Worn Out
Are you or someone you love working in a medical profession and struggling to make it through the work day? Are you finding it increasingly difficult to get out of bed and face responsibilities at your job? Maybe your workload is becoming too much to handle and it’s starting to affect your personal life? Well, we hear about it all the time – burnout rates can be extremely high among working medical professionals.
Up until now, the prevalence of this stress syndrome is estimated to range from 10% to 70% among nurses and 30% to 50% among physicians, nurse practitioners, and physician assistants! According to a study conducted by the Mayo Clinic in 2015, more than half of American physicians are suffering from at least one sign of burnout and this prevalence continues to increase through the years. Well, what is burnout, anyway?
Burnout is a term used to describe a physical, physiological and psychological stress reaction syndrome caused by long-term exposure to intense work-related emotional and interpersonal pressures (Biksegn et al, 2016).
What are some common signs and symptoms of burnout? What are the various coping mechanisms used when suffering from this stress? Are there ways we can minimize or even prevent this on some level? Throughout this article, I will be addressing the history of the term, questions regarding possible reasons for the occurrence of burnout,
different ways to positively cope with and manage this stress, and potential minimizing strategies within various susceptible medical professions. Included within these strategies, I will go over the specific reasons as to why this term is seen in such a negative light while incorporating various integrated disciplines.
When I was a young boy with such high ambition, it was common to change my mind daily about what I wanted to be when I grew up. Fortunately, I had the best motivators anyone could ask for. Between my friends, family, and teachers, I “researched” a plethora of careers and created a detailed analysis of pros and cons (in crayon, of course). First on my list, along with many other children, was joining the medical field. How could there be any negativity associated with saving lives and making good money? I found out quickly that not everyone wants to deal with the stresses involved. As I dug further into this nonsense, I concluded that these stresses are associated with many other medical professions on my list. Finally, I discovered the word I was looking for – burnout!
Burnout, according to Melinda Smith, et. al, it is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress.
Typically, this occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands. Although you can imagine how scary this sounds on an emotional and physical level, there are many ways to try to minimize these negative outcomes in a variety of professional settings. In addition to minimization, it is important to bring to light various causes and common symptoms of burnout in hope that you, too, can cope with them in a safe way (2016).
How did burnout come to be?
Back in the 1970s, burnout began to be described and discussed; however, it was primarily limited in reference to people working in the fields of human services, health care, social work, legal services, police work, and psychotherapy. The main concept of these professions revolves around helping and serving others. At this time, researchers performed qualitative interviews and case studies to obtain a vivid idea of why people lost both their energy and their sense of the value of their job. Once again, they found that the loss of meaning was especially prevalent within professions dedicated to having goals to help and serve others (Schaufeli et al, 2008).
As soon as burnout became a widely recognizable term, some researchers sought out potential causes of this stress syndrome and linked specific historical events dating back to the early 1960s.
In an attempt to ignite a vision of public service, President John F. Kennedy challenged Americans to “ask not what your country can do for you, but ask what you can do for your country”. Later, President Lyndon B. Johnson launched the “War on Poverty” that triggered a large influx of motivated young people into human services professions. However, after struggling to eliminate poverty for a decade or so, they found themselves more and more disappointed. The very reasons that poverty was so prevalent lessened the workers’ efforts to make an impact on their patients. This made it especially difficult for children of poor families and decreased their opportunities for care. As a result, the drive to perform or show compassion towards their patients significantly decreased (Schaufeli et al, 2008).
Burnout was initially viewed as a threat for young service professionals who served clients that felt entitled with unsolvable problems. “Eventually, it was believed that these workers would become exhausted, pessimistic, and overall discouraged through their experiences.” Despite these original interpretations, those professionals that entered the workforce in the 1960s are now heading toward retirement and society’s view on who experiences burnout has since changed drastically (Schaufeli et al, 2008).
What Causes Burnout?
Over time, researchers have been able to study why this stress syndrome affects so many people. “Some [underlying causes] are personal—age, educational level, recovery status—while others are organizational characteristics—caseload, available resources, autonomy, and role expectations” (Oser et. al., 2013).
