Female doctors show more empathy than male doctors. They ask their patients more questions, including questions about emotions and feelings, and they spend more time talking to patients than their male colleagues do. Some have suggested that this might make women better doctors. It may also take a terrible toll on their mental health.
Studies indicate that female doctors are at greater risk of burnout than male doctors, and that this might be linked to differences to do with empathy. Burnout is bad for doctors and their patients. People with burnout feel exhausted, emotionally depleted, cynical and detached. They are also less satisfied with their work.
Doctors who develop burnout make more errors, are less likely to answer patients’ questions or fully discuss their treatment options. Interestingly, as people develop burnout, they show reduced empathy for others (so-called compassion fatigue). Compassion fatigue has been called the cost of caring because it is more commonly seen in health professionals such as nurses, psychotherapists and doctors.
One theory about why compassion fatigue sets in is that high empathy causes greater levels of emotional arousal and distress, so the reduction of empathy is simply a survival mechanism to cope with experiencing long periods or extreme emotional stress. This theory has been used to explain why medical students and doctors report lower levels of empathy as they progress through medical school and their post-graduate medical training. It might also explain why doctors’ brains show a reduced response to witnessing people experience pain, compared with people who aren’t doctors.
Men and women burn out differently
As well as the differences in risk of burnout, the way female doctors burn out appears to be different to the ways male doctors burn out. Identifying and understanding these differences might be important for recognising when doctors are developing burnout and getting help and support for them in time.
A four-year study of Dutch GPs found that, for female doctors, burnout begins with emotional exhaustion (feeling emotionally depleted), and then progresses to feeling increased depersonalisation (feeling detached or cynical about people and work). Finally, they tend to feel less work-related personal accomplishment and have reduced self-belief in their competence at work. This last component of burnout, reduced personal accomplishment, involves evaluating one’s work negatively and is likely to compound the problem as it increases stress and emotional exhaustion.
Conversely, male GPs report depersonalisation first rather than emotional exhaustion. Also, males did not report a reduced sense of personal accomplishment at work, even though this is one of the three traditional components of burnout. This means that, as they burn out, male doctors feel growing depersonalisation and emotional exhaustion but they often still feel effective, capable and competent at work – which is typically not the case for female doctors.
High suicide rates
In 2005, Eva Schernhammer of Harvard Medical School argued that there are stark differences in the psychological demands on female doctors, compared with males. Her review of 25 studies found that the female doctor suicide rate was about 130% higher than women in the general population.
In contrast, the suicide rate among male doctors is 40% higher than the suicide rate of males in the general population. Schernhammer concluded that the stress and burnout experienced by female doctors combines with other risk factors to contribute to high rates of psychiatric illness and suicide, compared with male doctors.