I am often asked by medical students trying to choose a residency, “Do you still get excited by what you do? Do you still love your job? Are you bored?” These are obviously complex questions to answer. I think the underlying reason students ask these questions is that the idea of burnout or “becoming jaded” has been shown to them through multiple attending (and resident) physician examples.
The medical student asking these questions is making sure they will still like their specialty twenty years from now. They are afraid of burning out.
I used to think this topic (and many other similar subjects) were “mushy” topics that people only discussed if they had problems. I then started to realize that all of us have problems or know someone that does. We can continue to ignore these topics and pretend they aren’t a problem, or we can step up and combat the issue head on. Before we do that, though, we have to define the enemy. What exactly is burnout?
Burnout was introduced in the 1970s by Herbert Freudenberg. It can be described as a downward spiral that begins with poor work-life balance, multiple stressors, and deteriorating mental status. The Maslach Burnout Inventory (MBI)-Human Services Survey, which is the most commonly used tool to detect burnout consists of three main components:
- Emotional Exhaustion = measures feelings of being emotionally overextended and exhausted by one’s work
- Depersonalization = measures an unfeeling and impersonal response toward recipients of one’s service, care treatment, or instruction
- Personal accomplishment = measures feelings of competence and successful achievement in one’s work.
From this, you could infer that the symptoms of burnout could be seen as the following: feeling emotionally detached, overextended at work, or find that work is exhausting (and not rejuvenating), treating other people as objects/things rather than people, losing compassion or empathy for patients, feeling incompetent at work, unsuccessful, or failing to achieve.
What’s the big deal?
As the medical students allude to above, it is important to determine if you will still enjoy your chosen profession in the future. However, there are other reasons that recognizing and treating burnout are important!
Some estimates show that 27-75% of residents experience burnout.
Burnout has an effect on a lot of us! In fact, almost 70% of surgical residents in one study were determined to suffer from burnout. Even scarrier, 11% of that same cohort experienced suicidal ideation. If these numbers are not concerning to you, maybe that is because you are at risk for burnout yourself.
Cost is another reason: In a recent study out of Stanford, researchers determined that the cost of physician turnover (which is often attributed to burnout) can cost anywhere between $250,000-$1,000,000 depending on the specialty, expertise, and experience of the physician. Let that sink in for a moment. That is a lot of money.
It also directly affects patient care. It is a simple premise, but if your cup is not full you simply cannot fill up the cups of the other people you interact with, including your patients. Utilizing the same MBI survey mentioned above to detect burnout, one systematic review found that with increasing rates of burnout, patient errors increased and patient safety declined. The authors also aptly pointed out that medical errors made by burnt out resident physicians could also lead to more burnout (it worsens your personal view of achievements).
What can be done?
So, the problem is common and vast. How exactly do we deal with combatting burnout? As with most problems there are systemic/systematic solutions and individualized solutions. Let’s take a look at both.
If you are a young (or old) attending reading this, it is our responsibility to make wellness a priority in our training programs. We must make it part of the every day interaction we have with residents and medical students. From the study above looking at the degree of burnout in surgical residents, the following is said:
“If higher stress is associated with increased risk of burnout in surgical trainees, and burnout is associated with diminished mental health and performance, then addressing stress and burnout among our trainees should be a priority.”
Solutions may consist of the following:
- Annual wellness/burnout assessments, including the MBI survey or some other validated measurement tool.
- Consider the merits of mindfulness training to help promote resilience.
- Empowering residents to combat burnout and to discuss tough topics.
- Encouraging students, residents, and faculty to have conversations revolving around wellness, burnout, and mental health issues.
- Form a wellness committee that is focused on diagnosing and solving burnout.
While we certainly need to place system’s based wellness initiatives into practice, there is some onus on the individual to help promote wellness and prevent burnout in their own life. How can we accomplish this?
- Involve your loved ones (spouse, significant other, children, family, and friends).
- Let people know when you are struggling so that they can help. This is a community effort!
- Exercise has been linked to decreased amounts of depression and improvement in stress. I’ve put enough links in this post. (It is well documented, though, I promise!).
- Deal with other causes of stress (Financial counseling, preventative health visits, etc.).
- You can also use well established programs to help combat this issue such as the STEPSforward program offered by the AMA.
What do you think? Are you burned out (burnt out?)? Does your practice or hospital have successful wellness initiatives? How do you combat burn out in your personal life?