Grit, Physician Success, and Burnout

“Grit” is a topic that keeps coming up in client discussions.  It was the subject of a recent piece in the Journal of Bone and Joint Surgery:  True Grit in Leadership: 2018 AOA Critical Issues Symposium Addressing Grit, Sex Inequality, and Underrepresented Minorities in Orthopaedics.  J Bone Joint Surg Am. 2019 May 15;101(10):e45. doi: 10.2106/JBJS.18.01276.  From the abstract:

“ . . .encouraging a growth mindset, and enhancing grit may be as important as preparation for board examinations. Although talent and skill play a role in achievement, the effort put forth in developing a skill can dramatically affect the ultimate achievement.”

What Is It?

Grit is a popular topic.  It’s intriguing.  It seems straight-forward.  It makes sense to people.  But what is it?  Can we measure it?  Can we develop it?  What role does it play in physician success and burnout?

The 2016 book by Angela Duckworth – Grit, The Power of Passion and Perseverance, is making the rounds, as are her TED talks on the topic. Grit, as she describes it, fits with our model of what it takes to be successful.

Duckworth focused her Ph.D. research in psychology on the relationship between grit and high achievement. She studied West Point cadets, teachers, salespeople, and spelling bee contestants. She determined that, more so than intellect or talent, success is often due to a combination of perseverance and passion for long-term goals. It’s more than just work ethic. It’s a combination of:

  • Resilience;
  • A willingness to engage in deliberate practice;
  • Passion and sense of purpose; and
  • Self-control – Essentially managing the conflict between doing what you’d really like to do and what you know you need to do.

In her experience, these traits are the hallmark of high achievers.

Can We Measure It?

Grit is a broad “meta-construct”, so to speak. It’s like emotional intelligence in this regard. It’s a collection of distinct personality traits that, when examined together, make up a broad impression of a person’s behavioral traits and tendencies, in life, or more specifically, as applied to a job or task.

According to Duckworth, for instance, people with grit have a mix of valuable traits. They are hard workers with high levels of stress tolerance and perseverance. They also have a level of courage and tenacity, and naturally take initiative. Duckworth adds that they have a passion and sense of purpose, and a high level of self-discipline about achieving the goal. Wow – that’s a great mix of character traits and not an uncommon mix in driven medical students and successful, dedicated physicians.

Duckworth developed a short Grit Scale test which you can take on her website.

Can You Test or Interview for Grit?

Our team of psychologists tells us that we can, certainly, measure the personality traits that help make-up grit. We can measure inherent traits that contribute to leadership courage, initiative, drive to succeed, stress tolerance, self- discipline, and organization and planning.

What may be harder to measure is passion or sense of purpose, because this applies to a specific cause. It probably is, indeed, highly predictive of success and high achievement in many instances, but it’s not a personality trait, per se.

If you challenge me to master poker, I might be diligent and make use of natural self-discipline to work hard at it in a structured, deliberate manner, but the passion would be lacking because I despise both card games and gambling. If you task me with mastering golf, though, or becoming an expert in the details of Game of Thrones – well, you are going to see a high level of passion and sense of purpose!

Some authors will encourage you to interview for grit. They suggest questions such as:

  • How have you turned a dream into a reality? 
  • How have you dealt with failure and bounced back from it?
  • Describe a project that you had to work on for an extended period of time and how you stayed engaged. 

I like these questions. They are focused on past behaviors, and force the candidate to give specific examples. “How have you turned a dream into a reality?” might be a bit ambitious for most front-line or even manager-level positions. If you were choosing a unique individual to help you with a start-up – then the question is more relevant.

It may also have a role in interviewing physicians or other healthcare professionals but you might find that many respond that getting through school and practicing their profession is that dream – so the question wouldn’t add much useful information as far as differentiating candidates. You could, however, develop a line of inquiry that examines a physician’s passion for patient-centered care, or doing what’s right for patients, even in challenging situations. 

When is Grit Relevant?  A Role in Burnout?

Have you ever watched stories about how contestants prepare for the National Spelling Bee? THAT is passion and purpose. The same with West Point cadets and many medical students.   It’s not surprising that the mix of attributes we are discussing here are predictive of success in these arenas.

You could argue that today’s healthcare system makes grit all the more important for physicians – Not just to be successful in the face of compounding health system challenges, but also to guard against the epidemic of burnout.

There is, indeed, a terrible flaw in our health system (among many)  – placing too many demands on physicians and not valuing them enough to protect them and make them successful.  But – each situation is unique.  Some physicians can handle a particular situation without approaching a state of burnout.  Another in the same situation may suffer terribly. 

Personal characteristics play a role.  Higher levels of emotional intelligence, adaptability, planning and organizing skills and yes, grit, may make the first physician better equipped to cope with the stresses of the job – while the second struggles mightily.  Similarly, individuals can tolerate much more if there is still an underlying passion for the task.  If that passion is lacking, tolerance is lower.  Of course, LOSING that passion is a hallmark of burnout!

This is why burnout should be addressed at two important levels:

  • Address the operational/structural and resource challenges that are placing unreasonable demands on physicians; and
  • Examine each physician’s unique situation and find solutions that are tailored to that situation and his or her challenges.  Not everyone will benefit from mindfulness training – particularly if that doesn’t fix the core operational problems or that a physician struggles with lack of planning and organizing skills or knowledge of the best way to navigate his or her organizations.  The latter two can be improved and make life better for the physician.

Grit is an interesting and intriguing topic.  It’s application to physicians is, for all these reasons, unique.  Should we measure it when hiring physicians?  Can we develop it in physicians?  Like any popular topic, the danger is that people become enamored with a catchy concept without fully understanding it. This is one where the conversation should continue but trying to shoe-horn the concept of grit into physician hiring and development is probably a bit premature.

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