Wayne M. Sotile, PhD, a clinical psychologist from Winston-Salem, NC, says we’ve entered a very interesting time in medicine.  “Record numbers of physicians are saying that they would not recommend medicine as a career, and record numbers are claiming they’re going to drop out, particularly those over age 55,” said Dr. Sotile, who, with his wife, Mary, spoke recently to the Texas Medical Association’s annual meeting. “But at the same time, record numbers of medical students are entering medical training.  I think this is the most stressful time for medical families ever,” he said.

Dr. Sotile’s formula for physician burnout combines excessive workloads, expanded roles, and lack of support systems.

“Physicians now, as always, work harder than any other profession,” he said.  “Three times more physicians work 60-plus hours a week than workers in other professions do.  More than 20% of physicians work more than 80 hours a week,” Dr. Sotile says.

“Today, physicians must juggle many roles on top of the many hours they work in a day.  During the past l5 years, more women have entered the work force and men have become more involved in their families.  More than 40% of medical school students are women, so ‘the doctor and his wife’ simply does not describe the majority of physician marriages any more,” Dr. Sotile said. 

The Sotiles have written two books on medical marriages, The Medical Marriage: Sustaining Healthy Relationships for Physicians and Their Families (American Medical Association, 2000) and Beat Stress Together: The BEST Way to a Passionate Marriage, a HealthyFamily, and a Productive Life (John wiley & Sons, 1999).

“Women physicians are having an especially difficult time with expanding roles as they try to express their femininity without losing power, prestige, or respect in their profession or their homes,” Dr. Sotile says.  “Female physicians need to incorporate femininity into their lives to be whole people, but that’s very difficult when you’re working 80 hours a week in a male-dominated arena,” he said.

The multiple hours and multiple roles contribute greatly to physician stress, but probably the most heartbreaking ingredient of burnout is the decrease in support and respect for physicians from society.  “Physicians, almost universally, are caring people.  They’re programmed personality-wise to please others and try as hard as they can to be perfect, “ Dr. Sotile said.  “I‘ve seen what happens to physicians when they’ve delivered care out of the goodness of their hearts only to have it turned around in some way and become somebody’s lawsuit.”

Doctors are lacking professional and community support systems because they don’t feel comfortable talking about stress and burnout with colleagues.

But physicians are an “extraordinarily stress-hardy people” because they deal with stress by developing “high-powered coping strategies,” such as going numb, being directive, being quick in decision-making, and ignoring anything other that the task at hand, Dr. Sotile says.

“But the survival strategies those physicians have to learn to make it in the marketplace end up hurting their relationships,” Dr. Sotile said, “and, thereby, pulling the plug on the very thing they need to not get burned out ---  caring relationships with other people.”

Relationships are the Key

After treating 700 physicians during the past 20 years, the Sotiles determined what fuels physician burnout--and it’s not what you’d expect.

“None of the research suggests that physician burnout relates to hours worked, practice speciality, managed care, or governmental interference with the practice of medicine,” Dr. Sotile said.  “All those things are aggravations, but they do not differentiate who burns out from who does not.”

The research shows physicians burn out when their relationships with the people they work and live with fill with conflict. Two key interpersonal relationships--those between physician and spouse and physician and colleague--could lead to stress and burnout if they grow tense and cause the physician to suffer low self-esteem, feelings of inadequacy, dysphoria, obsessive worry, passivity, or social anxiety.

 “Mary and I strongly issue a call to the leaders in medicine to recognize the need for interpersonal skills training for physicians,” Dr. Sotile said.  “These are survival skills for physicians, and it is foolhardy not to attend to them.”

When it comes to medical marriages, the Sotiles advise physicians to give up the “myth of the balanced life.”

“If you’re going to be married to a physician, you’re going to have a spouse who works an extraordinary amount,” Dr. Sotile said.  “The good news is that this does not necessarily mean you’re going to suffer burnout, divorce, substance abuse, or disillusionment with what you do.”

"Medical marriages come in three forms that are fairly equally stressful: a male physician married to a nonphysician, a female physician married to a nonphysician, or a female physician married to a male physician.  Female physicians, 70% of whom marry spouses with comparable earning power, have the highest rate of divorce,” Dr. Sotile says.  “Half of female physicians marry other physicians.  Only about l2% of male physicians marry women who have comparable earning power, but physician wives today lead busy lives and expect the participation of their husbands at home more than past generations.” he added.

In a two-physician marriage, the spouses have more compassion for each other’s love of medicine and the demands it places on their lives.  “But the risk is that there will not be a stress absorber in those marriages because both members are working very hard and tend to pull toward their traditional roles,” Dr. Sotile said.  “Research suggests that in about 80% of the two-physician marriages, the woman still assumes primary responsibility for running the home--even when she makes more money than her husband--which creates a tremendous stress overload for her,” Dr. Sotile adds.

“The new generation of physicians views the baby boomers as a bunch of workaholics,” Dr. Sotile said.  Physician leaders are recognizing that the new generation of doctors is willing to take pay cuts to work fewer hours, and these leaders are encouraging the same practice in older physicians to avoid stress and burnout.

And Dr. Sotile says physicians need to get rid of the “conspiracy of silence and admit that they are stressed.”

We Can Be Heroes

“Physicians are the heroes,” Dr. Sotile said.  “They are extraordinary people.  They are more intelligent than most people, they’re able to work harder than 98% of the people in the history of the world, and they do stuff that’s more important than most people even dream of doing.  Why would they settle for a half-baked life?  In order to have the whole package, they’ve got to take care of themselves and take are of each other.”

“Physicians also should realize that lack of illness is not the same as health and happiness, “ Dr. Sotile says.  He thinks this may be happening already as evidenced by the increase in requests for programs similar to the one the Sotiles  presented at TexMed ‘99.  “Physicians show up in record numbers to hear messages of this sort and stay overtime, whether it’s grand rounds or a conference.”