Physician burnout has been blamed on everything from working far too many hours to administrative fatigue stemming from bureaucratic pressure and dissatisfaction with EHR technology.
Physicians subscribe to the myth of invulnerability, experts say, and don't want to ask for help.
But there may be a key element missing from these explanations, according to a perspective from a fourth-year student at Harvard Medical School published Wednesday evening in the New England Journal of Medicine.
That element? The frustration of trying to help disenfranchised patients.
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"Medical students are trained to think from a vantage point of individual agency, and we become stuck there," wrote Leo Eisenstein. “'What can I do?' begins as an earnest, ambitious question, but it so often spoils to a cynical one."
He pointed to community clinics where physicians and medical students experience feelings of powerlessness when they realize patients' environment or circumstances preclude them from benefiting from medical advice.
They "may feel demoralized when they realize that their instruction 'Do not take this medication on an empty stomach' translates into patients taking their medications only sporadically because they don’t have enough to eat," Eisenstein wrote.
The solution? Eisenstein said he believes the secret is to organize.
Doctors need to expand their focus from addressing social determinants one patient at a time, and instead band together to push for broader changes, Eisenstein wrote. In one example, he pointed to a group of health professionals in Boston called SIFMA NOW which advocates for supervised injection facilities as a harm-reduction strategy for people addicted to heroin.
Not only does the action help patients, but a physician resident described the action as a 'balm' for herself.
"Beyond whether we must or should do it for our patients," Eisenstein wrote, "collective advocacy to address the harmful social determinants of health can buoy physicians’ morale and thus be an act of self-care."
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He might be an idealistic medical student, or he might just be on to something.
His perspective comes on the heels of a study published in the Annals of Internal Medicine which tied physician burnout to the frustration of being unable to give immigrant patients equal care.
However, it's likely to face skepticism from plenty in the medical field. A national survey from Leavitt Partners released last month also pointed out most doctors feel addressing social determinants of health is not their job. One caveat: Younger physicians and those doctors who worked with poorer patients were more likely to believe that assistance to help increase income and assistance arranging transportation would benefit their patients to a great or moderate extent.