By understanding the specific causes of burnout, you can try to avoid these triggers and potentially save your future self from the negative side effects in the long run. Oftentimes, burnout stems directly from your job and feeling overworked or undervalued raises your risk. Have you been working long hours and haven’t had a vacation in years? Are you a stay at home mom dealing with the daily stresses of children or an aging parent? There are many different situations in life, both inside the workplace and out, that can be factors in whether you become a victim of burnout.
On the Job
If you feel as though you might already be facing some signs of burnout relating to your job, I want you to take some time to conduct a small interview (with yourself!). Some potential questions you should ask include:
“Do I feel as though I have little or no control over my work?”
“Am I experiencing a lack of recognition or reward?
“Am I completing tasks that are unchallenging or monotonous?”
“Are my expectations unclear or overly demanding?”
“Is my work environment too strenuous day in and day out?”
If necessary, I want you to save your answers somewhere you can access them. At a later date, complete the same interview and compare your answers. Later on in this article, I will be discussing common relievers of this stress syndrome in hope that your future answers will indicate a positive change has been made. These signs of burnout (feeling as if you have little or no control over your work, experiencing a lack of recognition or reward, completing tasks that are unchallenging or monotonous, having unclear or overly demanding expectations, or even working in a high-pressure environment) may appear in conjunction with not getting along with coworkers or a boss, not having enough personal time, or experiencing a lack of social time and should be addressed.
Personal Life
In addition to your work demands, your personality and the lifestyle you live can also present burnout symptoms. In addition to the interview about your work life, take some time to answer the following questions regarding your personal life:
“Do I experience a lack of relaxation time or socializing time?”
“Do I lack close and supportive relationships?”
“Do I face too many responsibilities and not receive enough help from others around me?”
“Am I getting enough sleep?” (neither am I)
“Some deep, underlying personality traits contributing to these stresses may include possessing perfectionistic tendencies, having an overall pessimistic view of yourself and your surroundings, feeling a need to be in control all the time, and having a high-achieving personality” (Smith, et. al., 2017).
Dimensions of Burnout
According to the Maslach Burnout Inventory, or MBI, there are three main dimensions of burnout: emotional exhaustion, depersonalization, and reduced personal fulfillment. “Emotional exhaustion is considered the central factor of burnout syndrome and is characterized by a feeling of exhaustion, lack of energy, and physical and emotional overload.” The individual lacks motivation and becomes unable to relax. The idea of depersonalization results in negative attitudes and feelings that can lead to a loss of sensitivity towards patients and represents the interpersonal context in burnout. Overall, the individual may belittle their relationship with colleagues, patients and their place of work. This is characterized by an emotional ‘numbing’ and concealing of emotions; thus, its most common symptoms are anxiety, increased irritability, lack of motivation, a reduction in idealism, despair, selfishness and alienation (Manzano-Garcia, 2017).
Specifically, lacking personal fulfillment refers to a feeling of incompetence and not enough satisfaction and productivity at work. For example, this may occur when the professional begins to question their choice of profession and wonders whether they can be successful. Their work may no longer satisfy them, or they can experience a sense of being ‘not good enough’ both personally and professionally. “Consequently, their ability to carry out their work and the contact they have with people is affected; therefore, their productivity and service provided to patients is reduced” (Manzano-Garcia, 2017).
Burnout Side Effects
Why should we be concerned with burnout among medical professionals? On the surface, the negative effects of burnout may be very apparent; however, with extreme physical and mental exhaustion comes other possible consequences that lie deeper within one’s life. There are potential professional and personal consequences associated with this stress. If these not addressed, they can manifest and become much more difficult to treat the symptoms.
Audrey Lyndon discusses how, “clinician burnout…may impair clinicians’ ability to maintain safe practices and detect emerging safety threats.” She continues to explain how the emotionally exhausted clinician can become overwhelmed by work to the point of feeling fatigued, unable to face the demands of the job, and eventually become unable to engage with others. Consequently, this burned-out clinician can develop a sense of cynical detachment from work and begin to view patients as objects. Ultimately, these symptoms can cause the person to lose their sense of ability to contribute meaningfully and feel as if they are no longer effective (2016).
