by Dr. Shama Nosheen and Dr. Christopher Cirino
Doctors are often considered lifesavers. However, the greatest life that they can preserve may be their own. Optimal patient care relies on measures that protect physicians from burnout and workplace fatigue. Doctors run the risk of errors in medical decision-making and prescribing.
Burnout among health professionals is alarmingly high in the United States. The National Academy of Medicine reports that nearly half of doctors and nurses experience symptoms of burnout. As a result, it comprises patients’ treatment by increasing health professionals’ absenteeism, turnover, malpractices, and other health risks. Therefore it is essential to take necessary measures to prevent burnout among health professionals.
What is Burnout?
Burnout is a physical state where a person is physically and mentally exhausted. It takes the joy out of a career, family relations, and friendship. Mostly burnout is related to a stressful work environment resulting from chronic exposure to difficult situations. Stress occurs typically due to continuous exposure to situations like working long hours, taking care of ill family members, listening to upsetting news, and other conditions.
The Term ” Burnout” was first introduced in the 1970s by Herbert Freudenberger. Herbert describes burnout as a severe condition that leads to mental, emotional, and physical exhaustion. During burnout, a person adopts a pessimistic approach towards life, leading to stress. And prolonged stress can eventually lead to other diseases like heart disease, diabetes, and mental health conditions.
What are the Components of Burnout?
Burnout is not always easy to track, but tracking it offers the benefit of addressing the potential causes earlier. There is a stigma to burnout which often silences those enduring it. A doctor may experience the initial stages, and conceal it from others. Employers may use anonymous surveys such as the Maslach burnout inventory to identify its prevalence in staff.
It is essential to look at crucial components of burnout to identify it in the first place. Burnout has the following three features:
Emotional exhaustion connotes feeling tired all the time. A provider may have trouble getting prepared after a week of several busy days, but with burnout, even a regular schedule seems burdensome. And with emotional exhaustion, the motivation to work does not always return after a vacation.
Cynicism creates detachment between a provider and his/her colleagues or a hospital’s mission. It is a negative outlook that can sow discord, fracture the cohesiveness of a care team, and sabotage the quality of patient care. Empathy cannot exist alongside cynicism.
Decreased Personal Efficacy
One significant component of burnout is the loss of personal efficacy. When a doctor experiences burnout, there is a collapse of confidence. One’s relationship with handling work duties becomes increasingly difficult to accomplish. Consequently, there is lower productivity and quality care in one’s professional life. Ultimately, it bleeds into one’s personal life and relationships.
What are the ramifications of doctor burnout?
Burnout and depression are highly prevalent among doctors, residents, and medical students. Studies support that burnout rates are around 50% and higher across the board. We must be concerned about the following short-term or long-term effects of burnout:
1-Compromised quality and safety:
Cross-sectional studies of burnout among US doctors indicate significant effects on quality and practice. Burnout is an independent culprit for malpractices and medical errors, making a bidirectional relationship. Self-perceived errors in medical practices are outcomes of worsening burnout, depression, and depersonalization. Moreover, emotional exhaustion among doctors has also affected the patient mortality ratio, especially in intensive care units.
2-Decreased patient satisfaction:
Depersonalization among US physicians significantly correlates with patient satisfaction with the health care system. A meta-analysis of burnout among doctors indicates two-fold increased odds for low patient-reported satisfaction. Depersonalization increases 4.5 fold increased risk of patient dissatisfaction. At the same time, mild personal exhaustion has no significant effects.
3-Effects on doctor turnover and work effort:
Burnout is closely linked with job dissatisfaction and intent to leave current medical practice for reasons other than getting retired. When these intentions translate into actions, it reduces professional turnover and loss of productivity. Studies suggest that there is a relationship between burnout and leaving medical practice. Although reducing workload and hours of medical practice may give some relief to physicians, it strains the healthcare system already struggling to meet the needs of patients.
