Physicians spend years in graduate school and post-graduate training. Their resilience built up over long years of study, however, doesn’t insulate them from workplace toxicity, which can make working in medicine intolerable and contribute to clinician burnout, according to a KevinMD article.

Turgeon C. Why do physicians stay in toxic work environments? KevinMD.com. February 4, 2022.

Recognizing the signs of this kind of workplace is the first step toward developing strategies to make it more bearable and sustain long-term employment.

Defining a toxic healthcare environment

Experts have offered their take on what characterizes a toxic healthcare environment. Observations from the KevinMD research, as well as from articles published by Cleveland Clinic and Reflections of a Millennial Doctor, yield a list of possible red flags:

8 signs of a toxic work environment. Cleveland Clinic. January 12, 2022.

Time to face the truth: Healthcare workplaces are toxic. Reflections of a Millennial Doctor. December 17, 2018.

• Too much bureaucracy and not enough flexibility

• Too many mundane/rote tasks (for example, excessive data input into EHR)

• Long hours

• High patient counts (for example, seeing 20+ clinic patients in one morning)

• Feeling fatigue, sleeplessness, headaches, or joint pains induced by the workplace

• Abundant microaggressions in the workplace

• Lack of motivation, opportunity for growth, appreciation of work

• Work-life imbalance compromises quality of life

• Malignant colleagues, executives, or administrators

• Management doesn’t address issues and simply replaces disgruntled employees

Psychiatrist Robert Emmons, MD, writing in the Journal of American Physicians and Surgeons, cited other characteristics, such as:

With 50% of physicians ‘burned out,’ pushback against toxic workplace needed, states Journal of American Physicians and Surgeons. GlobeNewswire News Room. December 19, 2019.

• Surveillance that benefits the organization and not patients

• Punishment by administration for refusing to go with the flow

• Excessive certification and testing

• Scapegoating clinicians for the organization’s problems

• Pay that is lower than expected or below fair market value

Why docs tolerate these environments

Reasons why physicians choose to remain employed in such environments can be idiosyncratic, but some common themes seem to crop up, according to KevinMD.

The first is learned helplessness, which refers to the phenomenon in which a person grows accustomed to and accepts the abuse of their environment without trying to escape.

Physicians are used to putting their heads down and not complaining, a behavior learned during medical school and residency. This tendency could play a role in their persistence in a sour work. If a physician does complain and refuses to follow procedure, this could be perceived as a betrayal by administrators.

Related link: Practicing what they preach: Psychiatrists discuss burnout, self-care, and staying well in MDLinx webinar

What you can do

There are steps a physician can take to help resolve workplace issues and avoid burnout, as suggested by the KevinMD article:

• Setting limits and saying “no” (for example, refusing a last-minute sick visit from an unscheduled patient when the clinic is packed)

• Taking a break from checking work email on days off

• Negotiating extra pay for administrative tasks

• Talking it out with a supportive network of peers

• Taking advantage of an employee coaching program (if available)

• Knowing if the situation isn’t improving and it’s time to make a change

Note that a reduced workload or increased pay may not always be the right answer for every physician. Sometimes getting leadership on board in listening and responding to physician concerns may do the trick. Compromising with administration can go a long way toward making a workplace more tolerable.