Some Physicians are More At Risk than Others
Personality traits and mental health issues also play a role
There’s no denying the serious systemic and cultural issues driving so many doctors to desperation. But what about all the physicians who are not suicidal, the 46% who are not feeling burnt out? Other factors, it would seem, must also play a role, factors specific to individual physicians.
In fact, one UK study concluded, “Stress is not a characteristic of jobs but of doctors, different doctors working in the same job being no more similar in their stress and burn-out than different doctors in different jobs.” Subsequent research by the same authors found that the physicians who reported stress and burnout early in their careers, during training, were the same ones troubled by apparently external problems, such as excessive workload and lack of support, five or six years later.
Some of the characteristics attributed to physicians—such as perfectionism, self-denial, and compulsiveness—may help explain the high rates of burnout and suicide generally, but they fail to explain why some doctors suffer and others thrive. To answer this question, several researchers have looked more closely at specific personality traits. Most make use of a taxonomy formulated in the 1980s, which boiled down human personality into five categories, often called the Big Five:
- EXTRAVERSION: talkative, energetic and assertive
- AGREEABLENESS: sympathetic, kind and affectionate
- CONSCIENTIOUSNESS: organized, thorough and deliberate
- NEUROTICISM: tense, moody and anxious
- OPENNESS: creative, imaginative and insightful
According to the UK study, physicians troubled by external factors are rated as “high on the personality trait of neuroticism and low on the trait of conscientiousness,” while contentment in medicine “relates directly to the personality traits of greater extraversion and lower neuroticism.”
Other researchers have identified a similar, if somewhat more expansive list of traits that might contribute to burn-out. “These include Type-A personalities (competition, time-pressured lifestyle, hostility and excessive need for control), low hardiness (involvement, sense of control and openness to change), perfectionism, neuroticism (anxiety, hostility, depression, self-consciousness and vulnerability) and low self-esteem.” One physician who works with doctors concerned about burnout, favors the Enneagram Personality System, which has 9 basic personality types.
Mental illness is also a factor. A wide range of mental health issues also play a role in burnout, and those who commit suicide are often plagued by the feelings of helplessness and desperation that characterize depression. But one psychological condition of particular concern for those in helping professions is codependency.
Most doctors and nurses go into medicine because they want to help people. For some, this desire becomes an unhealthy obsession. A great deal has been written about codependency, but the broad outlines of the condition are generally agreed on. Among other things, people who are codependent:
- Feel worthwhile only when they are needed by or helping others. Have a need to fix and rescue others;
- Don’t set appropriate limits on others. Have difficulty say-ing no. Don’t protect themselves or their own interests;
- Focus on others rather than themselves. Worry about meeting other’s needs, not their own. Poor self-care;
- Need to be perfect. Hypersensitive to criticism or perceived disapproval;
- Are unaware of their own feelings, desires and needs.
More has been written about nurses and codependency than about physicians (a 1989 study concluded that as many as 80% of practicing nurses exhibit signs of codependency). But Stephen Schenthal, CEO and Founder of PBI, believes codependency is especially common among physicians who encounter problems with professional boundaries, and may well be an underlying issue in some physician suicides.
“These doctors feel they can’t ever do enough, and are willing, even eager, to sacrifice their own well-being to help their patients,” he explains. “In the end, they lose sight of themselves and their own needs. They neglect their personal lives and lose themselves in their work.” This loss of work-life balance is a primary driver of burnout.
Codependency, like most mental health problems, is difficult to self-diagnose. And the condition itself exacerbates physicians’ reluctance to seek professional help. With their whole identity wrapped up in caring for others, codependent physicians are even more fearful than others that admitting their struggles might jeopardize their license. As one study of physician suicide noted, “For someone whose work helps to define his/her personal and professional identify, a crisis in a work situation might feel more threatening than for someone whose personal identity was less reliant on work satisfaction.”