Physician burnout has become so prevalent, that it’s reaching pandemic type proportions. It’s estimated that at any given time, 42% of physicians are experiencing symptoms of burnout. And it affects all levels of training from medical students right up to senior level doctors. But what exactly is burnout? It is most commonly measured using the Maslach Burnout Inventory developed in the 1980s. It is usually described as having three main components: exhaustion, depersonalization and low sense of personal accomplishment. Some would describe it as a type of “moral injury”, or as Christina Maslach puts it “an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will”.
The exhaustion experienced in burnout is both physical and emotional, but high emotional exhaustion is the true predictor of burnout. You are emotionally overextended and unable to feel fully recovered between shifts. You may find yourself thinking that you don’t know how long you can continue to go on like this. It is the most common symptom of physician burnout, and something you have likely experienced at some point in your career.
Depersonalization is often referred to as “compassion fatigue” and may be experienced as a sort of detachment from one’s job responsibilities, including the patients that we see. You may find yourself needing to vent about your patients or your job more frequently than not. You develop a sense of cynicism and sarcasm, and feel put upon by your patients. It manifests as a very real lack of empathy for your patients and affects how you treat them. And it does not stop at patients – you may display similar feelings and behaviors towards coworkers and trainees.
Most physicians in medicine today have felt at some point that they are impeded from doing what is best for their patients. They find themselves having to make decisions that go against their core beliefs. This causes doctors to doubt the meaning and quality of their work and they start to see themselves as incompetent. There is lack of a sense of personal accomplishment and thoughts of “what’s the use, my work doesn’t really serve a purpose anyway”.
When these three aspects combine, many physicians will start to experience burnout. So why does this matter, why should we be concerned about burnout? For one, it is associated with higher medical error rates. It also contributes to lower quality of care and lower patient satisfaction, which in turn may lower their adherence to treatment plans. Burnout leads to lower job satisfaction, higher absenteeism, and higher physician turnover rates. And in their personal lives, doctors don’t fare much better. Physician burnout affects personal relationships and may lead to failed relationships. It can lead to alcohol and other substance abuse and is often a factor in physician suicide. Recognizing physician burnout is truly a matter of life and death.
In order to work on burnout prevention, we must first look at some of the causes of burnout. What factors about doctors and our jobs inherently contribute to burnout? Being a physician is filled with stressful clinical work – it takes a lot of physical and emotional energy to deal with hurt, sick, scared, dying people and their families. We have great responsibilities often with very little control over the outcomes. What’s more, we are taught in training to ignore our physical, emotional and spiritual needs to unhealthy levels. Lack of work-life balance means that we are usually spending too many hours at work and lack the opportunity to recharge at home.
Of course, each specific job has unique stressors that could include call rotation, personality clashes, the ways we are (or are not) compensated for our time, and local health care politics. The leadership skills of your supervisor can play a big role, especially when there is a lack of respect for what you do on their part. The administrative burden has become overwhelming with EHRs, charting and paperwork that are inherent in the way medicine is practiced today. This is combined with insufficient or decreasing reimbursements for what usually works out to be more time spent on our part.
As physicians, we are often plagued by perfectionism, feeling that we must have all of the answers all of the time. We must do everything ourselves if we want to know that it’s been done right. This combines with an increasing lack of control and lack of autonomy on a day to day basis. We have been inundated with payer imposed requirements such as prior authorizations and workplace metrics from so called “medical reform”. We have less control over how our time is spent and are often forced to spend less time with patients than we want.
It is estimated that physician burnout costs the medical system billions of dollars every year, so there should be good incentive for organizations to try and prevent or combat burnout at all levels. However, many efforts are focused on the individual with interventions such as stress management techniques, mindfulness and physician “wellness” programs. Research has shown that interventions directed at the operation of healthcare organizations have much more significant effects in reducing physician burnout. This might include changes in the work schedule and environment, decreasing individual workload by improving teamwork and allowing physician participation in decision-making.
More research and interventions are definitely needed to help treat and prevent physician burnout. This starts with talking about it more and acknowledging what a problem it is has become. I’ve seen several studies where the majority of doctors would not recommend going into medicine to their own children. And even more studies projecting severe doctor shortages in the coming years. Burnout has a profound effect on the medical system and the individual lives of doctors. As put by one physician experiencing burnout, “I’m afraid if something doesn’t change, I am going to make a mistake and someone is going to get hurt”. We can’t afford to deny the epidemic of physician burnout any longer.
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