Physician burnout: Focus on the environment, not the individual
SAN FRANCISCO — Burnout should be viewed as a red flag that prompts change at the environmental and systemic levels, although it is often mistakenly labeled as a problem among individuals, according to a presenter here.
Christina Maslach, PhD, professor of psychology at University of California at Berkeley, and author of the Maslach Burnout Inventory, provided an overview of what burnout is (and is not) and offered recommendations for creating a new, healthy workplace.
“Burnout has always been defined as a prolonged response to chronic situational stressors on the job,” she said. “Let me say that it’s really more about an experience; it’s a job stress kind of experience, and I want to emphasize the word ‘chronic’ because we find that some of the most important stressors that are causal factors here are the everyday things that begin to erode and wear you down. It’s not necessarily a particular crisis or emergency, it’s the stuff that is happening all around you.”
Burnout is a pattern of three dimensions: exhaustion, cynicism (negative reaction to the job) and professional inefficiency (negative evaluation of self), Maslach explained.
Research in health care professionals has demonstrated that burnout is associated with outcomes that effect not only physician behaviors, but also judgments by colleagues and patients, including:
- poor quality of patient care;
- more medical errors;
- dysfunctional relationships with colleagues;
- greater risk for substance abuse;
- greater risk for depression and suicidal ideation; and
- a stronger intention to leave the medical profession.
According to Maslach, a survey of medical professionals revealed that only one in 10 of them would recommend their profession to their children.
“Burnout is often mistakenly labeled as a problem of individuals, leaving the underlying systemic and cultural problems unaddressed,” she said. But burnout involves both the person and the situation.
To help rethink the problem, Maslach defined what burnout is not:
- only one of the three dimensions mentioned above;
- a psychological disease or clinical deficit (but it can be a step in the path toward depression or anxiety);
- diagnosed by a cut-off score (like a number on a thermometer); or
- a synonym for all kinds of other problems (like boredom, lack of creativity, laziness or workaholism).
“Burnout should be viewed as a red flag, a warning signal,” she said.
To rethink solutions, Maslach recommended a new model for a healthy workplace, which would involve:
- creating a sustainable workload (not asking employees to do more with less);
- looking at how to build appropriate choice and control;
- recognizing and rewarding by providing positive feedback;
- creating a supportive work community (ie, figure out how to work out problems, trust each other, implement mentoring);
- creating fairness, respect and social justice; and
- defining clear values and meaningful work.
“If we look at those six areas and use them as guidelines, we can begin to develop better solutions for burnout,” she said. – by Stacey L. Adams
Maslach C. Burnout and depression: Different challenges to physician health. Presented at: APA Annual Meeting; May 18-23, 2019; San Francisco.
Disclosures: Maslach reports receiving royalties from the Maslach Burnout Inventory.