According to the Association of American Medical Colleges, women experience burnout faster than men, and about 40% of women physicians walk away from the profession or go part time within six years of completing residency. Could you talk about that and what your own research has shown as far as retention and burnout rates for women in medical positions?
Despite how wonderful and satisfying providing patient care can be, there is a hidden risk in what we do. A disturbing paradox emerges precisely because the better you are, the more passionate you are, the more deeply you care for your patients, the greater the risk. Caregiving is hard, and it can take its toll professionally and personally.
While women now account for half of new medical school students and an increasingly larger number of practicing physicians, there is a lack of studies about gender-related differences in physician burnout. Women physicians differ from their male counterparts: They may lack role models, face challenges of dual-career couples, have to reconcile having only a finite number of years for childbearing, face lack of equality in salaries, receive a lower number of promotions to leadership positions, confront biases and experience higher rates of sexual harassment.
As gratifying as our work is, it can also be profoundly isolating, especially when we feel we can’t let our colleagues know if we’re not OK – a feeling that millions of health workers, including me, have had during our careers. – Kathleen Flarity, DNP, PhD
Burnout is a psychological syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment. The emotional exhaustion construct is especially real in women, who tend to give and give until there is nothing left to give, at work and at home. You can’t pour from an empty vessel.
How did military training affect your own experience with, and view of, burnout?
I was the Aeromedical Evacuation (AE) commander at Bagram Afghanistan at the height of the conflict, in charge of the AE and Critical Care Air Transport teams and also personally flew combat medical missions throughout the area of responsibility. I was the most symptomatic during that deployment because I not only felt the pain and suffering of the soldiers, sailors, airmen and marines I cared for but also the pain and suffering of my teams I directed. It is not normal to care for triple amputees’ day after day. The gift in that is it drove my passion for research to help build resiliency while still maintaining compassion and empathy.
What does personal well-being look like to you and how do you maintain it?
I now include my personal well-being in my definition of success. I have figured out what I need to renew, re-energize and ‘re-passion’ to bring my best self to the people I love and care for, and the people I lead. It was a journey, an ability to change perceptions and take care of me – to show self-compassion and grace; to be able to say I did my best today, and my best is good enough and let it go rather than ruminate over what I could have done better or failed to do.
I know you raised children during an incredibly busy work life. Can you define what is often referred to as the “second shift”?
The second shift is a term coined by sociologist Arlie Hochschild. It refers to the household and childcare duties that follow the day's work for pay outside the home. While both men and women experience the second shift, women tend to shoulder most of this responsibility. Women are more likely to perform most of the work within the home, and this leads to increased time pressures and fewer opportunities for self-care.
After all these years of dialogue on sharing the household duties equally, why is this still an issue; what can women do?
I think it's important to have those discussions early on in a relationship with your partner. Especially if you plan to have kids. I deployed when my daughter, Tori, was 18 months and my son, Patrick, was 3 years old. Prior to that deployment, my husband had never put Tori's hair in piggy tails or taken her shopping for clothes. And you have to be OK with the level they do; often, it won’t be the way you would do it. While deployed, I recall seeing pictures of my daughter in a dress that my husband had put on backward and her hair all a mess, but she was smiling and loved. And that is good enough.
What are some of the things that need to be done within the medical profession to address this issue of burnout, which is increasingly being labeled urgent?
It is a combination of organizational and personal responsibility. We need to increase access to mental healthcare for health workers. Far too much of the literature focuses on personal resilience, implying the fault or deficiency has been with the caregiver while neglecting the fact that two-thirds of the problems lie with the organization, since its culture and systems/processes have predictably produced burnout in the first place.
We need to build a culture that supports well-being. It’s time to break the traditional silence surrounding the suffering of health workers. As gratifying as our work is, it can also be profoundly isolating, especially when we feel we can’t let our colleagues know if we’re not OK — a feeling that millions of health workers, including me, have had during our careers. Culture change must start in our training institutions – where the seeds of well-being can be planted early – providing evidence-based interventions to enhance resiliency and mitigate compassion fatigue and burnout.
The well-being of our people is the foundation to our mission and success. If you take care of your people, your teams are better, your communities are better and ultimately the world will be better for it.
Note: This interview was edited for length and clarity.
Pictures at top: Tori and Patrick pose with their mom as children in photo at left and pin her brigadier general stars on her as adults in photo at right.