Own Your 10%

By Dr. Dael Waxman

In the national conversation about root causes of healthcare professional burnout, increasing attention has been directed toward the many “systems” issues that contribute to this malady. These include EMR, prior authorization, and abundant regulations from various stakeholders in healthcare. For physicians who have been told to “do yoga to increase your resilience,” this recognition that “it isn’t me,” is welcome and long overdue. Indeed, it is now well accepted that the experience of burnout in an individual is a symptom of an unrelentingly stressful work environment – the canary in the coal mine if you will – and not an inability of the physician to cultivate resilience.

While I applaud this acknowledgment that the cause of burnout does not solely reside in the individual, I caution us to not be too quick to place blame entirely on “the system” either. Burnout occurs when there is a mismatch between the individual factors that a person brings to a work system and the system factors that exist therein (Maslach). It is generally accepted, by academics and policy professionals alike that, currently, about 80-90% of burnout is attributed to the system factors and 10 -20% reside within the individual.

What are these individual factors? While there are abundant individual differences between healthcare professionals, there are also plenty of similarities. We tend to be compulsive, perfectionist, competitive, and compassionate. We also delay gratification, put patients’ needs before our own, and are likely to exaggerate self-blame when mistakes are made. These are just a few common traits that are so integrated into our being that we actually have a blind spot for recognizing them in ourselves and, therefore, the challenges that they can present to us in the healthcare work setting.

So, how do individual factors contribute to burnout? Consider just the quality of perfectionism. While laudable and something that we should continue to aspire to, we all know that human medicine, like all disciplines, is an imperfect science. If we expect ourselves to be perfect, then when the inevitable misdiagnosis, mistake, or overlooked lab result happens, we tend to self-flagellate for days, months, and years. In addition to its impact on our future patients (we may be extra vigilant and order unneeded tests), it has a deep impact on our mental health. Indeed, many incidences of physician suicide emanate from this expectation of self-perfection.

What is a healthy way to mitigate some of these traits that may lead us down the path of burnout? The first step is awareness; acknowledgment that we have a characteristic that can both serve us well as a physician but also can be a setup for a pitfall. The second step is to notice our natural tendencies as a result of these traits and determine if these tendencies cause us to behave predominantly in self-serving or self-harming ways. Third, if self-harming, take intentional steps to change that behavior. If we take the perfectionist trait as an example, when one notices that they are engaging in relentless self-blame and holding solely an internal dialogue about it (and still suffering), one can change that behavior by opening up to a trusted colleague or therapist or coach.

Physician resilience and burnout expert Wayne Sotile, Ph.D. affirms that 90% of burnout is a systems issue. However, he also invites us to dig deep and carefully examine ourselves in order to “own your 10%”. By so doing, we reduce the chances of burnout due to unconscious self-infliction.

So, as we all work to create a culture of workplace well-being, in addition to being in the conversation about how to reduce the administrative burden, we also need to be in dialogue with ourselves about how we may be inadvertently creating our own suffering.

Own your 10%. Indeed, the only thing we really have control over is ourselves.