Massachusetts Medical Society: What Does Gender Have to Do with Physician Burnout?

What Does Gender Have to Do with Physician Burnout?

Click here to view video testimony on Physician Burnout

By Thomas Flanagan, MMS Media Relations Manager, and Lucy Berrington

Discrimination has become less overt in the twenty-first century; it hides in the “small stuff” that isn’t small at all. A road to promotion may be lined with AM meetings, excluding physicians with primary responsibility for children. Administrative supports may be unevenly distributed, bolstering some physicians more than others. Women who entered medicine earlier, especially those in male-dominated specialties, tell stories of more explicit bias: reputational hits behind the scenes, or resentment of women partners “diluting” their male colleagues’ salaries. “Like many other women, I’ve succeeded anyway, but it grinds on you,” says a senior radiologist on the North Shore. “It burns you out. I got to the point that I took 2 ½ years off. When people talk about burnout, it’s these little hits to your self-worth on top of the normal stresses of medicine. After a while, you think, "What am I doing this for?”

Women physicians burn out at higher rates than male physicians, studies show. Burnout is an unrelenting state of emotional exhaustion that can cause compassion fatigue and a decrease in professional effectiveness. It is the result of multiple contributing factors, some of which affect physicians of all genders.

Lauri Meade Lauren Meade, MD

“We know from the literature that avoiding burnout is about reducing chaos in the environment and increasing physician control. Everyone goes into this system where there’s lot of chaos and limited control,” says Lauren Meade, MD, Director of Clinical Learning and Development at Sound Physicians, a multi-state physician practice. In that context, to whom does an organization, profession, or society grant the right to self-advocate—or not? “Women and minorities tend not to speak up, akin to imposter syndrome,” says Dr. Meade. “We don’t feel entitled to complain because we’re supposed to be grateful to have gotten in the door.”  

That unwillingness to complain was evident in conversations with several physicians. “I’ve always prided myself on not being whiny, not having a chip on my shoulder, making it about personality, not gender,” says the North Shore radiologist, who asked not to be identified. “If you tried to make a legal case for discrimination it would be an uphill battle. But most women, myself included, would say it’s real; there’s something there. It’s very true that the doors are only partially open to women. Women have to work harder to stay in the same place.”

This perceived pressure to relentlessly prove oneself may be a driver of burnout.  “I do think often women and people of color have to go above and beyond in order to level the playing field. The doors are not equally open,” says Myechia Minter-Jordan, MD, president and CEO of the Dimock Center in Roxbury. “I can see the level of acceptance that comes from my Ivy League academic credentials and my residency program at Johns Hopkins. The fact that I have those achievements matters.”

Across medicine, women physicians are underpaid, and have fewer professional supports, compared to their male colleagues, research shows. The burnout risk may also be amplified among women physicians because they are more likely than men to work with underserved patient populations. “Burnout is an issue we work on with our clinical care team and administrative staff,” says Holly Oh, MD, Chief Medical Officer at The Dimock Center in Roxbury. “The issues families and patients bring in, that we work very hard to support them with, can be really draining emotionally, as well as how easy or hard the system has made it for staff to help those patients.”

Burnout likely reflects, too, the dual weight of professional and family responsibilities, a recurring theme in our interviews. Physician Moms Group (PMG), a powerful and growing online community, has risen to prominence on the strength of fellowship and peer support. In a survey of nearly 6,000 members of PMG, published in JAMA this year, 78 percent of respondents reported discrimination in their careers related to gender or motherhood (pregnancy, maternity leave, or breastfeeding). That discrimination most frequently took the form of a lack of input into administrative decision-making (the autonomy issue), and being treated disrespectfully by nursing and support staff. (A Boston physician interviewed by Vital Signs, who is married to a male surgeon at the same hospital, had an interesting but discouraging observation: “I do feel I am treated better in the operating room because of him, just because we’re married. I have a friend whose husband is in another surgical specialty, and since he has started working at the same hospital, she’s noticed a change in how she’s treated, too.”)