Suffering from burnout is not only a personal battle and it is vital to understand the impact it has on patients, as well. Lyndon continues on to say, “Burnout is viewed as a threat to patient safety because depersonalization is presumed to result in poorer interactions with patients. Clinicians with burnout are more likely to subjectively rate patient safety lower in their organizations and to admit to having made mistakes or delivered substandard care at work.” As a result, a number of influential organizations, including the American Medical Association and the Mayo Clinic, have begun to address burnout as a priority (2016).
A consequence that follows the impaired ability to maintain safe practices includes the chance of causing bodily harm to patients. As time goes on and the issue is not addressed, these impaired abilities become more prevalent.
What if the doctor who is performing your surgery finally succumbed to the emotional fatigue and was unable to continue half way through? Or the nurse that has been taking care of you suddenly decides you don’t need the best care possible? Big or small, ANYTHING interfering with the care of patients should be addressed immediately.
Some studies are revealing that people are displaying signs and symptoms of burnout even before they begin their career. Specifically relating to students in the medical field, “medical schools and [their associated] residency programs are responsible for ensuring that future doctors are well prepared to deliver high-quality patient-centered care, uphold ideals of the profession and be leaders within evolving health care systems.” In an ideal world, these trainees should also enter the workforce optimistic about their future in medicine and become (if not already) satisfied with their career choice. In order to push these students toward these goals, medical educators design and implement better and more sophisticated programs. “However, some of the components of the programs have an unintended and detrimental impact on trainees’ mental health” (Shanafelt, 2016).
One study found that “burnout has the potential to erode these students’ professional development and diminish a number of professional qualities such as honesty, integrity, altruism and self-regulation.”
If seen early on and not treated effectively, this can manifest into a future career and be molded into an individual’s personality. If students are facing a sense of diminished honesty during school, what is stopping that from entering their future career? “The students that were found dealing with burnout were substantially more likely to engage in unprofessional behavior and had a much higher chance of cheating and engaging in plagiarism.” Once one enters a ‘profession’, there are certain expectations of them to become a ‘professional’ and not engage in these behaviors. However, if these behaviors are forming before entering the workforce, it’s possible that cheating and copying other’s work without permission will continue into their respective professional settings (Shanafelt, 2016).
In addition to its professional ramifications, burnout can have a tremendous personal impact. Dyrbye found that burnout was independently associated with an increased risk of alcohol abuse or dependence. Some students who were suffering from these symptoms were also found to be having suicidal thoughts in addition to alcohol abuse (2016).
The effects on an individual can branch out to affect personal relationships and once people are dealing with the symptoms, they tend to find other means of coping and can send themselves in a downward spiral.
Are Some Professions More Prone to Burnout?
Certainly, when we ask this question, we immediately assume that some jobs incur less stress on the worker compared to others. For example, when I was a cashier at the local ice arena concession stand, I was rarely a victim of stress and certainly did not battle with it as frequently as being a student. When looking at burnout rates across different medical professions, many factors must be reviewed. These include the type of job, the associated responsibilities and their various difficulties, number of hours worked, and the types of people you work with. Any number of these factors can make a large impact on your overall happiness, both inside the workplace and out.
Before diving deeper into this question, I first needed to research specific medical professions. Here, I located a list of medical specialties with the highest burnout rate. This site discusses how work-related burnout continues to be a problem among physicians; however, more and more medical specialties are feeling this overwhelming stress.
A study published in Mayo Clinic Proceedings was conducted by physician burnout experts that surveyed 6,880 physicians to “evaluate the prevalence of burnout and physicians’ satisfaction with work-life balance compared to the general U.S. population relative to 2011 and 2014”.
Upon completion of the initial survey in 2011, it was found that approximately 45 percent of U.S. physicians were meeting the criteria for burnout. This percentage increased to 54.4 percent three years later in 2014! Also from 2011 to 2014, it was found that every one of these specialties reported increased burnout rates.
