Burnout in physicians and surgeons is a response to multiple factors that can negatively impact their professional and personal lives, leading to emotional exhaustion/depletion, depersonalization, reduction in career satisfaction, and negative patient and non-patient personal interactions. Burnout may be a progressive process that waxes and wanes over the years, depending on the work and personal environments, but it may eventually lead physicians and surgeons to consider early retirement or a career change away from direct patient care. Quality-of-life issues with respect to work-personal balance can be caused by burnout as well as affected by this condition. In sum, burnout has come to the forefront as a major professional issue that needs to be recognized, understood, and mitigated.
Explore this issue:April 2017
Younger physicians and surgeons may be more susceptible to developing burnout, perhaps in part because they have not yet developed appropriate experience and coping mechanisms. Indeed, it is estimated that up to 50% of medical students exhibit signs or symptoms of burnout at some point in their undergraduate medical career (Bull Am Coll Surg. 2011;96:17–22). This may well carry into residency training, and might even be exacerbated by increased educational and clinical pressures and decreased personal recovery time. Residency training is a time of highly accelerated acquisition of knowledge and skills and includes challenges in time management and wide-ranging experiences. Particularly in the surgical specialties, each resident physician brings to the training experience an abundance of intellectual and technical skills, cultural and family experiences, biases and perspectives, and personality traits. For surgeons, a healthy dose of obsessive/compulsive behavior is felt to be necessary, with perfectionism often a goal, even when these behaviors can occasionally reap negative results.
One of the best studies performed to date on burnout in otolaryngology residents was a survey published in 2007 by Golub and colleagues (Acad Med. 2007;82:596–601). The survey results were based on the responses of 514 otolaryngology residents in the second through fifth years of training. The authors reported an 86% response rate for residents reporting moderate (76%) or high (10%) levels of burnout at some time during their residencies (See “Maslach Burnout Inventory–Human Services Study Subscale Stratification of Otolaryngology Residents,” below). Interestingly, high levels of personal accomplishment seemed to buffer or protect against burnout.
If emotional exhaustion is an early predictor for the development of some level of burnout, it seems reasonable that close observation of a resident physician for this phenomenon would be a salutary finding to prompt intervention and mitigation. When depersonalization of oneself and of the patient leads to diminished capacity for self-realization and concern for the patient, burnout is at a serious stage. What follows may be an obvious lack of concern for personal appearance and care, and for the care of and interaction with patients. Errors and mishaps in patient encounters may occur, and these may further depress the resident, leading to lowered feelings of self-worth and a downward spiral of competency. Bedside manner becomes worrisome.