With You All the Way

Image Credit: Pixabay

Author: Meaghan Mercer, MD
2014-2015 RSA President
Originally Published: Common Sense May/June 2014

Emergency medicine is a specialty known for high burnout. Professional burnout is described and measured in many different ways, but it encompasses a loss of enthusiasm for work, emotional exhaustion, disparagement, depersonalization, a loss of empathy, and feeling a lack personal accomplishment. A study done in the 1990s showed that, of surveyed emergency physicians, 77-80% of physicians said that EM had met or exceeded their career expectations but 31-33% still noted that burnout was a significant problem in their work life. We have a dichotomous emotional response to our work: a love of what we do and a component of exhaustion from it. We can have large swings of daily highs and lows, or a day full of benign abdominal pains. We often present ourselves as emotionally open and able to look at all things objectively, but with burnout we can become emotionally blunted. How do we prevent this? There have been many proposals on how to prevent burnout, but fundamentally the answer is in rediscovering what drew us to EM initially and letting that continue to motivate us day to day.

As residents we have numerous motivations: reward, punishment, acknowledgment, evaluations, pride, and peers; but Dan Pink makes a compelling argument in his book Drive that the greatest motivators are autonomy, mastery, and purpose. These intrinsic factors sustain our creativity, passion, and enhanced performance. As we enter the post-residency world, our intrinsic motivation is what keeps the spark going.

Autonomy is the ability to be self-directed, and when this is allowed in the workplace it leads to engagement in tasks. This is seen in teaching institutions. As residents progress through their training they begin to take control of their education, challenging ideas and testing themselves. New graduates often express much higher job satisfaction, unrelated to the sudden increase in their free time, because of their new ability to be self-directed in medical decision-making. Mastery motivation is the impetus to achieve and improve your skills in the absence of any physical reward. When external forces are no longer looming over us, telling us we have to keep learning, we have an innate desire to know and do more. We want to be masters of our field. This is the same force that often drives our hobbies. Playing an instrument, climbing the difficult route, and finishing an art piece, all fulfill our need to master a subject or task. Purpose is the challenge and desire to contribute. This is an obvious motivation in the FOAM movement. The brightest minds in our field have endless demands on their time, yet they use their free time to create materials to educate and advance the field and then give it away for free.

We are intrinsically motivated when we are doing an activity for ourselves and extrinsically motivated when we are doing it for a reward. Residency is the time to find out what motivates you. We take for granted this environment, where we have a great safety net of nurturing individuals that want us to succeed. Seize the opportunity to interrogate yourself, to find what drives you forward, and what will allow a life-long fulfilling career. Discover what gives you the deepest reward — do a fellowship so you can master a specific realm of our field, contribute to the ever growing FOAM movement to add purpose to your research or self study, or find something you love outside of medicine so that you have balance and passion all areas of life.