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Understanding Burnout in Healthcare
Understanding Burnout in Healthcare
By Stacey J. Drubner, JD, LICSW, MPH
Many believe that burnout is simply something which we must accept, with no real options for prevention or relief. However, burnout is extremely harmful to individuals who experience it, and it threatens to negatively impact anyone who works in or interfaces with the healthcare system. There are consequences to well-being, job satisfaction, retention of the work force, patient experience and other system costs. Moreover, research indicates that those in healthcare are impacted by burnout more than those who work in other industries. If you have concerns about burnout symptoms in yourself or a colleague, contact the Mass General Brigham Employee Assistance Program at 866-724-4627.
The Prevalence of Burnout in Healthcare
The 2019 Medscape National Burnout, Depression and Suicide Report, (which included 15,000 US MD respondents across 29 specialties) found that 44% of physicians report being burned out.
A 2019 paper (JAMA Network Open-Health Policy) on physician burnout in the MGPO (Massachusetts General Physicians Organization) found that overall, burnout increased from 40.6% to 45.6% from 2014 to 2017 survey points. The increased rate was associated with exhaustion and cynicism. Physicians in earlier career stages were found to be the most vulnerable to burnout.
Other studies show that 25-33% of critical care nurses manifest symptoms of severe burnout.
Many believe that burnout is simply something which we must accept, with no real options for prevention or relief. However, burnout is extremely harmful to individuals who experience it, and it threatens to negatively impact anyone who works in or interfaces with the healthcare system. There are consequences to well-being, job satisfaction, retention of the work force, patient experience and other system costs. Moreover, research indicates that those in healthcare are impacted by burnout more than those who work in other industries. There is risk across all medical disciplines and professional training levels.
On a positive note, one recent study (in press) in Mayo Clinic Proceedings (2019) found that burnout levels in physicians have started to trend downward for the first time since 2011. This may be in part because those in a position to study burnout and adopt measures to prevent/counteract burnout have been taking notice and allocating resources to improvement efforts. No longer is the focus just on those who are affected by burnout but also on important system changes. Research on burnout involving nurses and physicians has increased significantly. Those who are engaged include but are not limited to The National Academy of Medicine, the American Medical Association, the Massachusetts Medical Society, the Massachusetts Health and Hospital Association, and well-respected care delivery systems, including Mass General Brigham (MGB) and its hospitals. MGB signed onto the National Academy of Medicine’s Request for Commitment to its Action Collaborative on addressing burnout.
The EAP continues to serve as a confidential, expert resource for physicians, nurses and other employees struggling with burnout.
What is Burnout?
Burnout is not a diagnosis but rather a combination of symptoms:
Cynicism and detachment
Loss of ability to empathize and connect
Feelings of ineffectiveness and lack of accomplishment
The practical translation of this definition is that individuals who are committed to caring for others are not able to do so as effectively and efficiently as possible, and they are unable to thrive personally and professionally.
Causes of Burnout
Burnout is the result of a combination of factors and there are different pathways that ultimately lead to burnout for different individuals. Some of the factors identified in the literature are as follows:
Administrative and technical burden, particularly navigating EMR systems
Lack of control over work
New payment models
Not being able to operate at license/training level
Publicly reported quality metrics
Repeated exposure to helping families with stressful decisions
Complicated ethical issues
Diminished or inadequate time and space to meet with colleagues
Impact of Burnout
No one is Immune to the Potential Effects of Burnout
Whether you are a medical provider, other type of employee, co-worker, part of leadership, a patient or family member, you may be impacted by burnout in the healthcare workforce.
Increased anxiety, depression and suicidality
Increased substance use/misuse
Other physical health impacts – headaches, cardiac, digestive, blood pressure
Negative impact on healthy life-style – sleep, nutrition, exercise, interest in hobbies
Negative impact on relationships inside and outside of work
Job impacts – impaired job performance, decreased perception of job performance, dissatisfaction with job, absenteeism, job changes
Decreased quality and poor patient safety outcomes
Increased medical errors, healthcare associated infections, negative 30-day mortality rates
7 billion attributed annually to hospital-employed physician turnover
The cost of replacing a PCP or specialist ranges from $100,000 to $300,000
One study found that the yearly productivity loss attributable to burnout may be equivalent to eliminating the graduating classes of 7 medical schools
Are You or a Colleague Experiencing Symptoms of Burnout?
Burnout manifests differently in different people and some of the burnout symptoms might be indicative of other conditions or co-occurring conditions, such as compassion fatigue, relationship concerns at home, financial stressors or other mental health concerns. Regardless of the cause, further exploration should be triggered when symptoms are persistent and/or cumulative. For further assistance, please contact the EAP at 866-724-4327
Job Symptoms Loss of enjoyment, detachment, apathy, performance problems
Tools to Measure Burnout Burnout is not a diagnosis but rather a cluster of symptoms. When these symptoms accumulate and/or are persistent, this should generate concern. There are many instruments constructed to measure burnout or symptoms related to burnout. The most commonly used instrument is the Maslach Burnout Inventory, which is a validated, reliable and has 22 self-report questions. Some MGB hospitals have used abridged versions of the Maslach. Click here to view the Maslach Burnout Inventory (Abbreviated)
Help for Burnout
Remember you are not the only one experiencing these types of challenges and stresses
Talk to someone-family, friend, colleague, mentor, unit director
Consider letting leadership know about your concerns about burnout – maybe there are opportunities for assessment and improvement on a clinic or department level
Your department or institution may offer assistance, available via targeted programs or grants. Some options may include initiatives around wellness programs, coaching or career development, reducing administrative burden and Epic training
The EAP is always here to help
Practicing a healthy lifestyle can help mitigate some of the effects of burnout. For more information, visit the Health Lifestyle section on the EAP Wellness page.
Helping a Colleague
Familiarize yourself with the warning signs of a potential developing or existing issue with burnout
No need to diagnose
Don’t be afraid to approach a colleague to register your concern
Just ask “How are you doing?” if you are concerned
If your colleague rebukes or avoids you, at least you have tried, and it might help to plant a seed for later
Let your colleague know you are available to listen if they need a friend or sounding board
Validate your colleague’s experience, as research shows that your colleague is not alone in being a healthcare worker with stress or burnout symptoms
Encourage your colleague to seek help
Let your colleague know that systems interventions are available within Mass General Brigham and your institution. Burnout is not something that anyone needs to face alone
Let your colleague know that the EAP is available to help
In case of emergency, please call 911 or your local hospital emergency service.
This site is not intended to provide any clinical assessment, counseling or other type of intervention. The Mass General Brigham EAP provides links to external websites for your convenience. The EAP is not responsible for the availability, accuracy, or content of outside resources or sites, nor does it endorse them. If you notice any malfunctioning links, please contact the us at: EAP@partners.org. The Mass General Brigham EAP is not a service available to the general public. For more information or to discuss concerns, please contact the Mass General Brigham EAP at 866-724-4327.
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