host Scott A. MacDiarmid, MD, FRCPSC, about how he came to study physician burnout. West is a professor of biostatistics, medical education, and medicine at Mayo Clinic in Rochester, Minnesota. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, North Carolina.


MacDiarmid: Hello everyone. My name is Dr. Scott McDiarmid. I'm calling in from Greensboro, North Carolina. I want to welcome you to our physician wellness series entitled Begin Your Journey. And I certainly want to thank Urology Times for helping us with this project. Without them, we just wouldn't be here today. The goal of this series is really to help create a world that lifts up physicians and health care providers who serve. I think it's a very important goal. We all know that physician health care provider burnout and loss of satisfaction in the job place is really a crisis in our country. I personally believe that we have to work together with loud voices, all of us, to encourage one another so we can be successful in our journey in fighting burnout. In this series, we're bringing on experts to hopefully bring some survival tactics and some solutions to the problem, and also encourage one another, again, to lift each other up and begin our journey and be successful together. I'm just honored and excited to introduce our first guest today, Dr. Colin West. Dr. West is a professor of medicine, medical education, and biostatistics. He's in the division of Internal Medicine and the biostatistics department and informatics at the Mayo Clinic. He's got his PhD in biostatistics and he is a practicing general internist. He's in the trenches with the rest of us. And he's really well published on this matter. He speaks so well; he speaks to you. He's very compassionate. He's very humble. And I know he loves being a doctor, I can just feel that. I'm just grateful to have him here with us today. Colin, just say a few words about yourself. And how did it start? How did you get so much interest in physician wellness?

West: Thanks for the kind words in the introduction; no pressure on me here for the next 20 minutes or so, right? Interestingly enough, I do not have what some people would suspect as the typical origin story for people to get started in doing wellbeing work. I think there's a mindset out there that you have to have experienced a particular mental health crisis or some other major sort of breaking point event in your medical career. That's not actually my story. That doesn't mean I didn't experience stress and things like that in the course of medical training, just like everybody else. But I was pretty much a put-your-head-down-and-get-through-it kind of person; I didn't pay much attention to what was going on around me. And then when I was a chief medical resident, and I was, in some respects, the steward of the experiences of a very large internal medicine residency program at Mayo, where we had 170 residents that I was part of a team in program administration trying to support, it became a little bit more clear that pulling your way through this wasn't really the right approach. And we needed to be more mindful of this. And then at the same time, one of my close friends and colleagues, Tait Shanafelt, came to Mayo for his hem-onc training. Tait was interested in, at the very early part of his career, learning more about wellbeing and burnout and its impact on patient outcomes. I had a quantitative background; you mentioned my PhD in biostatistics. And so really, it was a matter of 2 people just out of residency, having a skill set and a shared interest where we decided, let's start exploring this a little bit. And sort of like the hydra, every question we finished led to 2 or 3 more that sprung up out of its wake. That's really how we got going is, oh my goodness, people aren't paying much attention to this. We have an opportunity to study this rigorously. As we started to do that, that led to natural collaborations nationally. We started working with people like Chris Sinski [, MD], at the American Medical Association; we combined forces with Lotte N. Dyrbye, MD, MHPE, who was also at Mayo at the time. And in 2011, we completed the first national prevalence study of burnout. That's really the inflection point where everything exploded, because when that paper was published in 2012, identifying that the prevalence of impactful burnout symptoms approached 50% of US physicians, almost overnight, things switched from being asked in our work, "well, is this really a big deal? Maybe this is just a handful of people who chose the wrong profession," to, "Oh, my goodness, 50% of physicians are dealing with these issues. It's more prominent than in the general population. What are we doing about this? And oh, by the way, Dr. West, why haven't you fixed this?" Like yesterday, you weren't even paying attention to it. Now, you want me to have fixed it already? And that's, I think, really the fork in the road that we've been going down now, for the past decade, where we've seen this become a nationally prominent issue that's led to even things like surgeon general's advisories.

This transcript was edited for clarity.

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