Burnout is a work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment. For physicians, emotional exhaustion is a state of emotionally worn out and drained at the end of a workday. They have a sense of working too hard, often feel tired, and a feeling of “bad days” greatly outnumber “good days” at work. Depersonalization Includes feelings of treating patients as objects rather than human beings. They will have a cynical and insensitive attitude to people around. At work, they feel disconnected and the result is strained relationships with other staff, and poor treatment of patients. Reduced personal accomplishment implies negative self-appraisal, feelings of being frustrated and incompetence. There is a sense that “nothing is getting done” or that the work they are doing is unimportant and meaningless.

Compared with medical staff in other professional categories, studies demonstrated that EM physicians were more susceptible to burnout, with burnout levels almost 1.5 times that of physicians in general. Burnout was once thought to be a late-career phenomenon, but recent studies either locally at one of our EM departments or internationally suggest that younger physicians and female physicians have higher rate of burnout compared with older colleagues and male physicians respectively.

Physician burnout can be due to work-related stressors, organizational factor and individual personal characteristics. 

Additional work processes related to patient care such as the need for comprehensive documentation and computerized physician order entry contribute to burnout symptoms. Excessive workloads (e.g. long work hours and high patient load), loss of support from colleagues and lack of control and autonomy have been associated with burnout. It is also noted that physicians in private practice may also have higher burnout rates compared to academic or other practices, independent of specialty, work hours and other factors. 

Organizational climate factors (e.g. negative leadership behaviors and limited interprofessional collaboration, lack of opportunities for advancement and social support for physicians) also contribute to higher rate of burnout. 

Physicians also tend to share some personal characteristics associated with burnout which include being self-critical, over commitment, perfectionism, idealism and loss of attention to work-life imbalance. 

Burnout among physicians has been associated with a significantly higher risk of making errors (e.g., medication errors, diagnostic errors, etc.), leading to sub-optimal patient care. Furthermore, physician distress contributes to increased physician turnover, reduced productivity, job dissatisfaction, higher absenteeism, poor interpersonal relationships (family and friends), and early retirement which can have negative effect on the healthcare system. Finally, it has been noted to correlate with depression in physicians, increased odds of alcohol abuse/dependence and risk of suicidal ideation.

Given the significant effects of physician burnout, researches have been conducted to explore how burnout can be mitigated. Individual-based interventions that have been shown to promote wellness include stress management, self-care, communication skills training, small group discussion, gratitude interventions, and professional coaching. The focus of these interventions is often the cultivation of skills such as resiliency, mindfulness, and reflection. For trainees, peer mentoring, professional development coaching, exercise, discussion of imposter syndrome, and self-care resources have been shown to support well-being.

Individual-based interventions can help to promote positive attitudes, increase confidence, and decrease depersonalization. However, It has been demonstrated that burnout is a response to the environment and it is necessary to have organization-directed interventions to reduce burnout as well. Organization-directed interventions can involve simple changes in the work schedule and environment, work tasks to reduce stress levels (e.g., reductions in the workload by improved team-work, changes in the work evaluation, increment of participation in decision-making), and even more profound reform in the operation of healthcare organizations. These interventions can lead to reduction in emotional exhaustion and depersonalization scores and can have more significant effects when compared with individual-directed interventions

References

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4. Patel, Rikinkumar S., et al. "A review on strategies to manage physician burnout." Cureus 11.6 (2019).

   
   

5. Patel, Rikinkumar S., et al. "Factors related to physician burnout and its consequences: a review." Behavioral sciences 8.11 (2018): 98.