A Parallel Pandemic
What is Burnout?
Burnout is a syndrome characterized by a triad of:
- Emotional exhaustion (loss of enthusiasm for work, lack of energy, feeling helpless/trapped/ defeated).
- Depersonalization (development of a negative, callous and cynical attitude towards patients and their concerns /colleagues/hospital; objectifying them).
- Sense of decreased personal accomplishment (tendency to see one’s work negatively, without value /meaningless (‘what’s the use’) and see oneself as incompetent).
Burnout is included in the 11th Revision of the WHO International Classification of Diseases (ICD-11) as an occupational phenomenon. Maslach Burnout Inventory, a 22-item questionnaire to measure all three burnout dimensions, is considered the gold standard for identifying burnout in medical research.
Burnout is distinct from stress:
- The difference between Stress and burnout is the ability to recover in the time off. Burnout is more of a cumulative phenomenon and generally is associated with a convergence of stressors.
- Importantly, burnout is not associated directly with an increase in tasks/duties and responsibilities. Rather, the degree of dissatisfaction and burnout appear to increase in inverse proportion to the resident’s sense of control or perception of fairness of the responsibilities.
- Residents are the “bottleneck” in the provision of services in the health-care team. They function as rate limiting steps in the system. Pressure mounts to perform at full steam 24*7. In addition they have to balance between academics and the discharge of their duties. It has been found that residents with burnout had more than a threefold increase in odds of regretting their speciality choice.
- Overall, burnout is associated with a variety of negative consequences including depression, risk of medical errors and negative effects on patient safety.
Issue of Concern:
Several stressors predispose residents to burnout, such as sleep deprivation, conflicts with coworkers, difficulty adjusting to a new environment, demanding patient responsibilities, and lack of control over managing one's time. Also, individuals who are inherently neurotic or introverted are at a higher risk.
Burnout may present with physical symptoms that might interfere with one's ability to work efficiently, such as headache, fatigue, gastrointestinal distress, flu, and sleep and appetite changes. Psychological symptoms like irritability and reduced concentration may be present.
It also increases the likelihood of developing depression, suicidal ideation, and cardiovascular disease.
Burnout Rates Vary Across Different Residency Specialties:
This variation among specialties was not statistically significant; however, burnout rates were as follows:
75% in obstetrics-gynecology followed by 63% in internal medicine, 63% in neurology, 60% in ophthalmology, 50% in dermatology, 40% in general surgery, 40% in psychiatry, and 27% in family medicine.
Being in one's first year in residency, mood fluctuation, dissatisfaction with clinical faculty, recent family stress, and being unmarried were all associated with increased likelihood to meet burnout criteria.
Psychiatry residents were noted to have additional stressors including fear and exposure to patient violence and suicide.
What can be done to improve Resident’s Burnout?
Faculty play key roles in recognizing burnout, talking to residents and knowing resources for treatment. They need to address the modifiable determinants of burnout and develop targeted interventions to support residents throughout their training.
The top three ways doctors cope with burnout are exercise, sleep and isolation from others.
Potential interventions include individual-driven measures like self awareness, healthy boundaries between work and non-work areas, creating focus where possible on work activities that provide the most meaning, promoting interpersonal professional relations, meditation and/or exercise and workplace driven interventions.
Practicing self care should not be equated with being selfish, reinforcing the concept of ‘Medice, cura te ipsum’ (Physician, heal thyself!).
1. Residream: Volume 7 ⬩ Issue 2 ⬩ Feb 2021