To the Editor:

Nationally, the emotional culture of academic medicine has been placed under the microscope, and resident burnout rightly receives much of the attention. However, two tropes currently dominate the conversation: Either burnout is a function of long hours in the hospital, or it is a function of emotional fatigue resulting from bad outcomes, increasingly complex patient panels, and a rising tide of paperwork.

Where, then, does this leave the “non-patient-facing” specialties, specifically pathology? In a recent survey of practicing physicians, fully 52% of pathologists reported symptoms of burnout.1 But pathologists do not pull 30-hour shifts in the intensive care unit or take care of nonadherent patients, and they are not subject to the mercy of patient satisfaction surveys. So, what do they have to complain about?

An absence of meaningful work can drive burnout. The concept of meaningful work has three parts: the work allows (1) a sense of mastery, (2) autonomy, and (3) tangible results. Pathologists pride themselves on their medical knowledge and enjoy the open-and-shut nature of pinning down a diagnosis. However, many complain of a significant lack of autonomy and respect. As a purely diagnostic specialty, pathologists depend on clinical colleagues for access to their patients. In an unhealthy environment, this can result in feelings of subservience and dependence on clinicians who see pathologists less as consulting colleagues and more as service providers. Residents naturally chafe under this erosion of respect.

A second driver of burnout is the isolation in which pathology residents practice. Unlike clinical residents who work on teams, pathology residents typically rotate solo on a service. They are responsible for all of that service’s cases and have no oversight, no mentoring senior, and a lengthy daily “performance” spent one-on-one with their attending. In addition, pathology residents suffer from the same burdens as others, struggling with the balance of service versus education, the stress of constant evaluation, and anxiety over fellowship and job selection.

Each specialty has unique challenges and unique root causes of burnout. The specifics are less important than the fact that all residents feel empowered to speak up and seek help. Framing the burnout conversation around common tropes like long hours or frontline fatigue seems inclusive, but it can inadvertently silence certain specialties by making them feel they have no “right” to be demoralized, and thus delay appropriate recognition and intervention.

In a culture under the microscope, let’s make sure those who wield the microscope are a part of the picture, too.

Jennifer Kasten, MD, MSc, MSc

Resident physician, Anatomic Pathology, University of Texas Southwestern Medical Center, Dallas, Texas; Jennifer.kasten@phhs.org.