What Am I Getting Myself Into?

I would be lying if I said I never questioned my choice to pursue a career in medicine. Given the tremendous financial cost and the overwhelming time commitment, will it actually be fulfilling? How will it affect my quality of life? my personal well-being?

The numbers aren’t in my favor. Burnout – defined as a combination of emotional exhaustion, detachment and a low sense of accomplishment – is prevalent among medical students and practicing physicians alike:

• A 2008 study by Dr. Dyrbye, et al. stated a burnout rate of 49.6 percent among medical students, approximately 10 percent of whom experienced suicidal ideation
• A 2012 Mayo Clinic survey found that 45.8 percent of doctors reported at least one symptom of burnout (Shanafelt 2012).

Unfortunately, over the last decade, burnout rates seem to be trending up rather than down. In true pre-med induced hypochondriac fashion, I fear the worst.

Recent research has found that burnout increases the risk for cardiovascular disease as much as well-known factors like body mass index or smoking (Bailey 2006). Further studies also indicate an increased probability of type II diabetes, male infertility, sleep disorders, and musculoskeletal disorders (Bailey 2006). One possible malefactor: lower cortisol levels.

Cortisol is the primary hormone involved in the body’s stress-response system that helps restrain immune system reactions. Research indicates that elevated cortisol levels due to chronic stress may result in glucocorticoid resistance in which receptors no longer respond to cortisol’s stop signal (Plotnikoff 2007). Over time, cortisol levels may rebound below normal, leaving the body vulnerable to a hyperactive immune response that produces chronic inflammation (Plotnikoff 2007). Such an inflammatory process is linked to the pathogenesis of other chronic diseases, including depression, and may produce a vicious positive feedback loop.

Antioxidant supplements are said to help lower cortisol levels and may be suggested as an initial preventative measure. But it isn’t that simple. For example, a 2004 study for the Cochrane Database linked increased mortality with supplemental vitamins A, C, E and beta carotene, and selenium (Offit 2013).

The medical field can’t support a burnout rate this high and climbing, it impacts everything from quality of teaching to quality of life for physicians and increases the likelihood of error in patient care. So what do we do? What structural or systemic changes can we make to help lower these statistics?

I don’t have an answer, but let’s talk. Something’s gotta give.

References

Bailey DS. 2006. Burnout harms workers’ physical health through many pathways. Monitory on Psychology. 37(6):11.

Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, Durning S, Moutier C, Szydlo DW, Novotny PJ, Sloan JA, Shanafelt TD. 2008. Burnout and Suicidal Ideation among U.S. Medical Students. Ann Intern Med. 149(5):334-341.

Plotnikoff NP, Faith RE, Murgo AJ, Good RA, editors. 2007. Cytokines: Stress and Immunity, Second Edition. Florida: Tylor & Francis Group, LLC.

Offit PA. Jun 2013. Don’t Take Your Vitamins. The New York Times [Internet]. [cited 2014 Nov 30]. Available from: http://www.nytimes.com/2013/06/09/opinion/sunday/dont-take-your-vitamins.html?pagewanted=all.

Rabin RC and Kaiser Health News. Mar 2014. A growing number of primary-care doctors are burning out. How does this affect patients? Washington Post [Internet]. [cited 2014 Nov 30]. Available from: http://www.washingtonpost.com/national/health-science/a-growing-number-of-primary-care-doctors-are-burning-out-how-does-this-affect-patients/2014/03/31/2e8bce24-a951-11e3-b61e-8051b8b52d06_story.html.

Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR. 2012. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 172(18):1377-1385.