A mere three years after completing her residency training in 2011, surgeon Carla Haack found herself in the throes of job burnout. She had been devoting her life to the hospital, working 14-hour days including weekends for months at a time. Often the opportunity to eat a meal wouldn't arise until the end of the long work day.
“You could have taken the textbook definition of burnout and stuck it on me. I was miserable, and the work became unsustainable for me,” said Haack, a general and acute care surgeon at Emory University Hospital. “I was exhausted, depleted and probably had some diagnostic features of depression.”
As a result of giving everything to the care of her patients, she ended up with nothing left for herself. Haack had even thought about leaving the practice. The combination of long hours, the increasing clerical demands of medicine and constant worries about patients' health led to symptoms of burnout.
Haack represents a growing number of physicians experiencing job burnout, characterized by emotional exhaustion, feelings of cynicism and a low sense of personal accomplishment. A 2011 survey by the Mayo Clinic found that nearly half of physicians in the United States have at least one symptom of burnout, and the phenomenon is more common among doctors than other professions. A type of burnout called “compassion fatigue” often affects health-care professionals and can result in a loss of empathy for patients, emotional numbing and a sense of no control.
This can have a detrimental effect on patient outcomes. Studies have found that higher levels of physician burnout correspond to more medical errors, which represent the third leading cause of death in the United States.
To combat physician burnout, some medical schools have launched programs to teach “soft skills” to better equip their doctors for today's stressful health-care environment. Learning compassion, empathy and resilience that speak to the human service challenges of the job have helped many individuals rediscover the meaning of medicine and why they became a doctor in the first place.
Since 2014, Emory has offered cognitively based compassion training (CBCT) courses free of charge for staff, faculty and students at the medical school. Each course runs for 10 weeks, meets once a week in person and also includes at-home exercises. Enrollment has grown every year, with a total of 171 faculty/staff members and 239 medical students having completed the course.
CBCT draws from traditions of Tibetan Buddhism mind training that have been secularized with a focus on compassion and well-being. The course begins with meditative exercises that emphasize self-compassion, then asks students to expand these emotions to their loved ones, strangers and finally difficult people. Each class combines didactic teaching and guided meditation.
A study on second-year medical students at Emory found that those randomized to CBCT reported increased compassion along with decreased loneliness and depression as compared with a control group. The greatest impact of CBCT occurred in students who came into the course with high levels of depression, who maintained their compassion throughout the semester. Those with similar levels of depression in the control group experienced a loss in compassion in the same time frame.
“Medical students are this really unique population that suffers from incredibly high rates of depression, suicidal ideation and burnout,” said study author Jennifer Mascaro, a biological anthropologist at Emory. “Not surprisingly, they also seem to suffer a decrease in empathy and compassion during training. It's hard to feel compassion when you're just trying to keep your head above water.”
An eight-week program at Stanford Medicine, called Compassion Cultivation Training (CCT), similarly combines traditional meditation practices with contemporary psychology and scientific research. The training involves daily guided meditation, breathing practices, and a weekly two-hour class with lecture and discussion. While CCT is open to members of the medical school and public, it does require a registration fee of $395.
James Doty, a Stanford neurosurgeon and director of the Center for Compassion and Altruism Research and Education, and his colleagues have studied aspects of CCT not only for health-care providers but also for people living with chronic pain and post-traumatic stress disorder. A randomized controlled trial of CCT found that adults who took the course showed significant improvements in all three domains of compassion — compassion for others, receiving compassion from others and self-compassion — as compared with a control group.
Similar programs exist for medical students and faculty at Massachusetts General Hospital, the University of Virginia School of Nursing and Georgetown University School of Medicine. Medical schools and hospitals are increasingly investing in compassion and empathy training with the hopes to combat burnout in providers but also for any downstream benefits that patients may receive. Patient-perceived physician empathy improves patient satisfaction and compliance, while burnout is associated with an increased risk of medical errors and malpractice.
“When a health-care provider is present and connecting, what happens? Patients' anxiety is decreased, they become calm — and this is all simply as a result of human connection,” Doty said. “So if we create an environment where patients feel that they're being truly cared for and that they're not just another cog in the wheel, it really changes everything.”
After completing the CBCT course earlier this year, Haack has already felt a greater level of engagement with work. While the long hours and paperwork do persist, compassion training has allowed her to exercise the self-care she had been lacking for years.
“Being a surgeon is one of those situations where somebody trusts you and puts their life in your hands, which is both a privilege and an incredible responsibility,” Haack said.” The class has already made a profound difference, and I've learned that having a genuine desire for someone to be happy and free of suffering does not mean that I have to carry their pain around with me.”