Physician Wellness: How to Prevent Burnout

What is physician burnout?

All over the world, every single day, medicine is practiced within the very precarious and emotionally salient relationship of physician and patient. Physicians navigate conversations riddled with immense fear and life-altering information. In the best cases, physicians guide people and families through making the most difficult decisions of their lives, holding their lowest lows and celebrating their highest highs. Sustaining this constant energy exchange, in addition to the fast-paced, high risk nature of the work, often leads to physician burnout.

Burnout is a psychological syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. It can occur among individuals who work with other people in any capacity — human services, mental health, medicine, criminal justice, education, etc. Different from simple work stress, burnout looks like the inability to recover one’s normal reserves of physical and emotional energy between shifts. A physician experiencing burnout may be caught in a long downward spiral, unable to recover the energy needed to offer quality care. Over the last 25 years, studies have shown that an average of 1 in 3 doctors suffer from physician burnout on any given day. Some surveys show physician burnout rates as high as over 70%.

The consequences of burnout are very serious for workers, their clients, and the institutions in which they interact. Quality of care is often compromised, leading to unnecessary strife and suffering. It is the largest factor in job turnover, absenteeism, low morale, and generally toxic work environments. Gone untreated over time, burnout can bring unmanageable symptoms of personal dysfunction. Physical/emotional exhaustion, insomnia, increased use of alcohol and drugs, and marital and family problems are just a few. Physician burnout can also be a fatal disorder. Suicide rates for both men and women are higher in physicians than the general population, and remain widely underreported. Learning how to spot burnout, relieve stress, replenish energy, and take steps toward continual healing are all integral to providing sustainable, quality care in the medical field.

What are the symptoms of Physician Burnout?

Symptoms of physician burnout can present themselves in a variety of ways, however there is a standardized way to assess when the syndrome is present and in need of attention. The Maslach Burnout Inventory (MBI) has been a standardized way to assess physician burnout since the 1970s, and diagnoses physician burnout with three cardinal symptom clusters: emotional exhaustion, depersonalization, and reduced personal accomplishment.

Emotional exhaustion occurs from the constant energy exchange previously mentioned. Compassion and empathy is required throughout the day to meet the dynamic emotional needs of patients, understand what their experiences are, and have emotionally intelligent dialogues. Oftentimes emotional exhaustion occurs when supporting other physicians experiencing burnout, or simply operating within a negative work environment conducive to emotional exhaustion. All in all, as emotional resources are depleted, staff members feel that they are no longer able to give of themselves at a psychological level, thus experiencing a depletion of emotional energy. Without adequate time off to recover, this energy can continue to experience a downward spiral.

This emotional exhaustion is almost directly related to depersonalization. Depersonalization is the absence of empathy or compassionate perspectives when working with clients. Negative, cynical attitudes towards clients begin to grow, while callous or even dehumanized perceptions of others often lead staff members to view their clients as somehow deserving of their troubles. This aspect of burnout is commonly referred to as “compassion fatigue.” It can create tension in any if not all relationships in the workplace. More often it is easier to notice in others than in oneself.

As one’s capacity to experience empathy and joy dwindles, and one’s perspective becomes largely cynical, it is dangerously easy to develop reduced personal accomplishment. In these situations, people can become depleted of compassion, which often also includes compassion towards the self. This is the tendency to evaluate oneself harshly and negatively, feeling dissatisfied with any accomplishments on the job. One may begin to question the quality of one’s care, or question if what one does even matters at all.

With emotional exhaustion, depersonalization, and reduced personal accomplishment, one can imagine the huge physical and psychosocial impacts that occur within the physician’s life as well.

What are the causes of Physician Burnout?

As mentioned before, compassion fatigue is a very huge cause. Acting as an emotional buffer between one’s stressful or concerning experiences and the patient will eventually lead to the erosion of energy. However, there are many other causes that, when paired with this work, can exacerbate physician burnout.

Lack of control within a work environment is a huge factor in being unable to meet one’s needs. Staff who feel unable to manage their work demands are ill-equipped to balance their professional life with their personal commitments, such as child care and important family events, leading to increased stress and negative emotional impact. This goes without saying that the consistent pressure of tight deadlines and time-sensitive tasks increases stress while also aggravating a chaotic workplace culture, causing a  simple lack of alignment around workplace values.

Before even entering the medical milieu as a physician, some say medical schooling and residency programs already plant the seeds for susceptibility to burnout. During the seven-plus years of medical education, certain traits become hard-wired into the developing physician persona seemingly ensuring success and stability throughout the career. Workaholism, martyrdom, perfectionism, isolation, and repression are only a few of these traits. The patient always comes first. In that same vein, showing weakness can break a patient’s trust, or seemingly sabotages one’s capability to reach a goal, whatever that may be. As one might guess, never showing weakness fuels burnout’s immense invisibility and negative impact. These traits that are championed as ones that will bolster a physician’s career are the same ones that can bring a physician to burnout. 

How do you avoid physician burnout?

The first step in prevention is the ability to recognize burnout as it arises. One cannot give what one does not have. Even if a physician can “handle” the stress, or has developed a high tolerance for stress, it is still imperative to alleviate this pressure in one way or another. According to Dr. Linzer’s research, physicians who consistently operate under stress are fifteen times more likely to develop burnout. Additionally, doctors who operate under high levels of stress are more likely to make mistakes, which can be dangerous and potentially fatal depending on the situation.

One can relieve stress by first addressing aspects of the work environment that encourage it, and instead advocating for and encouraging a culture of self-care. One can also relieve stress with intentional breathing, or a “squeegee breath.” Take a big breath to the top of one’s head, hold it for three seconds, then exhale all the way, releasing any stress, tension or worry out with your exhale. Hold the exhale, then allow the breath to continue as normal. Incorporating whatever appropriate self-care, stress-relieving activities such as this into the work day routine helps significantly.

Keeping one’s support network sturdy, and remembering to access love and joy from others, increases emotional security. Perhaps asking the question, “what is one relationship you have been feeling a need to pay more attention to lately?” such as a mother, father, spouse or significant other, one of one’s children, or a friend. Then, make a point to connect with that person in a genuine way.

Reconnect with a motive or purpose. Physicians are encouraged to periodically reconnect with the things they love about their profession, such as naming one thing they love about their job, and then setting an intention to experience this joy in the next day ahead. This can be a very powerful method to seek out and savor the small joys, holding those experiences close, and allowing them to give more emotional energy back. At the same time, perhaps after reconnecting with what they love about practicing medicine, a physician may re-examine these factors to determine if a change in career is necessary, such as a more research-oriented, non-clinical position.

In any case, take a break. The central idea of physician burnout is to notice, treat, and re-examine how one’s needs can be met. Both the patient and physician deserve physical wellness, happiness, and the fulfillment of positive relationships.

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