What extinguishes the fire? –Understanding doctor burnout
Burnout. It’s a word that’s on everyone’s lips, particularly in the medical world. There has been a recent swell in research examining burnout in medical professions with some disturbing findings. In fact, a recent systematic review identified that up to four in five doctors are currently experiencing burnout. However, what exactly is burnout and why is it a big issue?
The leading model of burnout (the Leiter and Maslach model) proposes that burnout comprises three related dimensions:
- Emotional exhaustion – feeling emotionally drained by your work
- Depersonalisation – seeing people as collections of symptoms rather than people, (i.e., acting more like a robot than a person); and
- A lack of personal accomplishment – feeling a lack of achievement within one’s work
Doctors with burnout tend to have poorer personal wellbeing and are less empathetic and responsive to their patients. Burnout has also been associated with various adverse outcomes for medical trainees and doctors, including increased suicidal ideation; difficulty concentrating at work; and substance abuse. The effects of burnout in medical practitioners are widespread: patients of doctors with burnout experience longer recovery times in surgical settings and increased medical errors; colleagues are more likely to develop burnout themselves; and productivity is lowered, imposing costs for practices and the broader community.
As the saying goes, an ounce of prevention is worth a pound of cure, and so an important finding is that the high prevalence of burnout in doctors can be traced back to medical training. Therefore, interventions to prevent or reduce burnout in medical trainees should be a priority. A precursor for designing such interventions is identifying the factors associated with burnout. Although there has been a lot of research in this field, I observed that there were no reviews to consolidate this work. Therefore, under the supervision of Dr Diana Dorstyn at the University of Adelaide, and Associate Professor Jill Benson AM and Dr Taryn Elliott from GPEx, I conducted a systematic review and meta-analysis of variables associated with burnout in medical interns, residents, and registrars. The aim was to use statistical techniques to combine the findings from multiple studies so that we could generate accurate estimates of how individual (mental health, gender, etc.) and work-related variables (workload, social supports, rewards, etc.) relate to burnout. After reading many articles; poring through data; and consuming far too much green tea, I narrowed the sample of studies to 33 articles with a pooled sample of 7,229 medical trainees.
So, what did we find? First, none of the demographic variables (age, gender, etc.) related to any burnout dimension. This is important, as it shows no correlation between burnout and the variables we are unable to change. However, individual and work-related variables related to burnout. This indicates that interventions to tackle burnout require individual and organisational strategies.
What specific variables were most important though? The strongest personal variables concerned mental health and wellbeing, especially depression and perceived stress. This indicates that maintaining your mental wellbeing is an essential first step for preventing burnout. Wellbeing is an area which has a shared responsibility between the registrar, training post and training organisation. GPEx, for instance, strives to provide accessible support to registrars throughout their training: the GPEx Wellbeing Workshop helps registrars develop practical ways to self-manage their own mental wellbeing. The GPEx Wellbeing Framework (see below) identifies the critical elements contributing to one’s wellbeing, and underpins the organisation’s wellbeing policy, education and support integrated within training. GPEx encourages all registrars, supervisors and training posts to familiarise themselves with this framework.
Regarding work-related variables, the significant protective factors were finding work to be rewarding; having a supportive workplace community, and having a sense of control over workload and training. Conversely, experiencing high work/life conflict and a high workload were associated with higher levels of burnout. It is vital for all of us to be proactive in managing these work-related variables. At GPEx, we are in regular contact with our registrars, supervisors and practice managers to ensure that our registrars are happy and coping with the pressures of GP training. As always the registrar’s personal training advisor or our medical educators are only a phone call away and available for help if any troubles arise.
The final key finding of this project was that some variables’ importance appeared to change based on specialty (i.e., surgical vs. non-surgical). For example, the overall analyses examining all trainees, income satisfaction was not related to emotional exhaustion. Yet, income satisfaction related to emotional exhaustion for surgical registrars. Although these analyses were based on limited data, this suggests that burnout levels and the relevance of certain variables may vary based on a trainee’s specialty. Therefore, burnout interventions may need to be tailored to the specific area of medical specialisation.
To summarise, we identified multiple modifiable individual and work-related variables that may be useful targets for preventing and reducing burnout in medical trainees. At GPEx, we focus on ensuring that our policies and practices adequately support our registrar’s wellbeing. Therefore, these findings will identify any gaps in the program and develop strategies for continual improvement. In fact, we are currently in the process of developing a wellbeing app that will be launched in 2019, so watch this space!
Lastly, fostering an environment that supports the mental wellbeing of our registrars requires a combined effort so we also encourage registrars and accredited practices to consider how they too can make positive changes in response to the findings from this research.
Dyrbye, L., & Shanafelt, T. (2016). A narrative review on burnout experienced by medical students and residents. Medical education, 50 (1), 132-149.
Leiter, M. P., & Maslach, C. (1982). Burnout in health professions: A social psychological analysis. In G. Sanders & J. Suls (Eds.), Social Psychology of Health & Illness (pp. 227-247). Hillsdale, NJ: Erlbaum.
Rotenstein, L. S., Torre, M., Ramos, M. A., Rosales, R. C., Guille, C., Sen, S., & Mata, D. A. (2018). Prevalence of burnout among physicians: a systematic review. JAMA, 320(11), 1131-1150.
Shanafelt, T. D., Dyrbye, L. N., West, C. P., & Sinsky, C. A. (2016, November). Potential impact of burnout on the US physician workforce. In Mayo Clinic Proceedings (Vol. 91, No. 11, pp. 1667-1668). Elsevier.
Written by Shaun Prentice