This past week, discussions of the U.S. doctor shortage dominated the health op-ed sections of the New York Times, Wall Street Journal, and Washington Post, among others. In the current Washington Monthly, as James Hamblin discussed here yesterday, Phillip Longman addressed the open secret that the most academically prestigious medical residency programs routinely train the fewest number of primary care physicians. Concerns about salaries, student debt, and physician burnout discourage these students from staying in medicine -- and, more importantly, from selecting primary care and preventive medicine specialties as a career.
Yet few if any writers addressing the doctor shortage describe a structural component of medical training that dissuades students and residents from long-term employment as physicians: American medical trainees receive next to no specialized training in worker health and safety.
Physician burnout -- a symptom cluster reflecting feelings of emotional exhaustion, low personal accomplishment, and depersonalization and isolation -- is a psychiatric epidemic in most industrialized countries. While burnout itself is not a DSM-5 diagnosis, the resultant anxiety disorders, depressive disorders, and suicide are. (For those interested in a more feeling version of this feeling, New York internist Danielle Ofri has characterized physician burnout in her new book What Doctors Feel .) Medical trainees work in an underfunded patient care system, then immerse themselves in the service of patients whose demands they cannot meet alone. Deprived of institutional supports in the medical community for burnout prevention, the experience of medical training detracts those who would try full-time practice, in particular primary care practice, from continuing.