“Resilience isn't just about being able to bounce back; it's about being able to bounce back better,” 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 the prevalence of health care provider burnout and also discusses the myth surrounding provider resilience. 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: Share some of your data on why you believe, like I do, [that] it's a national health crisis. It's a public health crisis. We won't have time to look at the negative impact. I think most of the listeners know what it does to the system downstream. But the prevalence numbers...are really quite something, aren't they? Could you share that with us?
West: Absolutely. When we look at physicians—and this has only been exacerbated by the pandemic—the most recent mid-pandemic data we have found 63% of US physicians experienced impactful levels of burnout. It's worse in particular disciplines. In emergency medicine, 84% endure symptoms of burnout. Nurses historically have been a little bit better, but even there, nationally ,the numbers have been 35% or 40%. Things are worse during the pandemic. And there are many more nurses than there are physicians. So if we just start tallying up the numbers of health care professionals that are involved, we're looking at 500,000 or 600,000 physicians at any given time [and] more than a million nurses. [There are also] nurse practitioners, physician assistants, our residents, our fellows, and our medical students. All of these people in total, millions of people that are interacting with patients, striving to help our patients have the best possible outcomes, are not able to function at their very best because of this issue. And that's where we cast this as a public health crisis. Because if you think about a condition, if you were to cast this as a disease - which, really, it's a work experience—but if you cast it as this kind of work experience that has adverse consequences that you alluded to, and it affects 40%, 50%, 60% of our health care professionals, that's a massive, unacceptable consequence for our patients and for our colleagues.
MacDiarmid: Tell us about resilience. Are the folks going into medical school not resilient? What's doctors' resilience like compared with the normal population?
West: This is a really important topic, because historically, one of the main talking points around burnout and distress on a larger scale in medicine has been, well, physicians and other health care professionals, they just need to be more resilient; they need to be grittier. It's a myth. I'm going to start with the true part of things. The true part of things is that resilience is a good thing. Being able to adapt to stressors, and ideally even grow from stressors, which is really that post-traumatic growth aspect. Resilience isn't just about being able to bounce back; it's about being able to bounce back better. That's important. And it does relate to increased resilience associated with lower levels of burnout. That part's the true part. Now, the myth part is that we aren't recruiting people that are resilient enough or gritty enough, that health care professionals are somehow deficient in this regard. We have done national studies in the past few years looking at this, because I think if you ask someone who's actually in the medical profession, they kind of roll their eyes at you. "Like, seriously, you don't think I'm gritty enough with the training that we've been through? And the stress of the work that we do? Are you kidding? It's insulting." And from a resilience standpoint, we deal with adversity in everything that we do, and we try and help our patients through adversity. So the idea without data was, wait a minute, we're pretty resilient to begin with. And then about 3 years ago, we published in JAMA Network Open the first national look at resilience among physicians, and it showed exactly what we hypothesized, which is that physicians actually, on average, have markedly higher levels of resilience than the general US population. Now it is true that those physicians with the highest levels of resilience did have lower levels of burnout than physicians with lower levels of resilience. So resilience is a good thing. But even those physicians who were at the maximal level of resilience, 30% of them were experiencing serious burnout symptoms. So resilience is not a panacea. And I think although we need to maintain and even maximize resilience where we can, it's not our exit strategy to solve burnout. It's something we actually should be looking the other way and say, Isn't it remarkable how strong these human beings are, that are working in medicine, physicians and beyond, to be able to stay as strong as they are, as resilient as they are, despite all of the challenges that are facing them, and let's stop forcing them to be even stronger, to become superhuman? And let's start thinking about the learning and working environments that they should expect that allow them to thrive.
This transcription was edited for clarity.