Burnout, a crisis among physicians in training

Stephen Russell, Sanjay Desai and Brian Garibaldi, Tribune News Service

This month, the American Medical Association invested $15 million dollars in eight ambitious programmes to address the workplace needs of our current health system. Among the goals of this grant was to address the crisis of burnout among training physicians by investing in wellness innovations. In many ways, it is an issue as important and consequential as President John F. Kennedy’s moonshot programme that became fully realised 50 years ago this summer.

In September 1962, when Kennedy stood beneath the brow-swabbing heat of Houston and claimed, “we choose to go to the moon in this decade and do other things, not because they are easy, but because they are hard,” he echoed a call to action that required the collaboration of a nation. Shortly after his January 1961 inauguration, Kennedy had pledged to a joint session of Congress to commit the nation to the moon program. Crystalizing his thinking under the Texas sun a year later, he said, “because that goal will serve to organize and measure the best of our energies and skills.”

And organise them it did. Houston would be home to the Mission Control Center. The US Naval Academy in Maryland would become a pipeline programme for astronauts. California’s Jet Propulsion Laboratory provided American’s satellite response to Sputnik and soon became part of NASA. So did Alabama’s Army Ballistic Missile Agency, which went on to develop and produce the rockets that would carry America’s astronauts to the moon and back. By July 1969, against staggering costs and steep odds, the nation had realized Kennedy’s moonshot goal.

Just as President Kennedy saw that an urgent national problem can be solved with an ambitious national response, the American Medical Association aims as high with the urgent problem of physician well-being.

American physicians are weary, and it is affecting the health of our nation. Half of practicing physicians experience burnout. Among physicians in training, up to 70% report symptoms of burnout. Numerous studies have shown that burnout negatively impacts clinical performance. And poor clinical performance risks the heath of all patients. What is less clear, though, are the reasons for this medical professional blight and how to fix them.

In early 2019, the National Academy of Medicine identified the relationship between the learning environment and resident physician well-being as an area that needs further study. The AMA “Reimagining Residency” Grant has now given training programs an opportunity to do just that.

Like Kennedy’s collaboration in the 1960s, we are partnering with institutions across the country to study the problem. Our hypothesis is that increasing the time physicians spend directly with their patients will improve well-being and clinical skill. The task will not be easy. Studies show residents have far more continuity with a digital description of their patient than the actual person.

We believe the public deserves the same rigor of evidence in how to best train our physicians as it demands for foundational science. Working with residency programs at Johns Hopkins Bayview, Johns Hopkins Hospital, Stanford and University of Alabama Birmingham, we will create a “Graduate Medical Training Laboratory” to identify associations between the learning environment and burnout and clinical skill. Informed by these data, we will design and test interventions and prepare residents to practice patient-centered medicine for the 21st century.

We believe we must invest in the medical moonshot, not because it is easy, but because it is hard. But more than that, because of what it will make of us in obtaining this information. Just as Kennedy’s space exploration investment yielded unanticipated innovations in technology and teamwork, we hope the AMA’s investment in medical education will also yield a renaissance of physician and patient communication during every clinical encounter. If in pursing this medical moonshot we only serve to “measure the best of our energies and skills,” the health of a nation will surely notice.