Are you burnt out? This seemingly casual question may not be as easy to answer as you might think. Being burnt out can easily be mistaken for feeling tired, stressed, or depressed. But according to a growing body of research on physicians, recognizing and addressing this work-related syndrome may help protect your well-being, along with that of your patients and colleagues.
What is burnout?
“Burnout” likely originated as a slang term to describe substance abusers, and it generally connotes ideas of being demoralized, used up, or spent. In the 1970s, mental health researchers applied this term to the “compassion fatigue” they were studying among human service professionals. Defined as a “prolonged response to chronic emotional and interpersonal job stressors,” burnout is measured in 3 domains: 1) Emotional exhaustion, or the sense of having nothing left to give; 2) Depersonalization, or a sense of detachment from others; and 3) A lost sense of personal effectiveness and accomplishment (Maslach C et al, Annu Rev of Psychol 2001;(52):397–422).
Vignette: Burnout or depression?
A 55-year-old psychiatrist had worked for 25 years in private practice, doing primarily medication management along with some psychotherapy. Over a period of several years, he had become increasingly frustrated with both the administrative and clinical burdens of the job, including the preauthorization paperwork required by insurance companies, patient requests for letters, calls from patients’ families, and difficulties with a cumbersome electronic medical record system. He found that he was exhausted, especially when he thought about going to the office—which gave him a feeling of dread. When he greeted his patients in the waiting room, he did so without any spark or interest, and he felt that most visits had become rote exercises in asking questions and writing prescriptions.
The psychiatrist increasingly doubted that he was really helping patients and wondered if there was anything meaningful to what he was doing. He thought more and more about quitting. When he shared these feelings with his wife, she encouraged him to see a clinician to check for signs of depression— but he rarely felt demoralized during the weekends or during his day off during the week.
On the advice of a colleague, he took 3 weeks of vacation from his practice, and decided to make a number of adjustments to his schedule and his procedures. He stopped using the electronic medical record system for anything other than transmitting prescriptions, and he scheduled more appointments for 30 minutes or longer, as opposed to the 15- to 20-minute visits that had become the norm. He also joined a monthly journal club of local psychiatrists. Within a few weeks, he found that he was again looking forward to work and enjoying his contact with patients.
Symptoms and effects of burnout
As the vignette illustrates, burnout can be mistaken for depression. Although doctors who report burnout do not have higher rates of mental illness than unaffected doctors, burnout has been associated with suicidal ideation in medical students. More ominously, U.S. physician suicide rates are approximately 4 times higher than the general population, and the highest among any profession. Several physician risk factors are identical to those in the general population: Caucasian race; higher age; being unmarried, divorced, or separated; and having medical or mental health problems. However, physician suicides appear unique in that they are more common following job problems than relationship problems, they also sometimes occur after lawsuits or the perception of having made an error (Gold KJ et al, Gen Hosp Psychiatry 2013;35(1):45– 49). In many published vignettes, suicide victims appear to have endured their professional pain in profound emotional isolation and without interruption to their professional responsibilities, such that most others did not notice that anything was wrong. Physician burnout affects patients as well. It is associated with increased medical errors, decreased professionalism, decreased patient satisfaction and treatment adherence, and less communication with collateral providers (Shanafelt et al, JAMA 2009;302(12):1338–1340). Burnout also may cause physicians to leave clinical practice, or to avoid disadvantaged patient groups, as indicated by a recent study of psychiatry residents whose responses to an emergency room rotation made them less likely to consider future jobs involving the Medicaid population (Dennis NM and Swartz MS, Psychiatr Serv 2015;66(8):892–895).