Pushing Back: Recognizing the Need to Advocate for Systemic Change in a Sustainable Medical Field

The present culture of medicine and medical education predispose practicing physicians and resident physicians to the development of burnout. The occupational pressures and stressors associated with this field are complex and multifactorial, and their effects on physicians’ mental and physical well-being can be profoundly negative. Previous efforts to address the phenomenon of burnout have largely focused on promoting resilience in physicians; however, a more large-scale, systemic approach is necessary for a more comprehensive and productive method to combating burnout. Previous research has identified the importance of preventing the onset of burnout rather than treating its symptoms. In order to accomplish this, a cultural shift in medicine is required such that partnerships across all levels of the organizational hierarchy work to promote a new culture that encourages practicing physicians and physicians in training to “speak up” and advocate for systems-based changes to promote a healthier workplace and workforce. In this chapter, the authors define important phenomena related to the concept of burnout, including moral injury, resilience, wellness, and wicked problems. These phenomena are then used in a comprehensive discussion about the healthcare system and the potential role that systems-based changes can play in addressing the problem of burnout among practicing physicians and those in training.