Intended for healthcare professionals

Careers

Burnout weakens sense of vocation, researchers find

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1002 (Published 28 February 2017) Cite this as: BMJ 2017;356:j1002
  1. Abi Rimmer
  1. BMJ Careers
  1. arimmer{at}bmj.com

Abstract

A study from the US suggests that rewarding work may be linked to better patient outcomes. But the head of a support service for UK doctors argues that a sense of vocation may lead many doctors to burn out. Abi Rimmer reports

Doctors who have burnout are less likely to view their job as a vocation, which could affect patient care, researchers in the US have found.1

A team from the Mayo Clinic in Rochester, Minnesota, found that compared with doctors who had not experienced burnout, doctors who were completely burnt out were less likely to find their work rewarding.

Doctors who see medicine as a calling “appear motivated by work that is personally meaningful and promotes a greater good,” the researchers said. “In contrast, physicians who do not view medicine as a calling may assign more value to their work as a means to earn a living,” they said. “Therefore, one potential consequence of professional burnout is physicians who are less intrinsically and prosaically motivated because they see medicine less as a calling but more as a job—a way to simply earn a pay check.”

The researchers warned that patients may be put at risk by doctors who had lost their sense of vocation. “If the practice of medicine is not seen as work that is personally rewarding and serving a greater good, physician performance may suffer and, more importantly, so too may the quality of care that patients receive,” they said. “Therefore, fostering a workplace that supports physician wellbeing and medicine as a vocation merits greater attention.”

The Mayo Clinic team surveyed doctors between October 2014 and May 2015. They received 2263 responses, a response rate of 63.1%. Of the doctors who responded to the survey, 28.5% (639) reported that they had experienced some degree of burnout. This was measured using a single item measure with a five point response scale.

But Clare Gerada, medical director of the Practitioner Health Programme, which is a confidential service for doctors with mental health or addiction problems, believes that it is doctors’ sense of vocation that can lead to their becoming burnt out.

“During our medical school training and as we continue to develop as doctors, our personal and professional identities merge into one, which I call ‘the medical self’: ‘I am a doctor; the doctor is me,’” she told BMJ Careers. “This is the essence of vocation and explains why you can’t leave work behind at the end of the day. It’s why we find it so difficult to take off our metaphorical white coats.”

Gerada said that in the past UK doctors could expect to be looked after by the health service, in return for displaying a sense of vocation and dedication to their work, but that this was no longer the case. “At the moment the health system is failing to care for those who work in it and in so doing causing a doctor’s vocation to be harmful to them—it’s becoming part of the problem,” she said.

“The doctor will continue to give to their patient beyond what is healthy for the doctor. And that’s what I see in my service. The last thing to go is care for patients. We see it with presenteeism, we see it with doctors who have life threatening illnesses who continue to work.”

She added, “Does burn out lead to a loss of vocation—I don’t think it does. I think vocation is one of the reasons doctors become burnt out, not the opposite. The more the vocation, the greater the risk of burn out.

“Does loss of vocational spirit harm patients? I would say no. Paradoxically it can make it safer for patients as it stops this unhealthy (in the current climate) amalgam of the personal and professional self—which prevents the doctor from seeing themselves as having needs as well as their patient.”

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