Over the past 10 years, much has been written about clinician burnout and methods to mitigate or prevent burnout in our healthcare workforce. Burnout, defined as a syndrome of depersonalization, emotional exhaustion, and decreased effectiveness, is a complex and multifactorial issue. Causes of burnout can be classified as either external or internal. External factors include increased administrative burden, healthcare worker shortages, and (of course) an ongoing pandemic. Internal factors include reduced resiliency, inadequate coping skills, and lack of social support. Typical approaches to addressing burnout within healthcare organizations focus on the internal factors – with initiatives and projects related to well-being, mindfulness, and optimal physical or mental health. While these programs do have some success at reducing burnout, the implied message to the clinician is that the onus is on the clinician to “fix” her own emotional or mental state and “cure” her own burnout. A radical approach would be to offer such solutions to clinicians while also acknowledging, and addressing, the external factors that so often frustrate our clinicians.
In his book Drive, author Daniel Pink states that the source of motivation stems from three primary human needs – autonomy, mastery, and purpose. Autonomy = having control over your own work: managing your own time and making decisions on what you do and when. Mastery = being able to use and improve the skills that you enjoy. Purpose = making a difference: understanding that what you do has value. Mastery is generally not a source of frustration for clinicians. Autonomy is definitely a challenge. The current landscape of medicine can deplete a clinician’s sense of autonomy. Purpose is another area in which clinicians struggling with burnout often feel “lost.” The day to day humdrum of completing medical records and addressing “paperwork” and other non-value added tasks can erode a sense of purpose that led these highly motivated, intelligent, and competent individuals to a career in medicine.
Clinicians may not even realize that this sense of purpose is fading. They may make such statements as “I just don’t enjoy practicing medicine anymore.” “I don’t feel connected to my patients.” They often question their choice of clinical practice and may even leave clinical care.
There is a well-known quote by Mahatma Gandhi – “The best way to find yourself is to lose yourself in the service of others.” A recent medical mission trip – and the opportunities to truly serve an underserved community – reignited my sense of purpose in medicine. Accompanied by several other clinicians as well as non-clinical volunteers, I practiced medicine in the Dominican Republic through an amazing organization called One World Surgery that provides primary care, specialty, and surgical services there. This was my second medical mission in this area; my first was in 2019 and missions last year were on hold due to the pandemic. It was medicine at its purest. We were seeing patients in challenging physical conditions (including intense heat) – and the work was hard – but it was incredibly and immensely rewarding. We left our pop-up clinic every day knowing that we had made a difference in the lives of the patients and their communities. We shared a joy in caring for patients that may not otherwise have had access to medical care. We were freed from cumbersome charting and administrative burdens. We felt valued for our work and for our skills.
Service in this way can be the antidote to burnout. Mission work, or a similar type of volunteer work, can spark the joy that may have been lost along the way.