A great part of being a physician is being able to handle stress, be it making executive decisions in high-pressure situations or juggling numerous appointments with little respite. However, a phenomenon known as burnout is growing in prevalence amongst physicians, causing concern that this group who we expect to care for us in sickness may not be receiving the care they need [1,2].
Burnout is a psychological syndrome that results from prolonged exposure to occupational or educational stressors. Using the Maslach Burnout Inventory (MBI) classification, there are three dimensions to burnout: emotional exhaustion, depersonalization, and lack of personal or professional efficacy [3]. For physicians specifically, this can mean decreased energy levels and being unable to sustain themselves through their training, developing an overly callous demeanour in their care, a decrease in quality of care, or even medical errors.
The issue of burnout in physicians has been examined widely, but not much is known about burnout in future, aspiring physicians, ‘pre-med students’. Can we pinpoint some common denominators that may further predispose a pre-med student to burnout later on in their training or career?
In 2014, a study conducted at the University of California San Diego, which compared pre-med students to non-pre-med students, found that pre-meds had more severe depression and emotional exhaustion. The researchers also found that there might be certain factors outside of being simply a pre-med student – such as gender – that may increase the risk of an individual experiencing burnout later on in life. Female pre-meds had higher rates of burnout than males [3]. Reasons for this gender difference include the lack of female role models in medical curricula, and that females are currently underrepresented in executive positions [4]. Furthermore, being a physician is traditionally a male-dominated field, though it should be noted that the gender disparity is decreasing [4].
That being said, another pertinent factor in females’ higher burnout rate may be due to their tendency towards emotionality, based on gender socialization theory [5]. In 2011, a longitudinal study conducted on Dutch general practitioners found that in women, burnout is most often triggered by emotional exhaustion as compared to men. Based on gender socialization theory, there tends to be a stronger sense of tenderness, sharing, and being considerate and kind within women.
While these factors are not directly linked to causing burnout themselves, we can see how, if unaddressed, they may contribute to the unhealthy phenomenon.
To be clear, pre-med students who have these predisposed factors, which range from gender to ethnicity, will not all inevitably burn out. Burnout is not a reflection of one thing, but a multitude of factors, including personality and coping styles [6,7]. Thus, it is important to understand causes, risk factors, and context. In order to come up with appropriate solutions and interventions, we need more research in these areas (e.g., longitudinal studies) and we need to promote more awareness.
This can be done by simply choosing to incorporate mental health into physicians’ education. We are all stakeholders – as patients, policy makers, and members of society – in this cause. Thus, paying attention to the precursors of burnout is the first pivotal, incremental step in caring for those who will ultimately be caring for us.
By: Eva Huang
Edited by: Alisia Bonnick
Image by: Simon Shaw
References:
[1] Picard, A. (2015). Suicide Should Not Be an Occupational Hazard for Doctors. The Globe and Mail.
[2] Dyrbye, L., West, C., Satele, D., Boone, S., Tan, L., Sloan, J., & Shanafelt, T. (2014). Burnout Among U.S. Medical Students, Residents, and Early Career Physicians Relative to the General U.S. Population. Academic Medicine, 89(3), 443-451.
[3] Young, C., Fang, D., Golshan, S., Moutier, C., & Zisook, S. (2012). Burnout in Premedical Undergraduate Students. Acad Psychiatry Academic Psychiatry, 36(1).
[4] Rosenthal, L., Levy, S., London, B., Lobel, M., & Bazile, C. (2013). In Pursuit of the MD: The Impact of Role Models, Identity Compatibility, and Belonging Among Undergraduate Women. Sex Roles, 68(7-8), 464-473.
[5] Peckham, C. (2015). Physician Burnout: It Just Keeps Getting Worse. Medscape.
[6] Eaton, R., & Bradley, G. (2008). The Role Of Gender And Negative Affectivity In Stressor Appraisal And Coping Selection. International Journal of Stress Management, 15(1), 94-115.
[7] Yates, J., James, D., & Aston, I. (2009). Pre-existing mental health problems in medical students: A retrospective survey. Med Teach Medical Teacher, 30(3), 319-321.