According to current studies, health care professionals’ burnout increases the odds of alcohol abuse or dependence by 25% and suicidal attempts by 200%. Research studies indicate a 40% higher rate of suicide among male healthcare professionals than males of the same age in the general population and a 130% higher risk of suicide among female physicians.
Ways to reduce the risk of burnout
We have looked at what burnout is and its consequences on healthcare professionals. It is essential to take necessary measures to eliminate burnout and live a healthy life. Here we will look at how medical professionals and medical students can cope with burnout.
Approach for medical students
Being a medical student is not easy. There is a lot to go through from reading, exams, and clinical orientation. As a result, it’s easy to face burnout and lose productivity. Therefore med students need to Prevent burnout to achieve their daily goals. Here we will look at some tips for medical students to Prevent burnout:
One of the most significant pieces of advice for medical students is to know when to take breaks. The knowledge base in medicine can in no way be accomplished through medical school, let alone one’s entire lifespan. There are efficient study techniques that optimize learning and strengthen recall without requiring one to study constantly. Find ways to ensure self-care is part of the daily routine.
Get Enough Sleep
One of the most significant causes of burnout for medical students is lack of sleep. When we sleep, it gives time for our bodies to rest and relax, which recharges our bodies for the next day. Sleep and quiet rest provide a pathway for the brain to consolidate memories. A full night’s rest is the new “all-nighter.”
Being social beings, we flourish in the company of others. In medical school, students can create their tribes based on collective experience, common interests, and goals. Friendships formed in medical school can be long-lasting but must be nurtured. Burnout can be isolating but can be addressed by reaching out to friends, family, or professional support. Medical schools which address the nascent features of burnout through awareness, workshops, and counseling support do their students a great service.
Approach for doctors
All of the above strategies can be applied to every level of training and practice. Burnout is in many ways a behavior that results from a mismatch in expectation and workload. It has some features similar to procrastination when effective self-regulation and usual coping strategies are blunted by a work environment that imposes excessive tasks, and duties. The unbridled work demands deter a person from engaging. Here are a few approaches that can assist doctors in preventing and addressing burnout:
Obviously, the most effective strategy to prevent burnout among healthcare professionals is to develop a workflow and culture where it cannot develop. The equation can be tricky to develop, but would likely include aspects that make a job meaningful to each individual. For instance, it could include time and workload limits, a strong emphasis on mission and teamwork, and plenty of room for creativity. For most people, flexibility wins out over salary.
Aside from creating an ideal workplace culture, awareness and early detection of burnout can help an organization mobilize resources before job dissatisfaction increases and turnover. Interventions to resolve individual factors should focus on increasing the best harmony between the medical practice and the doctor.
Evidence-based organizational strategies to reduce the risk of burnout among healthcare professionals include following:
1- Acknowledgment and assessment of problem: Anonymous Burnout inventories and Provider surveys
2- Harness the power of effective leadership to create collaboration and give the providers a voice.
3- A Cultivation of Community among providers
4- Providing facilities and work-life integrations
5- Wise use of rewards and incentives: Increased salary for more work may instigate burnout (aka “Golden handcuffs”). Incentivizing taking paid time off (PTO) rather than saving the days can ensure important breaks and self-care support.
6- Aligning values and strengthening culture
7- Development of targeted interventions
8- Promotion of a culture of work-life balance
Socialization, support, and psychotherapy:
To reduce the effects of burnout, socialization and support have been proven effective. Counseling and psychotherapy have also reduced the risk of burnout. Peer support programs, teleconsultation helplines, and regular meetings with counselors should be established to address burnout among healthcare professionals.
Commensality dinners offer a team approach to preventing burnout. These meetings, often with groups of 6 to 10, encourage sharing and discussion. Studies have shown organizations that promote these team-building techniques and other workshops have lower rates of burnout.
To conclude, burnout among healthcare professionals can have various consequences. It causes harm to health professionals and compromises patient care. Therefore, organizations should adopt evidence-based interventions to prevent, identify, and address burnout among health professionals.