Medicine, NASA, and “The Right Stuff” Method
Burnout among physicians is now well understood to be pervasive and tenacious. The question is no longer “Are physicians burned out?” but is “How do we prevent burnout?”
Along with mitigating the effects of burnout, there is an intense focus on burnout prevention. In the current state, solutions generally fall into 2 buckets:
- Actions taken by individuals to improve personal well-being
- System-level factors that organizations can address to lessen operational demands such as productivity and excessive EHR data entry
Individual actions can positively impact a person’s overall work satisfaction, but working within a flawed system can be challenging beyond anyone’s innate capabilities to achieve any semblance of joy in their work. Seeking greener pastures, the result is often voluntary separation. Physician turnover is costly (at least $500k by most estimates) and should be considered an avoidable expense.
Let’s face it, medicine in the 21st century is not Marcus Welby, M.D. folks. By evidence of burnout studies, medicine is an extremely demanding profession and has made it apparent that some specialties fare better than others. According to Medscape’s updated 2019 National Physician Burnout, Depression & Suicide Report, between 28% and 54% of physicians reported feeling burned out, with an average of 44%.
Here’s what we know:
- Highest burnout: Urologists, Neurologists, Physical Medicine & Rehabilitation
- Lowest burnout: Public Health & Preventative Medicine, Nephrology, and Pathology
- Most likely to work long hours: General Surgery, Urology, and Cardiology
- Least likely to work long hours: Emergency Medicine, Dermatology, and Allergy & Immunology
- Least happy physicians: Physical Medicine & Rehabilitation, Emergency Medicine, and Internal Medicine
- Happiest physicians: Plastic Surgery, Public Health & Preventative Medicine, and Ophthalmology
We can learn a lot from the aerospace industry. They have led the field in establishing rigorous psychosocial selection processes. There’s even a field of medicine called aerospace psychiatry and psychology — where one provides mental health support to aviation professionals.
In an article titled, “Space Psychology 101: How NASA Keeps Its Astronauts Sane”, it explains how NASA operates with the foundation that the astronaut candidate selection process is probably the most important way to prepare astronauts for the mental rigors of space travel and life. The goal is to pick candidates who possess sound, resilient minds. There are nine different “suitability proficiencies”:
- Ability to perform under stressful conditions
- Group living skills
- Teamwork skills
- Self-regulation of one’s emotions and mood
- Judgment and decision-making
- Communication skills
- Leadership skills
So how does NASA keep astronauts sane under the extreme physical and psychological rigors of outer space travel? It starts at selection – the right person for the right job. In other words, do they have “The Right Stuff”?
For decades, industries other than healthcare have been using pre-employment screening instruments such as Myers-Briggs for personality testing to assess potential candidates’ fit for different positions. Ensuring a candidate is a good fit at hire saves a myriad of downstream consequences and is simply an industry best practice.
With the evidence behind personality typing and the knowledge that some personality types are better suited than others for particular vocations, it seems reasonable that burnout prevention measures should begin much earlier in an individual’s career– for example, as part of the medical school entrance process. Ensuring the right-fit for the demands of medicine is a proactive strategy for burnout prevention and retention in the later years of a physician’s career.
Not everyone’s cut out for medicine. In general, humans are not always well-suited at accurately understanding what career will make us happy and suits our personality type and proclivities. Sure, a future physician may have aced their SATs, ACTs, college GPA, MCAT and attended an Ivy League medical school, but one study suggests that personality is a strong predictor of well-being and resilience.
“The reality of medicine is that it’s a churning ocean of chaos, sinking un-sea-worthy ships by the score.”
Medical schools are the first opportunity to assess an individual’s fit for the career. There are many validated instruments that measure personality traits and could be useful for medical schools and students to asses a “fit” for the medical profession. The tool could further serve to steer prospective students into beginning to consider a medical career specialty that suits their nature and ability to cope with stressors.
Residency programs could likewise utilize cognitive and personality testing to take an even more prescriptive approach to steer candidates into the medical specialty they are best suited for.
To be clear: the demands of astronauts may not be exactly on par with those of physicians. Astronauts endure long duration space missions, tight quarters, intense workloads, separations from family, etc. However, NASA has developed an end-to-end process of selection, grooming, support and management that has been highly effective:
“So far NASA’s aerospace psychiatry program has been very successful. Gary Beven (NASA Flight Surgeon and Chief of Aerospace Psychiatry at NASA Johnson Space Center) says that every astronaut performs “exceptionally well,” for 95 percent or more of their mission duration. “Occasionally, they dip down to more mundane frustrations or frictions,” he concedes. Yet, for the entire time he and his team have been working with the ISS, “we’ve not noticed anything that would be of clinical significance,” nor anything that would terminate any mission or procedural activity due to psychological detriment.”
Considering the field of medicine has found itself with a mass of burned out physicians, it’s imperative that we endeavor to help those in need of assistance. A focus should continue with measures to assist physicians in coping and rejuvenation strategies, as well as significant organizational responsibilities to lessen the administrative and productivity burdens on physicians. However, burnout prevention begins at selection and well before a physician has even begun their career, and the earlier in the career cycle, the better.
This is not to say that medicine should institutionalize the exclusion of individuals from their dream of becoming physicians because a personality test deems them “introverted, sensing, feeling, and judgmental”, it simply means that some individuals are better suited for the demands of Emergency Medicine and others General Surgery. Wouldn’t it make sense to have this knowledge on the launch pad of an individual’s career rather than in orbit?