Healthcare providers including physicians, nurse practitioners, and physician assistants are susceptible to professional burnout. Since 1970, when burnout was first described in scientific literature, thousands of conceptual papers and empirical studies have investigated this multifaceted phenomenon. In 2007, the U.S. Department of Health and Human Services declared burnout a major problem resulting in poor retention of competent healthcare professionals, and it was then that burnout was officially described as an occupational hazard.
Unfortunately, most healthcare organizations invest few resources into preventing or treating burnout, and many administrators and executives lack fundamental education on this topic. This article will investigate the concept of burnout, discuss the scope of the problem, and recommend strategies for both individuals and organizations to manage its effects.
Defining Burnout
A healthcare provider’s chronic exposure to patients in distress can result in conditions known as compassion fatigue, secondary traumatic stress, or vicarious trauma, all of which can lead to a syndrome called professional burnout. The process of “burning out” refers to a progressive state that occurs through the cumulative impact of both empathizing with other’s suffering and being committed to their recovery.
Scientific research has demonstrated that professional burnout encompasses three symptom dimensions: (1) emotional exhaustion, (2) depersonalization, and (3) reduced personal accomplishment. Overall, the symptoms of professional burnout resemble those of post-traumatic stress disorder and can also include intrusive thoughts, nightmares associated with work, insomnia, chronic irritability, fatigue, difficulty concentrating, avoidance of patients or work events, hypervigilance, and angry outbursts. These symptoms can lead to serious personal repercussions for healthcare providers including problematic alcohol use, broken relationships, and suicidal ideation.
The Scope of the Problem
Most studies find that nearly 50% of healthcare providers are burnt out. A 2011 survey of physicians found that 37.9% reported high emotional exhaustion, 29.4% reported high depersonalization, and 12.4% reported a low sense of personal accomplishment. A follow-up survey in 2014 found that these rates of burnout symptomology have increased by 10% in just three years. Burnout impacts individuals by increasing their risks for substance abuse conditions, suicidal ideation, and physical illness.
The economic cost of professional burnout is substantial. A recent study of Canadian physicians found that the total cost of burnout was $213 million; $185.2 million due to early retirement and $27.9 million due to reduced clinical hours. Primary care providers accounted for 58.8% of these burnout costs. Another 2014 systematic review found the health care providers experiencing professional burnout are less productive overall, take more sick leave, and retire sooner. This study also demonstrated that provider’s experiencing burnout report both low job satisfaction and low organizational commitment.
In fact, a 2009 study found that healthcare providers experiencing professional burnout have:
- Lower patient satisfaction scores;
- Reduced empathy for their patients;
- Decreased patient adherence to treatment recommendations;
- Higher rates of malpractice lawsuits;
- Greater likelihood of changing careers; and
- Increased risk of making medical errors.
Who Is at Risk?
Healthcare providers are at a greater risk for professional burnout than the general population. Emergency room clinicians, primary care providers, surgeons, and mental health professionals tend to report higher rates of burnout symptoms. Younger providers and those with children are also at an increased risk. Healthcare providers who feel undervalued and disrespected by their colleagues or employing organization are also at greater risk for developing symptoms of burnout.
Risk factors for professional burnout are sometimes called the “big four,” and they include:
- Lack of control over work conditions;
- Time pressure;
- Chaotic workplaces; and
- Lack of alignment of values (around mission, purpose and compensation) between providers and their leaders.
Preventing Professional Burnout
A unique study published in 2013 investigated the habits of 200 German physicians who had never experienced symptoms of professional burnout. These researchers conducted semi-structured interviews with each of them and found three specific qualities they described as “resilience factors.”
These resilience factors included: (1) job-related gratification, (2) leisure practices, and (3) attitude. First, these German physicians were more likely to scheduled regular contact with their colleagues to discuss patient cases, reflect on errors, and set team goals. Next, they reported a positive work-life balance, at least two hobbies, and weekend get-togethers with friends and family. These hobbies usually included exercise and life-long learning activities. Lastly, these resilient physicians seemed to possess an adaptive attitude that meant accepting tough situations and leaving organizations that didn’t support their well-being. The study concludes by stating that the happiest physicians were those that did not derive work satisfaction from curing illness but instead from forming genuine connections with their patients and coworkers.
What Can Organizations Do?
Start an Anti-Burnout Team
To prevent their employees from burning out, organizations should create an anti-burnout committee comprised of physicians, nurse practitioners, and physician assistants from various specialties. An organization may wish to elect an anti-burnout champion to lead the initiative and understand the scope of the problem. This committee should meet with leaderships regularly to plan anti-burnout initiatives and review current projects.
Distribute a Burnout Survey
The American Medical Association teamed up with the Medical Group Management Association to create the “Mini Z” survey, a 10-item questionnaire that assesses a provider’s level of burnout. The Anti-Burnout Team should distribute this survey to all providers at least annually to assess their levels of burnout and to direct anti-burnout initiatives.
Involve Providers in Decision-Making
Create scheduled team meetings that include physicians, nurse practitioners, and physician assistants. Present relevant problems and allow providers to collaboratively find a solution. Decentralizing decision-making will increase employees’ feelings of autonomy and sense of control over their work conditions.
Create Shared Values
To promote a positive work culture, allow providers to develop their own team values and mission statement. Providers will naturally create team values that align with their own, promoting a sense of organizational engagement.
Increase Positive Feedback
Acknowledging the hard work and dedication of an employee can go a long way. Managers should provide positive social support, ongoing encouragement, and consistent gratitude to their employees. Providers should also offer positive feedback to each other in order to encourage teamwork.
What are your thoughts about professional burnout?
