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BLOG: Don’t get burned: Physician burnout and what you can do

The bottom line
Physician burnout continues to garner headlines in medical literature so much so that the WHO recently added it to their international diseases handbook as an occupational hazard. The earlier that this entity is recognized by oneself and in peers, the quicker we can implement wellness programs in our workplace to help combat it. Burnout cannot be solved individually; it requires an all-hands-on-deck team effort.

What is burnout?

Let’s be clear, there’s no true accepted definition of burnout. That being said, recognition of the symptoms that comprise burnout can help identify it. The symptoms related to the workplace specifically include: feeling exhausted; feeling mentally distanced from or cynical about one’s job; and problems getting one’s job done successfully (reduction in performance). While there are questionnaires developed to help identify it, it is unclear how to best implement these tools (diagnosis vs monitoring progression).

How common is burnout?

While burnout may appear to be a relatively new phenomenon in medical news, it has been around for multiple decades, dating back to the 1970s. At that time, it was a generalized term describing cases of physical and mental “collapse” due to overwork, high ideals and stress specifically in those in helping professions.

Results from a 2019 survey conducted by Medscape showed that 44% of physicians reported feeling “burned out” and 4% had clinical depression. When looking at specialties in particular, those with the highest rates were critical care, neurology, family medicine and ob-gyn.

How is burnout different than exhaustion, depression?

Identifying comorbid conditions such as depression and anxiety disorder, which can create similar symptoms as those described above, is pivotal in developing a treatment plan. While a trained mental health provider may be best suited for the diagnosis of DSM-IV related conditions, distinguishing them from burnout should come back to whether the developed symptoms are work-related in nature (consistent with burnout) or generalized to multiple areas in life (depression).

Don’t think of exhaustion itself as the same as burnout but instead one element of a constellation of symptoms that comprise the condition of burnout. It is easiest to think of burnout starting with exhaustion, then progressing to withdrawal from work-related activities, then cynicism, and finally a reduction in work performance.

What can clinicians do to overcome burnout?

At its core, burnout is centered around our health care occupation. Some of us feel tied to the hospital, while others are in a clinical, or a combination of both. It is important to have a life outside of medicine. This may involve taking up a new hobby (such as birding), focusing or finding a new religion (such as Buddhism), or falling back in love with a previous hobby.

It is important that hospitals and clinics develop programs to not only identify burnout, but also to help prevent it and implement treatment measures for it. By doing this, they are showing their staff that they acknowledge its importance, and care about the health of their staff. Furthermore, by doing this, they are ensuring that patient care is not compromised. Wellness programs have already been implemented at Ohio State University and Hennepin County Medical Center to name a few. Caregiver support teams have also been piloted to provide care to clinicians in hopes to curb the disturbing rise in physician suicide. If you are interested in starting pilot wellness programs or caregiver support teams, the articles listed below by Berger and Shanafelt are a great place to start.

For those of us who are academic staff, we must not only look after the medical education of our residents and medical students, but their mental well-being as well. By implementing programs in the academic environment such as retreats and wellness programs, we can create and strengthen resident’s resilience as they advance in their medical career.

Jacob Mathew, Jr., DO, FACOI, FACP, FAWM, CHSE, is a former major in the US Army, and is currently a practicing academic internist at Parkview Medical Center in Pueblo, Colorado. He is also the author of Internal Medicine: Intern Survival Guide.

References:

Berger L, Waidyaratne-Wijeratne N. Can Med Educ J. 2019 Mar; 10(1): e20–e27.

ClinicalKey for Nursing. Burnout still a major issue among physicians.

https://www-clinicalkey-com.stimson.idm.oclc.org/nursing/#!/content/playContent/1-s2.0-S1550830719302320?returnurl=null&referrer=null. Accessed May 29, 2019.

Cornelius A, et al. Cureus. 2017;doi:10.7759/cureus.1524.

Eckleberry-Hunt J, Lick D. Teach Learn Med. 2015;doi:10.1080/10401334.2015.1044751.

Eckleberry-Hunt J. South Med J. 2017;doi:10.14423/SMJ.0000000000000629.

Graham P, et al. Testing of a caregiver support team. Explore (NY). 2019 Feb;15(1):19–26.

Hart D, et al. West J Emerg Med. 2019;doi:10.5811/westjem.2018.10.39677.

Institute for Quality and Efficiency in Health Care. Information NC for B, Pike. Depression: What is burnout? Accessed May 29, 2019.

Kaira S, et al. Indian J Endocrinol Metab. 2018; 22(6) 812-817.

Low ZX, et al. Int. J. Environ. Res. Public Health 2019;doi:10.3390/ijerph16091479.

Mannocci A, et al. G Ital Med Lav Ergon. 2019 Mar;41(1):45-51.

Moffatt-Bruce SD, et al. Clin Obstet Gynecol. 2019;doi:10.1097/GRF.0000000000000458.

Shanafelt TD, Noseworthy JH. Mayo Clin Proc. 2017;doi:10.1016/j.mayocp.2016.10.004.

WHO. World Health Organization classifies work “burnout” as an occupational phenomenon. https://www.cbsnews.com/news/world-health-organization-classifies-work-burnout-an-occupational-phenomenon-2019-05-28/. Accessed May 29, 2019.

Zabar S, et al. J Gen Intern Med. 2019;doi:10.1007/s11606-019-04886-y.

