Why MD Anderson Should Be The Least Likely Place For Physician Burnout

By

Leonard Zwelling

https://www.nytimes.com/2018/10/10/magazine/for-doctors-delving-deeper-as-a-way-to-avoid-burnout.html

Siddhartha Mukherjee is both prolific and insightful. The Pulitzer Prize-winning author of The Emperor of All Maladies, the biography of cancer, has written another great piece in The New York Times Magazine of October 14, 2018 called “As the practice of medicine shifts, can doctors avoid burnout by finding meaning.”

Sidd relates his experiences in anatomy class in medical school and the fates of his three lab partners as they progressed in their medical careers. He goes on to generalize that a key to avoiding burnout—emotional exhaustion, depersonalization, and a sense of a lack of personal accomplishment—is to find meaning in the work we doctors select. These are the three scales on which the Maslach test for burnout are based and it is avoiding sliding down these scales that may be the key to avoiding burnout.

Dr. Mukherjee defines meaning as also having three axes—purpose, mastery, and autonomy. This correlates well with what my analyst once told me was the definition of fun. It is pleasure, engagement and meaning. So for doctors to avoid the trap of emotional breakdown and burnout, it is not through the avoidance of work, but through the sculpting of that work into meaningful activity that provides the physician with a sense of purpose, a feeling of accomplishment and genuine competence, and a belief that the doctor has some degree of control over his or her own life.

I can think of no place where such a life in medicine is more likely to occur than at The MD Anderson Cancer Center.

I am the prime example, because I kept changing what I did to feel like my career and professional life had meaning and the organization was able to accommodate my whims.

I came to Anderson in 1984 as a physician-scientist, boarded in medical oncology and expecting to pursue my previous roles as both an attending doctor and a lab-based investigator. I quickly learned that I may well have been board-certified in medical oncology, but that didn’t mean I really knew what I was doing. The clinicians I met when I arrived in Houston were far more experienced and skilled than I. I rapidly learned to defer to their judgment in matters of clinical care and I still do to this day. These guys and gals are the pros from Dover when it comes to caring for people with malignant diseases.

I was pretty good at running a lab and for many years that was the source of a feeling of competence, pride, and meaning, but it didn’t last. I was beginning to learn of an affliction I had (or have) that I call career ADD. Where else in the United States could I have taken two years to acquire an MBA while also running a full-time laboratory like I was able to do at MD Anderson? Not too many, although I did keep the grant dollars flowing. Goodness knows how.

Then I was given the opportunity to run a small little company within the walls of MD Anderson—the Office of Protocol Research. Only at MD Anderson could I have started from scratch to build an office that eventually oversaw the entirety of research administration and develop an operating system that is largely preserved to this day, as far as I can tell.

Alas, my utility ran out. I burned out running that office because I overstayed my welcome and the institution had had enough of me and in 2007, I was relieved of all of my administrative duties.

Where else but at MD Anderson could I have started all over again and spent a year on Capitol Hill, returning to be the interim head of the Carcinogenesis Department at Smithville before settling into my new endeavor of writing about health reform and even publishing a book on the subject. Only at MD Anderson.

But all things had to end and after 29 years of many careers, it was time to move on and I did.

My point is only that burnout should be avoidable at MD Anderson as it is nowhere else in the academic world. Sure the EMR will drive you crazy. Sure the infrastructure governing human subjects research is a hassle. Animal care and use forms can be oppressive and bureaucracy seems to be everywhere. But, it is less at Anderson than at most other places. The care is probably better and the skill level of your colleagues probably higher.

There was a time when the leadership at Anderson was of an ethically questionable nature and this alone can upset one’s sense of meaning and fun. But that’s over now.

It’s a new dawn. Take advantage of the various ways to avoid burnout at Anderson. You will be a better contributor and your contributions will be more highly appreciated. There’s no place like it.

Leonard Zwelling