Winter 2020 (Volume 30, Number 4)
Burnout and the Rheumatologist
By Lester Liao, MD, MTS
Rheumatology is not often thought of as a particularly
busy or stressful specialty. When we think of burnout,
our mind jumps to high stress, acute disciplines
that afford less control. Emergency medicine. Critical care.
So, it may seem unusual to consider the problem of burnout
for the rheumatologist. Are we not, after all, the best
For what it's worth, the annual Medscape Rheumatologist
Lifestyle Happiness and Burnout Report suggests we tend to
be less happy than the average physician at work, happier
than the average physician outside of work, and roughly
40% of us are burned out.1 By far the biggest contributor is
bureaucratic tasks, which include charting and paperwork.
The data aren’t perfect, but they provide a springboard for at
least two brief observations for rheumatologists.
First, we are not immune. This would seem obvious (no
less because we pride ourselves on our understanding of
immunology), but it is worthwhile to emphasize since we
have a tremendous capacity for self-deception.2 Low stress
does not effectively mitigate burnout because the suspected
etiology is unrelated. And we deal with an unusual batch
of drugs and diseases. Our consults and charting are perhaps
a touch more detailed, and from one Exceptional Access
Program to the next, we have our fair share of forms.
At the most superficial level, reducing tasks of this nature
would be a fine place to start.
But second, and more importantly, clinical interest is not
enough to banish burnout. I presume many of us joined the
ranks of rheumatology due to genuine curiosity. We attract
a particularly cerebral group. But that earnestness, which I
see persists in many colleagues even over decades, provides
little drive to continue with the paperwork, the meetings,
the electronic medical records (EMRs). We need something
more riveting. And this lies in the humanity of any practice.
A disease is interesting, but a person is inestimable. This is
of particular relevance for the rheumatologist, whose orientation
toward medicine is at least mildly skewed toward a
fascination with pathophysiology. The orthopedic surgeon
has a different tendency on her hands. But for us, we must
be mindful of this pitfall. If our goal is in satisfying curiosity,
in gathering data, or even in the cure, we have missed
the mark. This makes the patient a means to an end.3 And
when the patient is subservient to another goal, the heart
atrophies. Chronic pain becomes a nuisance, paperwork
a drag. These issues become impediments to the thing we
want or need. And this, in my mind, is the deeper issue at
The process, of course, is subtle. But it is inevitably present,
and I recognize it in myself. Yet if my child were ill and
needed paperwork, it’d be completed in a flash. The human
element is overpowering. Certainly, we must take other
measures to reduce burnout. But there are things the surveys
have trouble capturing. The totality of our work resides
in the patient before us. Lose this vision, and our work will
always leave us numb and disenchanted. Remember it, and
we may know we’ve changed a life forever.
1. Medscape. Rheumatologist Lifestyle, Happiness & Burnout Report; 2020.www.medscape.com/
slideshow/2020-lifestyle-rheumatologist-6012480. Accessed May 27, 2020.
2. Haidt J. The Righteous Mind: Why Good People Are Divided by Politics and Religion. New York, NY:
Pantheon Books; 2012.
3. Kant I, Wood AW. Groundwork for the Metaphysics of Morals. New Haven, CT: Yale University Press;
Lester Liao, MD, MTS
Pediatric Rheumatology Fellow, Hospital for Sick Children,
University of Toronto
International Doctor as a Humanist Association