What exactly is physician burnout? How is it different from overwork, exhaustion, or needing a vacation? Is it purely an occupational phenomenon? In this article, we explore the construct of the burnout syndrome definition as it relates to doctors.
Burnout is a work-related syndrome involving emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment.
As first described by Freudenberger (1974) and subsequently developed by Maslach and colleagues (1996), burnout is typically the result of chronic stress associated with emotionally intense work demands for which there are insufficient resources.
i.e. every healthcare system everywhere.
Burnout: “a state of fatigue or frustration brought about devotion to a cause, way of life, or relationship that failed to produce the expected reward”.
Freudenberger defined burn-out as “a state of fatigue or frustration brought about devotion to a cause, way of life, or relationship that failed to produce the expected reward”.
It is generally accepted that burnout involves a triad of experiences:
A burnout “diagnosis” depends on scoring sufficiently high in any one of these areas.
Burnout is recognized by the World Health Organization’s (WHO) clinical coding system, the ICD-11, as an occupational phenomenon, and not a medical condition.
According to the WHO:
“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
The most widely accepted standard for burnout assessment is the Maslach Burnout Inventory (MBI), which includes a Human Services Survey applicable to healthcare professionals.
The MBI is comprised of 22 items, each scored from 0 to 6 based on self-reported frequency of the feeling addressed by each item.
In this scheme, high levels of burnout for physicians are indicated by one of:
While hating your job (or at least the demands it puts on you without sufficient resources) may be part of it, burnout is considered distinct from plausibly related concepts such as job dissatisfaction, occupational stress, fatigue, anxiety, and depression.
Although burnout correlates with these problems, it may be present in their absence or absent in their presence. As a work-related phenomenon, burnout is further distinguished from depression. In particular, the emotional exhaustion domain of burnout has been suggested to map more closely to depression, but the depersonalization and low personal accomplishment domains of burnout do not correlate well with depression or other psychological issues.
The burned-out physician “is angry, irritable, impatient, has increased absenteeism, decreased productivity and decreased quality of care.”
None of this can be good for patients.
Amongst physicians, emotional exhaustion includes feeling “used up” at the end of a workday and having nothing left to offer patients from an emotional standpoint.
Depersonalization includes feelings of treating patients as objects rather than human beings and becoming more callous towards patients.
A sense of reduced personal accomplishment encompasses feelings of ineffectiveness in helping patients with their problems and a lack of value of the results of work-related activities such as patient care or professional achievements.
Physician burnout is associated with an increased risk of major medical errors. A recent meta-analysis involving more than 42,000 physicians found that physician burnout doubled the risk of adverse patient safety incidents and led to poorer overall quality of care and decreased patient satisfaction.
Furthermore, physicians reporting burnout symptoms work fewer hours and leave clinical medicine at a higher rate than do those not affected.
Burnout among primary care physicians and several other specialties also increases turnover, and therefore costs.
The Great Resignation will no doubt include healthcare workers. And it is patients who will lose out.
The burned-out physician “is angry, irritable, impatient, has increased absenteeism, decreased productivity and decreased quality of care.”
The total cost of physician burnout is estimated to be about $5 billion (USD) per year. This is because burned-out doctors are not as productive and they also have high levels of turnover compared to happy, healthy, doctors. This estimate does not even include litigation costs, which may be extremely high.
Read more about the economic impact of burnout in our Physicians Anonymous article here.
Burnout is an occupational phenomenon found when we suffer significant cynicism, emotional exhaustion, and a reduced sense of accomplishment at work. This is not good for physicians, patients, or the economy.
We hope that by exploring this issue, physicians will develop a greater understanding and start to work out the underlying causes for them – and then start to tackle them.
