We previously looked at the study by Jackson et al. that looked at medical students via a survey methodology and found high rates of alcohol use disorders and a strong correlation between burnout and alcohol use disorders.

Jackson Eric R, Shanafelt Tait D, Hasan Omar, Satele Daniel V, Dyrbye Liselotte N. Burnout and Alcohol Abuse/Dependence Among U.S. Medical StudentsAcad Med. March 1, 2016. doi:10.1097/ACM.0000000000001138.

The study identifies factors that are in play promoting alcohol use besides burnout and may be contributing to both, including younger age, higher debt, and single status. The limitations of the study include the cross-sectional rather than longitudinal strategy. It is impossible to determine causality or the direction of causality if it exists.

Indeed, correlation is not causation, but all correlation should also be run by an evaluation by common sense. It seems reasonable that being a younger age translates to having less context to make sense of the challenges of medical school and fewer coping strategies. The impact of debt on stress and burnout also seems quite likely.

Marriage often offers consistent support and would logically provide assistance with stress management (and the occasional warm meal). For single folks, the value of marriage may be approximated by expanding your social network to include individuals who look out for your health and best interest. If any of these potential risk factors apply to you, it may also be helpful to expend additional effort to ensure your well-being.

To address the “correlation is not causation” weakness, we are seeking to engage medical schools to complete similar studies at the onset and at the completion of subsequent years of medical training to help guide us in the development of our BurntOut game developed as a part of our Medical Student Burnout Project.

The collective data should provide insight into the order in which problems occur. In other words, is excessive alcohol use initially low and subsequently increased in medical school? Similarly, are symptoms of burnout initially low and subsequently increase? With multiple assessments over time, we should be able to gain insight into the development of burnout symptoms and increased alcohol use.

There is also a need to look at more longer-term burnout issues related to career choice. Doubting such a significant decision as going into medicine and the challenge of defining an entirely different path would be daunting. Since burnout scales typically only assesses Personal Accomplishment, a measure of “satisfaction with medicine” may actually be a more useful measure. Example questions include:

  • I think of giving up medicine for another career
  • I doubt the satisfaction I will get from being a doctor
  • I regret my decision to have become a doctor

In our self-assessment survey, we have included career regret among other markers. We need additional research to clarify the impact of career regret on burnout.