Disclosures: Matthew reports no relevant financial disclosures.

The bottom line
Physician burnout continues to garner headlines in medical literature so much so that the WHO recently added it to their international diseases handbook as an occupational hazard. The earlier that this entity is recognized by oneself and in peers, the quicker we can implement wellness programs in our workplace to help combat it. Burnout cannot be solved individually; it requires an all-hands-on-deck team effort.

What is burnout?

Let’s be clear, there’s no true accepted definition of burnout. That being said, recognition of the symptoms that comprise burnout can help identify it. The symptoms related to the workplace specifically include: feeling exhausted; feeling mentally distanced from or cynical about one’s job; and problems getting one’s job done successfully (reduction in performance). While there are questionnaires developed to help identify it, it is unclear how to best implement these tools (diagnosis vs monitoring progression).

How common is burnout?

While burnout may appear to be a relatively new phenomenon in medical news, it has been around for multiple decades, dating back to the 1970s. At that time, it was a generalized term describing cases of physical and mental “collapse” due to overwork, high ideals and stress specifically in those in helping professions.

Results from a 2019 survey conducted by Medscape showed that 44% of physicians reported feeling “burned out” and 4% had clinical depression. When looking at specialties in particular, those with the highest rates were critical care, neurology, family medicine and ob-gyn.

How is burnout different than exhaustion, depression?

Identifying comorbid conditions such as depression and anxiety disorder, which can create similar symptoms as those described above, is pivotal in developing a treatment plan. While a trained mental health provider may be best suited for the diagnosis of DSM-IV related conditions, distinguishing them from burnout should come back to whether the developed symptoms are work-related in nature (consistent with burnout) or generalized to multiple areas in life (depression).

Don’t think of exhaustion itself as the same as burnout but instead one element of a constellation of symptoms that comprise the condition of burnout. It is easiest to think of burnout starting with exhaustion, then progressing to withdrawal from work-related activities, then cynicism, and finally a reduction in work performance.

What can clinicians do to overcome burnout?

At its core, burnout is centered around our health care occupation. Some of us feel tied to the hospital, while others are in a clinical, or a combination of both. It is important to have a life outside of medicine. This may involve taking up a new hobby (such as birding), focusing or finding a new religion (such as Buddhism), or falling back in love with a previous hobby.

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It is important that hospitals and clinics develop programs to not only identify burnout, but also to help prevent it and implement treatment measures for it. By doing this, they are showing their staff that they acknowledge its importance, and care about the health of their staff. Furthermore, by doing this, they are ensuring that patient care is not compromised. Wellness programs have already been implemented at Ohio State University and Hennepin County Medical Center to name a few. Caregiver support teams have also been piloted to provide care to clinicians in hopes to curb the disturbing rise in physician suicide. If you are interested in starting pilot wellness programs or caregiver support teams, the articles listed below by Berger and Shanafelt are a great place to start.

For those of us who are academic staff, we must not only look after the medical education of our residents and medical students, but their mental well-being as well. By implementing programs in the academic environment such as retreats and wellness programs, we can create and strengthen resident’s resilience as they advance in their medical career.

Jacob Mathew, Jr., DO, FACOI, FACP, FAWM, CHSE, is a former major in the US Army, and is currently a practicing academic internist at Parkview Medical Center in Pueblo, Colorado. He is also the author of Internal Medicine: Intern Survival Guide.

References:

Berger L, Waidyaratne-Wijeratne N. Can Med Educ J. 2019 Mar; 10(1): e20–e27.

ClinicalKey for Nursing. Burnout still a major issue among physicians.

https://www-clinicalkey-com.stimson.idm.oclc.org/nursing/#!/content/playContent/1-s2.0-S1550830719302320?returnurl=null&referrer=null. Accessed May 29, 2019.

Cornelius A, et al. Cureus. 2017;doi:10.7759/cureus.1524.

Eckleberry-Hunt J, Lick D. Teach Learn Med. 2015;doi:10.1080/10401334.2015.1044751.

Eckleberry-Hunt J. South Med J. 2017;doi:10.14423/SMJ.0000000000000629.

Graham P, et al. Testing of a caregiver support team. Explore (NY). 2019 Feb;15(1):19–26.

Hart D, et al. West J Emerg Med. 2019;doi:10.5811/westjem.2018.10.39677.

Institute for Quality and Efficiency in Health Care. Information NC for B, Pike. Depression: What is burnout? Accessed May 29, 2019.

Kaira S, et al. Indian J Endocrinol Metab. 2018; 22(6) 812-817.

Low ZX, et al. Int. J. Environ. Res. Public Health 2019;doi:10.3390/ijerph16091479.

Mannocci A, et al. G Ital Med Lav Ergon. 2019 Mar;41(1):45-51.

Moffatt-Bruce SD, et al. Clin Obstet Gynecol. 2019;doi:10.1097/GRF.0000000000000458.

Shanafelt TD, Noseworthy JH. Mayo Clin Proc. 2017;doi:10.1016/j.mayocp.2016.10.004.

WHO. World Health Organization classifies work “burnout” as an occupational phenomenon. https://www.cbsnews.com/news/world-health-organization-classifies-work-burnout-an-occupational-phenomenon-2019-05-28/. Accessed May 29, 2019.

Zabar S, et al. J Gen Intern Med. 2019;doi:10.1007/s11606-019-04886-y.

Disclosures: Matthew reports no relevant financial disclosures.

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