Another study that was conducted on health workers found burnout rates ranging from 25–56%! The most common causes were, “patient death, the emotional struggles experienced during communication with patients, insufficient therapeutic relationships with patients, making critical decisions, [and] managing treatments that have severe adverse effect” (Guveli, et. al., 2015).
In addition to physicians experiencing the effects of burnout, nurses are also seen as extremely susceptible. “Due to their specific professional expectations and inclinations, nursing staff face work overload, excessively long working days, role ambiguity, and lack of autonomy.” Any one of these conditions alone can increase the likelihood of burnout; however, it’s common to see multiple at a time. The results can turn into a difficulty to cope along with a progressive loss of idealism and energy (Manzano-Garcia, 2017).
“During the interaction between the individual and [their] working environment, demands exceed the individual resources and the nurse experiences an effort-reward imbalance. In the long run, the stressful experiences resulting from this disequilibrium are very likely to result in states of exhaustion and burnout.”
Due to the requirements of the nurse’s job, issues involving role conflict, role ambiguity, bad work relationships, lack of appropriate staff, overtime hours, inadequate salaries, and lack of promotions all affect the emotional stability of the individual and contribute to these high burnout rates (Manzano-Garcia, 2017).
What are some ways to manage burnout?
After covering the potentially serious side effects of this stress syndrome, we need to discuss various ways to try to successfully manage the symptoms.
In order to deal with these daily stresses, many people adopt certain ‘coping styles’. “Coping styles are defined as stable psychological and behavioral strategies to overcome or tolerate external and internal challenges or stressors.” While some people try to cope with stress actively, others choose to cope passively. Active coping strategies are known to be either behavioral or psychological responses that are “designed to change the nature of the stressor itself or how one thinks about it.” Passive coping strategies, on the other hand, are seen negatively and lead people into activities (such as alcohol use) or mental states (withdrawal) (Li, et. al., 2014).
The activities I want to discuss are more in the category of ‘active’ coping strategies and some are more common than others. Despite the differences in causes and symptoms between the terms stress and burnout, some strategies for minimizing and eradicating them can be very similar. A few easy management techniques you can try include:
meditation: focusing your attention on things that are happening right now (paying attention to your breathing)
volunteering: helping others can have a tremendous impact on your emotional well-being and can take your mind off of yourself
exercising: release those endorphins!
working on a hobby: take your mind off of your current problems
Although these are just a couple stress-relieving strategies, they can really make a positive impact on the effects of burnout. For a much longer list of coping mechanisms, check out this site!
Try making a goal of exercising a few times per week, or promise yourself to meditate once a week over an extended period of time. Remember that interview? Over time, you might surprise yourself with how much stress can go away with simple tasks like these!
Interdisciplinary Intertwining
The signs, symptoms, and negative consequences of burnout can affect any number of individuals who work across a large continuum of jobs.
Sociologically
Merriam-Webster defines sociology as, “the systematic study of the development, structure, interaction, and collective behavior of organized groups of human beings.” When reviewing sociological factors, we want to look at how burnout affects large groups of people. These groups can be categorized into professions such as medical doctors or nurses and compared and contrasted with each other statistically. Analyzing these factors can allow us to see how burnout can change when presented with new career choices or job requirements. Are nurses happier with their job and don’t experience as much burnout as doctors? Or is it the opposite and we can see that doctors see higher prevalence of burnout due to an increase in required medical knowledge?
Psychologically
Psychology, the science of mind and behavior, helps prove that burnout is just as much a pervasive issue of the mind as it is of the body.
In addition to potentially becoming a debilitating physical stress, “psychological factors including personality and coping style are known to affect perceived distress of environmental factors and are important in light of developing effective intervention…[factors include] uncertainty of the job due to unpredictability of the clients‘ response, and having to manage to behave as a professional and provide warm care at the same time” (Schwartzhoffer, 2009). Constantly trying to cope with this stress syndrome take a toll on your mind and can affect decision making.
