Before the Medscape study, extensive research has been conducted on the phenomenon formally known as "physician burnout," but no National study had been conducted among U.S. physicians and then evaluated by their specialty. Additionally, Physician Burnout studies hadn't been compared to burnout rates of other professionals in other working fields. The Medscape study finds, in samples from 7,288 physician responses and 3,442 working adults from the general population, that 37.9% of physicians showcased high levels of emotional exhaustion, 29.4% detailed evidence of depersonalization and 12.4% admitted to feeling a low sense of accomplishment in their profession. When aggregated together, roughly 45.8% of these physicians admitted to experiencing at least one symptom of physician burnout, proving that physicians are more at risk than in other professions.
In the article Strategies to Prevent Physician Burnout, Kevin R. Campbell, MD, identifies burnout as "emotional, physical and mental exhaustion due to overwhelming and prolonged periods of stress." Put more caustically, Dr. Glen Gabbard describes it as "the erosion of the soul." The phenomenon is most commonly observed in middle aged physicians, but with the medical climate changing, younger MD's are more and more susceptible.
The Medscape study reports that burnout rates manifest highest among physicians who work in the "front line" of the care process. This includes specialties like family medicine, general internal medicine and emergency medicine. Physicians working in pathology, dermatology, general pediatrics and preventative medicine are shown to experience lower rates of burnout. Additionally, stress and burnout rates are observed to be slightly higher for doctors in private practice versus those working in academia, but it should be noted that the types of stressors the two doctors face are substantially different. Finally, female physicians show higher levels of burnout than their male counterparts.
Interestingly, and somewhat paradoxically, the pattern of physician stress defies that of other working individuals. Generally speaking, the unspoken norm is that the more training and specialization a job requires, and the more professional degrees pursued in obtaining the job, the less debilitating stress they incur and the less likely they are to experience burnout. However, this isn't the case with physicians. In fact, obtaining a medical degree seems to be a stress catalyst for many.
Why Do They Burn Out?
Kevin R. Campbell, MD, cites an overall "culture of selflessness" as the root cause of physician burnout. Ingredients like unconditional compassion and empathy makes a great recipe for stellar patient care, but not always for personal health. Since physicians are often trained to put their own needs aside in the pursuit of others, the unofficial medical school equation of "overwork and tireless labor = good doctor" is seared into the periphery of many ambitious caregivers.
Other medical factors, like shrinking reimbursements, a higher workload, confounding EMR's and astronomical increases in paperwork and administrative red tape contribute to the problem...and with significant health care reform on the horizon, the chasm between physicians and a sense of fulfillment could widen even more.
Essentially the burnout trajectory starts when overworked physicians start to "depersonalize." They lose a general sense of empathy and describe feelings of emotional detachment or dehydration. This has a detrimental effect on the way they deal with patients and compromises their efficiency and efficacy as caregivers. In more extreme cases, they lose a sense of self and purpose in their work, they start to feel that what they do makes no difference, and their feelings of worth diminish. Depression and bitterness creep into the practice and they become isolated and difficult to work with.
Burnout often results in careless errors and slip-ups, which in turn, add to a physician's rapidly mounting feelings of alienation and depression. It's a vicious cycle that feeds and builds on itself. Their personal lives take a hit, their relationships suffer, and their emotionally and physical stability skews out of whack.
What Can they Do?
It's certainly not all doom, gloom and grey-hued depression though. Most of burnout's remedies are rooted in simple observations and self-assessments. When it comes to fatigue, battery metaphors are often bandied about. For example, the phrase "recharging your batteries" may refer to someone who simply needs a vacation and a time to recuperate from the strenuous demands of a particular job. However, when it comes to physician burnout, the "battery" analogy doesn't hold any water. Basically, when a car's battery dies, it will not start and the machine refuses to function properly. When a physician starts experiencing burnout, he or she can actually keep going for long periods of time, running on theoretical fumes, to more extreme damage.
Dike Drummond, MD, highlights a more appropriate metaphor and encourages physicians to interpret their job as a store of three bank accounts. Physician's draw from these accounts, one storing physical energy (a physician's "get up and go"), one storing emotional energy (a physician's ability to be emotionally available to patients) and one storing spiritual energy (a physician's connection to their purpose in work) every day that they work. The balances are different for each physician, but the concept remains solid. Work can drain these accounts in various increments, and often times physicians are the last people to notice that they're quite literally running on empty.
To combat burnout, Physicians must understand their varied stores of energy and come up with a plan to restore them. Some of them are personal strategies and some are professional, but they're all research proven (In JAMA) to help physicians better cope with the demands of their job.
A simple step in physician efficiency is for physicians to be especially mindful of their own health. Making sure they get an adequate amount of sleep, nutrition and general exercise will have profound effects on their performances. Physicians can also analyze their practice situation, and can restructure things to further empower them and key them into success. For example, they can set up administrative support systems that help alleviate the burden of every day tasks that get in the way of patient contact. They can delegate paperwork and other administrative duties to free themselves up to better focus on the needs and wellbeing of their patients. Furthermore, it's not a sin for physicians to schedule time off when it's absolutely necessary and conducive to regeneration.
Maintaining emotional health is crucial for physicians striving to exhibit empathy and compassion to sick patients. For many, this involves identifying their personal and professional values, and pin-pointing what truly brings them joy. When physicians are aware of these values, they can make steps to integrate them into their daily routines. Additionally, frank discussions with spouses and colleagues about their situation can lighten the mental load. The more people "in the know" and on board to help cope and understand, the better equipped a physician will be. Lastly, physicians can identify, and spend time with, a mentor. An experienced physician in a similar field can give insights and advice in a unique way that no one else can.
If applicable, physicians schedule time for religious and spiritual activities to help them feel fulfilled and to locate their purpose. However, "spiritual pursuits" can be secular as well. Striving for calmness and wellbeing, along with paying attention to activities that give meaning outside of work all fall into the "spiritual" category. Soul searching, and asking questions like "am I happy and fulfilled?" and "Am I taking time to laugh?" are all relevant personal checkups that physicians can perform themselves.
If it is to be, it is up to Me
"Hospitals need to be proactive in mitigating the risk of burnout and adverse consequences," cites Pam Harrison in her article U.S. Physicians Suffer More Burnout Than Other Workers. Physicians must take care of themselves and address personal needs before they can address them with others. In a climate of change and uncertainty, physicians cannot always rely on their institutions to help them with personal problems, but with an eye on their own personal values and a careful analysis of their own strengths and abilities, they can combat the problem themselves.
Campbell, Kevin R. "Strategies to Prevent Physician Burnout." Kevinmd.com. Medpage Today, 11 Mar. 2012. Web. 14 Sept. 2012. http://www.kevinmd.com/blog/2012/03/strategies-prevent-physician-burnout.html.
Drummond, Dike. "Physician Burnout: Three Symptoms, Three Phases, Three Cures." Thehappymd.com. The Happy MD, n.d. Web. 14 Sept. 2012. http://www.thehappymd.com/physician-burnout-three-symptoms-three-phases-three-cures/.
Harrison, Pam. "US Physicians Suffer More Burnout Than Other Workers." Medscape.com. Medscape Medical News, 8 Aug. 2012. Web. 14 Sept. 2012. http://www.medscape.com/viewarticle/769565.
Spickard, Anderson, Jr., Steven G. Gabbe, and John F. Christensen. "Mid-Career Burnout in Generalist and Specialist Physicians." Jama.com. Journal of American Medical Association, 25 Sept. 2002. Web. 14 Sept. 2012.http://jama.jamanetwork.com/article.aspx?articleid=195312.