Burnout prevalence is 20 to 60 percent higher among women physicians than their male colleagues. Understanding why women physicians are burning out is important for identifying effective ways to address the problem.
Here’s my take on the underlying causes:
1. Women physicians provide more time-intensive care. Female primary care physicians have longer patient visits and engage in more patient-centered communication. Female surgeons in training write longer notes, spend more time in clinical review, and spend more time handling in-box messages than their male peers.
2. Female patients gravitate to women physicians and tend to want to talk more than male patients. A 2018 study found that women physicians have more female patients than male physicians do, and female patients want longer visits and more empathetic listening, especially from women. However, female physicians are generally not afforded additional time to meet these additional patient expectations.
3. Women physicians are more likely to be married to spouses who work full time than male physicians. A 2014 study of young physician-researchers showed that female physicians were far more likely to have a spouse that worked full time than male physicians (86% versus 45%). Two careers usually equates to more money, but also more stress and trickier logistical challenges.
About two years ago, I had an experience that opened my mind to the wider possibilities of professional coaching. After interviewing one of its founders, I participated in the Novant Health Leadership Development Program, which involves small group coaching in a 3-day, off-site retreat. I saw that coaching can change individual clinicians’ lives AND organizations. When cohorts of physicians received formal coaching in small groups, the process eventually reshaped the organization. Physicians and staff became more collegial and more willing to talk about how they’re doing. And, because they had more energy and bandwidth, they started engaging in improvement and fixing system problems, creating an EHR optimization team, for example.
Before participating in the Novant program, I was steadfast in my belief that the only way to reverse the epidemic of physician burnout is to fix our broken health care system—the toxic culture, the inefficient processes, the work arounds, miscommunication, errors, gaps, and chaos.
Coaching, to my mind, was one of those individual solutions that organizations tend to throw first at the problem of burnout. Like mindfulness training, yoga, and meditation, coaching could help folks become more resilient to chaotic workplaces but it didn’t change the chaos. While valuable, it failed to fix the real problem. Or so I thought.
When my co-author and I interviewed Christina Maslach, PhD, social psychologist and professor emerita of psychology at the University of California, Berkeley, for our book, I was struck by her observation that of the six domains she and her colleagues had identified as drivers of professional burnout, one seemed to be the most potent. It was community. She told us that workers who feel like their team mates or peers “have their back” are less likely to experience burnout, whereas workers in a toxic, competitive environment are at significantly higher risk. Interesting, but how do we build work environments that embody community? I recently learned about an innovative program to do just that.
Sunit Mistry, MD, a pulmonologist and assistant area medical director at Kaiser Permanente South Bay in Southern California, a 500-physician medical center, was inspired to launch a collegiality initiative after he personally experienced the downstream effects of an ineffective connection between physician colleagues. Weekends that a certain rather unhelpful colleague was on call, Mistry would arrive on Monday to find an onslaught of new cases. Referring physicians had delayed calling for a consult (and their patients’ care was delayed) because he or she didn’t want to tangle with that particular physician. Mistry was told, “I will never consult that doctor again…they always yell at me.” Hence he began searching for ways to bring collegiality back.