Episode #40: The Health Crisis of Physician Burnout with Dr. Sue Padernacht

Dr. Albert Rizzo:
Over the last 5 to 10 years, and likely longer, the term burnout has popped up in numerous articles related to many professions, but particularly in the COVID and post-pandemic years. The term has played a significant role in addressing the healthcare industry.

Today, we have with us Dr. Sue Padernacht, who earned a Doctor of Education in Organizational Change and Leadership from the University of Southern California. She has spent many years in corporate leadership, executive coaching, organizational consulting, and academic teaching. Her research focuses on physician burnout in the COVID-19 pandemic, healthcare organization and leadership, and implications for patient care and clinical team leadership with nurses.

I’m also happy to say that she’s recently been added to the American Lung Association's National Board of Directors. I could think of no one better to discuss this topic. So thank you for being with us today, Dr. Padernacht.

Dr. Sue Padernacht:
Thank you so much, Dr. Rizzo. It’s an honor to be here and to be serving on the National Board as well.

Dr. Rizzo:
Just so our listeners are on the same page, could you please give us the definition of burnout that we’re going to be discussing today?

Dr. Padernacht:
Sure. I like to begin with the opposite, which is well-being, because there’s a lot of confusion about that term. There are two constructs of well-being, which will lead into our discussion about burnout.

One is hedonic well-being—think of hedonism—associated with momentary experiences of pleasure and joy. It’s about seeking the nice things in life and avoiding bad feelings.

The other is eudaimonic well-being, which is longer-term and more sustainable. It’s associated with having a sense of purpose, meaning, growth, self-actualization, and contribution. This can be anything from raising children, becoming a physician and promoting patient well-being, or being an educator in the corporate world.

Eudaimonic well-being can sustain us even in the absence of hedonic pleasure. Medscape did a study in 2022 (published in 2023) on pulmonologist lifestyle, happiness, and burnout. Before COVID, in 2019, pulmonologists were at the top of the happiness scale: 89% reported being happy or very happy with their lives. Since COVID in 2022, that dropped to 59%.

For comparison, the general population was about three-quarters happy pre-COVID, and less than 50% post-COVID.

Burnout research arose from studying the impact of workplace stressors on mental health, codified by Christina Maslach and Michael Leiter at Stanford University. The World Health Organization adopted their definition.

Key points:

• Burnout is an occupational phenomenon. It doesn’t apply to being “burned out” by personal life issues.

• It is not a mental or medical illness, though it can lead to depression or suicidal ideation.

• It is a syndrome resulting from chronic workplace stress that is unsuccessfully managed. This is critical because physicians are resilient people; unmanaged stress is the differentiator.

Burnout has three components:

1. Exhaustion: Physical, cognitive, and emotional. That “I’m tired” feeling.

2. Mental distance / depersonalization: Cynicism, negative thinking, “I don’t care anymore.”

3. Reduced professional efficacy: Feeling you can’t perform at your best, sometimes due to systemic constraints.

The U.S. Surgeon General, Vice Admiral Vivek Murthy, said: “Burnout manifests in people but originates in systems.”

Dr. Rizzo:
That’s a great definition. I also came across the distinction between stress and burnout. Could you expand on that, and clarify that both can lead to depression, but are different?

Dr. Padernacht:
Yes. The research is mixed. Some see burnout as a subcategory of stress, while others say they overlap so much that the difference is subtle. Stanford’s work does a good job of parsing them.

Stress tends to be high-energy, associated with fear and anxiety, and a response to anticipated or immediate workplace pressures. There are two types:

• Eustress: “Good stress” that enhances focus, engagement, and readiness (like athletes or surgeons performing under pressure).

• Distress: “Bad stress” linked to elevated cortisol, chronic anxiety, and physical wear-and-tear, often over long periods.

Burnout, in contrast, is low-energy. The term comes from the analogy of a match—once the fuel burns out, it’s spent. Burnout is associated with loss: loss of meaning, purpose, growth, identity, agency, control, and significance. It affects professionals in high-purpose fields—physicians, firefighters, police officers, teachers.

Medscape found that in 2022, 42% of pulmonologists reported burnout having a severe impact on their lives, 33% moderate, and only 25% none.

Dr. Rizzo:
So emotion plays a role, but there are also physical, behavioral, and cognitive manifestations?

Dr. Padernacht:
Yes. We can categorize them into:

1. Performance:

• Increased medical errors, accidents, and patient safety issues

• Reduced patience, creativity, and innovation

• Suppressed executive functions and increased interpersonal conflicts

• Absenteeism, turnover, distracted thinking, depersonalization

2. Physical Health:

• Gastrointestinal, cardiovascular, sleep, and immune system issues

3. Mental and Emotional Health:

• Disillusionment with job, organization, and leaders

• Compassion fatigue and cognitive overload

• Feeling unappreciated, isolated, or disrespected

• Loss of control, with extreme cases leading to suicidal ideation

For example, the death of Dr. Lorna Breen in 2020 highlighted the impact of burnout on physicians—exacerbated by medical errors, high workload, physical exhaustion, and impaired interpersonal relationships.

Dr. Rizzo:
That’s sobering. Are there signs leaders should watch for in their workforce?

Dr. Padernacht:
Yes:

• Burned-out physicians are 63% more likely to take a sick day, 23% more likely to visit the ER, and 2.5 times more likely to leave.

• There’s a projected shortage of ~224,000 physicians in the U.S. by 2034.

• Annual burnout-related physician turnover costs are estimated at $5 billion.

Dr. Rizzo:
COVID-19 exacerbated burnout. Are there steps the healthcare industry should take to prevent this in the future?

Dr. Padernacht:
Yes. Start by gathering data about causes. The U.S. Surgeon General’s 2022 report outlines factors from societal culture to individual level. Some actionable steps include:

• Unsustainable high workloads: Use telemedicine and nurse practitioners to distribute work.

• Underrepresentation of diverse physicians: Recruit from underrepresented communities.

• Insufficient choice and control: Involve physicians in scheduling, policy, and decision-making.

• Ungratifying rewards: Some prefer time off and flexibility over bonuses or staff retreats.

• Unsupportive work community: Properly onboard and integrate traveling or new staff.

• Dissatisfaction with fairness and respect: Address inequities, microaggressions, unmet promises (e.g., childcare).

• Non-alignment of personal and organizational values: Physicians’ purpose (health promotion, patient care) may clash with efficiency or cost-focused policies.

• Patient misinformation and hostility: Social media misinformation adds stress and burnout risk.

Dr. Rizzo:
These are important issues. Burnout isn’t new, but COVID exacerbated it. The reasons likely won’t go away, especially in healthcare.

Dr. Padernacht:
Exactly. Recognizing systemic causes and implementing supportive policies is essential for physician well-being and patient care.

Dr. Rizzo:
Thank you for this insightful discussion, Dr. Padernacht. Could you share references for the audience?

Dr. Padernacht:
Certainly. I recommend Drs. Maslach and Leiter’s book The Burnout Challenge, as well as the U.S. Surgeon General’s 2022 report on healthcare industry burnout.

Dr. Rizzo:
Thanks again for helping us analyze physician burnout in a meaningful way. If listeners are interested, check out our episodes on indoor air quality with Dr. Mark Hernandez or long COVID with Dr. Julia Moore Vogle.

Be sure to subscribe and rate Lungcast on your preferred platform, and visit lung.org and hcp.com for more news and resources.

Until next time, I’m Dr. Albert Rizzo, reminding you that if you can’t breathe, nothing else matters.