Why Resilience Training Isn’t the Antidote for Burnout
Adrienne Boissy, MD, MA, Cleveland Clinic Chief Experience Officer, pauses to reexamine the oft implicit assumptions being made by some as we try to address burnout in this country.
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I’ve never heard the word “resilience” as much as I have over the past two years.
As burnout concerns grow and garner the attention they deserve, well-intentioned calls to build resilience, reduce stress and enhance mindfulness are everywhere. Workshops on enhancing resilience are everywhere. Careers have sprung up overnight and businesses built to restore joy in medicine.
I’m encouraged by these efforts. But I also want to pause … to consider the oft implicit assumptions being made by some as we try to address burnout in this country.
Assumption #1. Burnout results from a lack of resilience.
This is perhaps the most disturbing assumption. Let’s examine:
I held three jobs in college. I took MCATs three times in three years. I applied to medical schools all across the country. I, as all physicians do, completed residency for four years. This was followed by two years of fellowship. I completed a Master’s degree in bioethics and became a staff neurologist. During that time, I moved multiple times. I said goodbye to many relationships. I missed key events in the lives of my friends and family because I was working. And I accumulated hundreds of thousands of dollars in debt.
That’s just my story. Let’s also consider the stories of many foreign medical graduates who come to the United States to re-do their entire residency and fellowship here, despite practicing for years as staff in another country. In addition, the paths our nursing and other healthcare colleagues take are no less challenging and complex.
Becoming a doctor in the U.S. is a 10- to 15-year (and in some cases, even 20-year) commitment from the time you graduate high school. I often describe this path to doctorhood as a series of flaming hoops to jump through, which often reinforces the science and minutiae but not the humanity of medicine.
The journeys described above aren’t sob stories. I knew the road would be hard. But I discerned, as my colleagues did, that it would also provide me with deep meaning. We in healthcare are dedicated and committed at all levels to healing human beings. In fact, you have to be. Otherwise, why would you choose this path?
So resilience ― the very idea that you’re able to recover or bounce back from hardship ― is required to become a clinician. Ironically, the path to heal others can harm those who walk along it. The path itself selects individuals who can navigate and tolerate the challenges it produces. That’s an interesting, and perhaps unfortunate, feature in itself.
Is it any wonder then that 15 years after attending medical school, the idea of attending a resilience workshop rubs me the wrong way?
Assumption #2. Burnout is a personal problem.
A corollary to above. Without rehashing the last decade of research on the topic, the verdict’s clear that healthcare regulations haven’t only created burnout, but fueled it. Yet many, not all, of the solutions are targeted at “fixing” the individuals?
We spend time making our notes perfect and checking every box so that we fulfill billing criteria. We get phone calls if it isn’t completed properly. We wait on hold for 13 minutes to argue with an insurance company about testing we think is appropriate for our patient.
We have 21+ boxes in our electronic records that turn colors and become sparkly or bold to make sure we sign on time, email patients back and respond to staff messages. We upload CDs of imaging in the office. Equal time is scheduled for patients who have a single problem as for patients who are exceptionally complicated. We don’t eat lunch, skip urinating during the day and hydrate in the car (if we remembered to bring a bottle of water).
Burnout is actually a systemic problem, as beautifully highlighted in a Harvard Business Review article on the topic. It follows that efforts to reduce significant barriers in the system to give meaning and time back to clinicians will be most effective.
Assumption #3. Resilience is the ability to bounce back from tough times (which will inevitably pass).
This healthcare crisis isn’t going to pass. It isn’t something we just need to survive.
It’s also ironic that we think people who are in survival mode will be able to transform healthcare. Most of us don’t want to survive healthcare, we want to thrive and grow and evolve.
So let’s rethink resilience. As Sheryl Sandberg pointed out after the loss of her husband, post-traumatic growth is possible. If we can re-imagine resilience training as how to grow amidst stress, then I will come.
We’ve taken some of the most resilient and good-hearted people I know and exhausted them. Healthcare, with its boxes and rules and metrics, has “scorecarded” the meaning right out of caring for humans.
Now, I don’t want to leave you thinking there’s no hope. There absolutely is. And the very people who bring their best everyday despite what I’ve described will be the ones to do something about it.
I wrote healthcare a letter and would encourage you to add to it or write your own. #dearhealthcare
I have the profound privilege of caring for people.
My relationships with them matter and change me.
I care deeply about their well-being, their health, their suffering and their feelings.
You won’t be taking that away from me. Not with the clicks, calls, emails, messages and texts.
Whatever resilience training you were considering for me, please save for someone else.
I will grow stronger and fight harder for my patients than ever before.