The proletariat doctor: physician burnout as alienation

What Marx can teach us about modern medicine

Burnout has become a huge issue in healthcare today, affecting not only doctors but nurses, pharmacists, and many other providers. In a growing number of hospitals and clinics, staff members are complaining of chronic stress, emotional exhaustion, and a general lack of motivation — factors that are no doubt influencing the quality of care administered.

In tackling the problem of burnout, it has been framed as an emotional or psychological obstacle, with interventions like frequent breaks, a balanced lifestyle, and stronger support systems being suggested. These are similar to general guidelines for self-care, which advise people to form positive strategies for dealing with individual-level stressors and coping with adverse circumstances.

But physician burnout is more than just a personal problem: it has structural causes and should be viewed in that context. In this article, I’ll argue that we can use the Marxist notion of alienation, originally applied to the working-class proletariat, to understand the phenomenon of burnout. By so doing, we might gain a more comprehensive perspective and start to formulate new solutions.

What is burnout?

Topics like insurance reimbursement rates, coverage, and drug prices have seen renewed public interest in our political climate, where proposed solutions can adorn hopeful candidates’ platforms and inspire a significant amount of activism and engagement.

By contrast, physician burnout is largely absent from popular discussions about healthcare — despite the fact that it impacts health systems directly and can have real effects on patient outcomes. So pervasive and detrimental is the problem that Harvard’s healthcare system has even declared it a public health emergency.

Professional burnout is widely identified using the Maslach Burnout Inventory, which defines it as:

• Emotional exhaustion
• A feeling of depersonalization or cynicism
• A low sense of personal accomplishment

How do we know that professional burnout is impacting medicine today? By asking doctors…