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Burnout

Physician Burnout Before and After the COVID-19 Crisis

How to support those who take care of us.

Physicians are a tough bunch, no doubt about it. Years of rigorous education, high stakes, and high-stress medical school examinations are only the beginning of the odyssey that is medical education. The odyssey continues with rigors of sleep-deprived residency, and an ongoing on-call-related stress and sleep deprivation within the context of illness and death, making them tough out of necessity. However, medical careers, as all careers, are marathons, and physicians are merely human. So why is it that more is not being done to address issues related to physician burnout? If physicians’ careers are expected to last for decades, then “pacing” is the key, but there are many intrinsic and extrinsic factors that lead to physician burnout.

What is physician burnout? The term is still a working definition and the construct may need further refinement to become fully operationalized. However, based on extant literature, physician burnout can be conceptualized as a syndrome, closely tied to work, that presents with symptoms such as depersonalization, emotional exhaustion, and a sense of reduced personal accomplishment (e.g., Patel, Bachu, Adikey, Malik, Shan, 2018).

What causes physician burnout?

While there are many potential causes that lead to physician burnout, there seems to be a rather volatile mixture of intrinsic and extrinsic factors at play. On the one hand, physicians tend to be perfectionistic, idealistic, self-critical, sleep-deprived, and over-extended, while also struggling to maintain work-life balance, and keep adequate support system outside the work environment (e.g., absence of partner, spouse or children) (e.g., Shanafelt, 2009). On the other hand, organizational factors such as lack of positive leadership behavior, and limited interpersonal collaboration and social support for physicians are external factors that may influence burnout (e.g., Shanafelt et al., 2015).

How does the COVID-19 crisis impact physician burnout?

Source: Maida Hasanefendic Serdarevic
Source: Maida Hasanefendic Serdarevic

Earlier literature on physician burnout reported that physicians working in outpatient settings experienced higher rates of burnout compared to those working in inpatient facilities (e.g., Lee, Seo, Hladkyj, and Schwartzmann, 2013). Of course, given the nature of the COVID-19 crisis, it is likely that rates of physician burnout will increase in inpatient facilities. This is especially the case in settings such as ICU, where continuous exposure to severe sickness and death is likely to lead to exhaustion (e.g., Patel, Bachu, Adikey, Malik, Shan, 2018), but it is reasonable to anticipate that all inpatient settings will be impacted.

Are there solutions to physician burnout?

According to Patel and colleagues (2018) “timely-breaks and days off should be carefully planned.” This is clearly an organizational—level and leadership task. Also, when it comes to addressing individual-level variables related to physician burnout, physicians should be encouraged, and given the opportunity to engage in relaxation techniques like meditation, yoga, and other relaxation techniques, in addition to creating an environment where approaching therapists to process their stress, and vent their frustrations is encouraged (e.g., Patel et al., 2018).

Some research suggests that “family-friendly” organizations where physicians are empowered to exert control over the workplace issues are more likely to employ physicians with lower reported stress and higher career satisfaction (e.g., Williams et al., 2002).

As a psychologist, I would strongly recommend that hospital leaders create conditions in which physicians would be enabled to tend to the physical, psychological, and spiritual aspects of their humanity. Easy access to physical recreation, social supports, psychological and religious services would be a great start. Google employees have their ping-pong tables, why can’t health care staff have a decent stationary bike? Of course, I don’t expect hospital leadership to be all over this, so ultimate responsibility lays with doctors themselves—relearning to take care of yourselves first might be the most important thing you can do for your patients.

Also, I would like to suggest that more needs to be done on a macro, or societal, level. Society needs to do more to advocate for and show an appreciation for physicians, nurses, P.A.s, respiratory therapists, and all health care workers.

It should not have to take a pandemic for us, as a society, to recognize the importance of health, life, and those who help us sustain it.

References

Lee R.T., Seo B., Hladkyj S., Lovell B.L., Schwartzmann L. Correlates of physician burnout across regions and specialties: A meta-analysis. Hum. Resour. Health. 2013;11:48. doi: 10.1186/1478-4491-11-48.

Patel, R. S., Bachu, R., Adikey, A., Malik, M., and Shah, M. (2018). Behav Sci. (Basel); 8(11): 98. doi:10.3390/bs8110098

Shanafelt T.D. (2009). Enhancing meaning in work: A prescription for preventing physician burnout and promoting patient-centered care. JAMA;302:1338–1340. doi: 10.1001/jama.2009.1385.

Shanafelt T.D., Gorringe G., Menaker R., Storz K.A., Reeves D., Buskirk S.J., Sloan J.A., Swensen S.J. (2015). Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin. Proc.; 90:432–440. doi: 10.1016/j.mayocp.2015.01.012.

Williams E.S., Konrad T.R., Linzer M., McMurray J., Pathman D.E., Gerrity M., Schwartz M.D., Scheckler W.E., Douglas J. (2002). Physician, practice, and patient characteristics related to primary care physician physical and mental health: Results from the Physician Worklife Study. Health Serv. Res.; 37:121–143.

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