The Challenge of the Iron Doc Model and Why it Needs to Change

Posted on August 27, 2018 by Liz Ferron, MSW, LICSW

Updated June 18, 2020

The Challenge of the Iron Doc Model and Why it Needs to ChangeIn a paper published on the New England Journal of Medicine Catalyst site in 2017, Brian Bohman, MD, and nine colleagues from six institutions, including the Stanford University School of Medicine, the Mayo Clinic and the AMA, call on clinical leaders to: “Lead a paradigm shift in rejecting the historic 'iron doc' culture by encouraging physicians to extend to themselves and their colleagues the same natural compassion that they show to their patients.”

The iron doc paradigm the authors refer to is the tradition, carried through in both training and practice, of making physicians prove themselves worthy of their white coats by undergoing physical, mental and emotional ordeals. Long work shifts without sleep, meals or bathroom breaks; heavy patient loads; on-call availability day and night are just some examples of demands seemingly designed to take a heavy toll.

While there’s no doubt physicians need to develop strength of will and learn to function under challenging circumstances, we need to be realistic in expectations. It is becoming increasingly apparent how this traditional attitude, enforced by institutions and internalized by many physicians, is contributing to the epidemic of burnout among U.S. physicians, an epidemic estimated by Medscape to affect about half of all physicians.

Dr. Bohman and colleagues emphasize developing a “culture of wellness” for all physicians in healthcare organizations is key to reducing burnout and challenging the iron doc mindset is crucial to building a healthy culture. The challenge involves, in their words, “abandoning the antiquated and dangerous misconception that self-care and patient care are competing interests.” Organizations need to partner with physicians to reduce excessive demands, while the physicians themselves should take responsibility for giving their inner iron doc a break by learning to set reasonable boundaries and developing self-care techniques.

To learn more about practical ideas for physician self-care, read our blog post Tips and Advice for How to Practice Self Care.

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