James Hernandez, M.D., Weighs in on Physician and Pathologist Burnout
A recent article in CAP Today highlights burnout and what it means in regard to physicians, pathologists, and health care professionals. James Hernandez, M.D., Associate Professor of Laboratory Medicine and Pathology at Mayo Clinic in Arizona, was interviewed for the article.
According to Dr. Hernandez, even when they do know the definition, physicians and pathologists often react by practicing the art of cognitive dissonance.
He says, “I don’t think a lot of pathologists are aware of how difficult this is for the profession and the high prevalence.”
In 2013, a physician wellness survey was conducted, and the data turned out to be eye-opening. The burnout rate among physicians was 24%. Around the same time, a leading figure in physician burnout research, Tait Shanafelt, M.D., then with Mayo Clinic’s Division of Hematology, found in a national survey that 54.4% of physicians reported at least one symptom of burnout and that rates were rising. A similar survey done three years earlier showed 45.5% of physicians reported at least one symptom of burnout. And satisfaction with work-life balance had dropped, from 48.5% to 40.9%.
For pathologists, a Medscape survey from 2015 puts the specialty on fairly happy ground compared with other specialties. In the category of physicians who are burned out, depressed, or both, pathologists (along with rheumatologists) weighed in at 42%. Out of 29 specialties, neurology “led” the pack at 55%, followed by critical care at 54%. Burnout rates were lowest in plastic surgery, at 32%, just ahead of dermatology (34%) and orthopedics (36%).
When it came to being happiest at work, pathologists ranked third (34%) among specialties (behind ophthalmology, 37%, and plastic surgery, 35%). The unhappiest groups were cardiology and internal medicine, both of which brought up the rear at 21%.
Outside of work, pathologists were also fairly happy—48% reported out-of-office satisfaction, along with radiologists and critical care physicians. (Allergists and immunologists were the happiest when they left the office, at 61%, while cardiologists were the least happy, at 40%.)
“So, we’re (pathologists) better compared to other specialties,” concedes Dr. Hernandez. “But that’s still a lot of pathologists.” Just as troubling is the gender gap—45% of women pathologists are affected by burnout/depression, versus about 33% of men, he notes.
Dr. Hernandez thinks about it this way: As he walks through his lab and talks with his colleagues, he’s mindful that even if he can’t see it directly, about a third of them are burned out. “And this is a pretty good place to work!” he says.
According to Dr. Hernandez, pathologists by definition tend to be inquisitive and conscientious. Left unchecked, these attributes hurtle toward perfectionism. Acknowledging and learning from a mistake translates into excellence. The flip side is dysfunction. When fear of making a mistake causes paralyzing indecisiveness, then it’s time to seek help, says Dr. Hernandez, who calls himself a recovering perfectionist. Pathologists might take a hint from baseball’s star "closers." “You have to move on,” he says, “and not perseverate about past errors.” There’s also little point, he says, in obsessing about extremely rare disorders in the differential diagnosis.
At Mayo, Dr. Hernandez says he makes it a point to set an optimistic tone as a matter of course.
“Not in an intrusive way, but to show I care. We can let people know, in no uncertain terms, that we’re supporting them.”
At Mayo’s lab, this includes an approach called a "just culture." When a mistake occurs, “We ask if two people could make the same error,” and if the answer is "Yes," then it’s a system error that requires a different solution. “Most of the time, it’s a slip or a lapse. It’s not an egregious error, so it’s up to everyone to anonymize whoever made the error and then see what we can do to improve it.”
In addition to letting his colleagues know he’s got their backs, Dr. Hernandez says he regularly lets them know he cares about them personally.
“I want them to enjoy coming to work. It’s hard enough as it is, and I don’t want to add to their stress.”
There’s nothing complicated about this. During National Laboratory Week, for example, he made a point of thanking each person in the lab for their work and acknowledging their critical role in patient care. While despair can be infectious, he says, so can optimism.
He cautions that it’s not OK to pry, however. “We can’t ask if they’ve gotten help. We can offer support and point to resources. But we can’t ask if they’ve gotten help, or even push them to get help.”