Burnout. It’s a hot topic in medicine in general, and EM specifically. It seems that every single month one journal or another brings mention of burnout. Even the internists are worried about us: a JAMA Internal Medicine Study found that emergency physicians are the most burned out specialty in medicine, with 65% self-reporting burnout.
Let’s back up a little. It seems intuitive that burnout matters, but what exactly is it, and why is it so important now? One definition that makes some practical sense is simply the failure to bounce back. Resilience and burnout are flip sides of a coin, and when our resilience wanes, we start to feel burnout. We are tired regardless of hours slept, feel emotional exhaustion, low personal accomplishment, and depersonalization.
Burnout has many causes but it runs rampant in medicine for a number of reasons. Our jobs are inherently stressful. Not more so than all others, but more so than many. Our work is more physically demanding than many other professional jobs, and we have a stress-inducing combination of high-stakes work with little control over workload and even, in many cases, outcome. Add to that the fact that we are the recipients of other people’s fear, pain and stress and we transact in catastrophic life events, and it’s easy to see where this will drain a physician’s reserves.
Despite the age-old presence of these stressors in the practice of clinical medicine, we aren’t taught to achieve work-life balance. Instead, we are en-cultured to put other people’s needs ahead of our own and to sacrifice our mental, emotional, and physical well-being to our patients and careers. This includes sacrificing family and life time that could recharge us. Instead we are expected to give long hours only to clinical medicine, in training and beyond. Given that medicine tends to attract perfectionists with excellent work ethic, it’s no surprise doctors burn out and have trouble talking about it. (This is before we even address administrative changes and factors that contribute.)
All of this can lead to decreased effectiveness at work, but it can also have consequences at home. According to the ACGME, burnout has been shown to increase medical errors, impair professionalism, reduce patient satisfaction, increase risk of depression, suicidal ideation, and addiction, and increase the risk for motor vehicle collisions.
At this point in the blog post, I know you have two questions that remain:
How are we doing as a group, and how can we do better?
During ACEP Wellness Week, UIC EM residents were asked to complete a burnout survey. The link to the survey as well as a brief summary of our data are included below. It’s no surprise that this affects us as much as any other group of physicians, despite the strength of our supportive community. That community acts a resource, and one of the things that we can try to do together is start addressing the issue of burnout. So how did we do?
Resident Burnout Survey Results:
Date administered: 1/26/2017
Completed Surveys: 26
Low Score: 26
High Score: 56
Average Score: 40.3
|15-18||No sign of burnout here.|
|19-32||Little sign of burnout here, unless some factors are particularly severe.|
|33-49||Be careful – you may be at risk of burnout, particularly if several scores are high.|
|50-59||You are at severe risk of burnout – do something about this urgently.|
|60-75||You are at very severe risk of burnout – do something about this urgently|
One of the first things we can do is acknowledge that burnout is not a problem to be solved. Problems have solutions, and we set ourselves up for failure by looking for a solution to something so insidious that ebbs and flows in intensity. Instead, we should work on long-term management and minimizing the effects of something that will require perpetual and ongoing attention.
Many of the tips from our ACEP Wellness Week email on work-life balance are the first steps you can take to help mitigate burnout. These include prioritizing yourself, saying “no”, and scheduling important things like workouts, date-nights and family time on your calendar, to give them equal priority with your clinical and non-clinical duties.
It’s important, though, to not get overwhelmed by making these changes. Pick one. One thing to try each week for a few weeks to reclaim your life and re-center yourself. Keep your goals reasonable, like one social meal each week with a friend, or one single workout if you’ve lost the habit. Why not start now?
http://epmonthyly.com/article/from-burnout-to-balance/, accessed 3/3/2017
http://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/Education, accessed 3/3/2017
http://www.aafp.org/fpm/2015/0900/p42.html, accessed 3/6/2017
Dr. Marinelli is an attending EM physician at Advocate Lutheran General Hospital.