Medicine
Throughout this article, I have presented the problems of burnout within professions such as physicians, nursing, nurse practitioners, and physician assistants; however, researchers have identified this problem occurring regularly in so many more work environments! We could sit here all day and discuss jobs around the world that experience this stress syndrome and that’s just not acceptable. Assisting patients, managing medical forms, and interacting with emotional and physical disabilities takes a tremendous toll on these healthcare workers and it’s up to us to try to manage the causes in a positive way.
Individually, these three disciplines are affected by burnout and the signs and symptoms are present. Each of these also affect the other and go together as a whole. The premise of psychology allows us to review how the mind comes into play. What are the thought processes an individual goes through when dealing with burnout? How do their emotions affect their work life balance? Psychology is a major key player when identifying burnout causes and relievers.
Sociologically, we can identify a whole group of healthcare workers and tie their collective views together with individual thought processes. Questions such as, “What is a general consensus on how to handle this stress?” This can then be compared to a specific individual and bring to light even more new questions that weren’t previously thought of. Both psychology and sociology are connected to the broad spectrum of medicine when burnout is researched. We can now ask questions pertaining to why the prevalence is so high among medical workers, or why certain groups are more prone to the effects of burnout compared to other groups.
It is vital to combine these disciplines to figure out common solutions and without the interdisciplinarity, the entire concept is just a fruit bowl.
Why does any of this matter?
It’s not just the future of our healthcare workers, it’s our future as patients! Burnout is increasing throughout these professions and we, as patients, are going to be the ones suffering if necessary precautionary measures are not met. In all, it’s vital to address why burnout is an issue in the workforce, discuss common signs and symptoms, and ways to properly contain and minimize these emotional and physical boundaries. I’m here for you! We need to look at this matter from a psychological, sociological, and medical perspective in order to ask new questions and successfully solve this problem.
Don’t just blindly follow others within your field. Be a leader, save the world!
Works Cited
Biksegn, A., Kenfe, T., Matiwos, S., & Eshetu, G. (2016). Burnout Status at Work among Health Care Professionals in a Tertiary Hospital. Ethiopian Journal of Health Sciences, 26(2), 101-108. doi:10.4314/ejhs.v26i2.3
Dyrbye, L., & Shanafelt, T. (2016). A narrative review on burnout experienced by medical students and residents. Medical Education, 50(1), 132-149. doi:10.1111/medu.12927
Guveli, H., Anuk, D., Oflaz, S., Guveli, M. E., Yildirim, N. K., Ozkan, M., & Ozkan, S. (2015). Oncology staff: burnout, job satisfaction and coping with stress. Psycho-Oncology, 24(8), 926-931. doi:10.1002/pon.3743
Li, X., Guan, L., Chang, H., & Zhang, B. (2014). Core Self-Evaluation and Burnout among Nurses: The Mediating Role of Coping Styles. Plos ONE, 9(12), 1-12. doi:10.1371/journal.pone.0115799
Lyndon, A. (2016, February). Burnout Among Health Professionals and Its Effect on Patient Safety
Manzano-García, G., & Ayala, J. (2017). Insufficiently studied factors related to burnout in nursing: Results from an e-Delphi study. Plos ONE, 12(4), 1-20. doi:10.1371/journal.pone.0175352
Oser, C. B., Biebel, E. P., Pullen, E., & Harp, K. H. (2013). Causes, Consequences, and Prevention of Burnout Among Substance Abuse Treatment Counselors: A Rural Versus Urban Comparison. Journal Of Psychoactive Drugs, 45(1), 17-27. doi:10.1080/02791072.2013.763558
Schwartzhoffer, R. V. (2009). Psychology of Burnout : Predictors and Coping Mechanisms. New York: Nova Science Publishers, Inc.
Schaufeli, W., Leiter, M., & Maslach, C. (2010). Burnout: 35 Years of research and practice. IEEE Engineering Management Review, 38(4), 4-18. doi:10.1109/emr.2010.5645750
Smith, M., Segal, J., Robinson, L., & Segal, R. (2016, December). Burnout Prevention and Recovery
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