Burnout appears more common among women physicians who have experienced maternal discrimination, according to the PMG study. The weight of responsibility for families continues to fall heaviest on mothers, even when committed dads are in the picture. “Even though men identified having children as somewhat of a setback to their academic careers, it affected women far more,” says Dr. Megan Evans, an OB-GYN at Tufts Medical Center, who co-authored an analysis of work-life balance in two-physician households. Similarly, the unrecognized “housekeeping work” that keeps a practice or program functioning—logistical tasks, holiday celebrations—seems to fall disproportionately to women, according to physicians who spoke to Vital Signs.

Physicians who believe that they are experiencing burnout and would like help are welcome to self-refer for a free, confidential intake at Physician Health Services at the MMS; call (781) 434-7404. 

       

Strategies for navigating a high-risk system


Vital Signs
talked to women physicians about their preemptive measures against burnout.


Get Comfortable Saying No

Justine Carr, MD“A lot of it is about recognizing that saying no to one thing is also saying yes to something else. When you’re comfortable saying no to potential opportunities, you’re saying yes to competing priorities. Overreaching can potentially set you up for failure, a cascade of worrying about meeting family and work needs, catching up during late hours, facing the day tired, irritable and resentful, and ultimately underperforming. You always need a little bit of a margin. Once I recognized the importance of prioritizing immediate needs, I found peace of mind. I never really expected or planned for the bigger opportunities that came along, but I believe they unfolded for two reasons. First, I had a track record of competence in my work. Second, my family needs declined as the kids went off to college and my husband was strongly and enthusiastically supportive of my pursuing new opportunities as he was also doing.”

Justine Carr, MD; former chief medical officer of the Steward Health Care System; former chair of the National Committee on Vital and Health Statistics


Schedule Time Off

Myechia Minter-Jordan, MD, MBA“Even with an amazing husband who takes on much of the family demands, there are gender-related pressures that contribute to burnout. I’m still managing and planning for household and family, and trying to be in all the right places, as well as handle my work responsibilities. There’s no one who manages me. There’s nothing wrong with working hard — you should work hard — but then you should also find time to recharge so you can work hard again. I try to do that consistently, protecting my time for myself, so that I can be more present for my family and my job. No one will tell you to do that, and if you don’t, then I think that’s when you burn out.”

Myechia Minter-Jordan, MD, MBA; president and CEO of The Dimock Center, Roxbury


Self-Advocate for Your Salary, Career Goals, and Supports 

YiDing Yu, MD“As a resident, I led a women’s program that focused on empowering women to speak up and advocate for themselves. If you’re looking for something in your career, you’ve got to tell your boss what that is. ‘I want to have more leadership in management;’ ‘I want more protected time for research;’ ‘I'm looking for a raise that reflects my contribution to the department.’ Literature shows us women are often less comfortable advocating for themselves, but we advocate well for other people—so leverage that skill and use it to advocate for ourselves and other women. It may be there for the taking if we actually ask for it.”

YiDing Yu, MD; founder and CEO of Twiage; internist at Atrius Health; 50 Healthcare Leaders Under 40 (Becker’s Hospital Review)


Address Stress Points in the Program or Process 

Holly Oh, MD“The programmatic piece I love to do is, ‘How can I help make the system easier for patients and staff so that we can continue doing the work we’re really passionate about?’ The programmatic work is to make the system easier to navigate, so people can feel they can stay vital in this work. The other piece is our improvement culture. When we talk about gaps or deficits it’s not to attribute blame; it’s ‘How can we do this better?’ I think that helps to inoculate ourselves against burnout. If people can feel like they can always improve their work situation and have some control over that, that helps immunize against burnout.”

Holly Oh, MD; chief medical officer and director of Quality Improvement at The Dimock Center, Roxbury 


Set Boundaries
Women In Medicine“I’ve recently returned to medicine, because a hospital group approached me. I have learned so much over the years that I was able to negotiate something I can commit to — three days a week, on call within certain parameters, a certain amount of vacation. Previously, I didn’t have the opportunity for work-life balance. As a young woman, I would have taken one for the team; ‘Whatever you need.’ I think it’s going to go better this time because I’ve learned not to be so accommodating. I’m not out until the evening, in meetings where some guy doesn’t appreciate me or is jealous. It took the experience of burning out for me to know how to avoid that.”

Radiologist, North Shore


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