Article | Telltale Signs of Physician Burnout | NDPHP | North Dakota Professional Health Program

How Did We Get Here?

Burnout is associated with any type of service work that requires high levels of creativity, problem solving, or mentoring. The term burnout was coined in the 1970s to describe detrimental psychological effects occurring as society shifted away from an industrial economy and toward a service economy. Concurrently, social structures that previously supported the work of service professionals were increasingly being stripped away, leaving jobs that place greater demands and provide fewer personal rewards.

Unless you've been living (or working) under a rock, you've probably noticed that the term “physician burnout” has become nearly inescapable of late, as this formerly silent epidemic has emerged from the shadows and onto just about everyone's lips in the medical community and, increasingly, in the broader community. Blog articles urging patients to “fire” their physician if they suspect he or she might be a victim of burnout don’t help the situation and only serve to further stigmatize doctors.

To put it in perspective, the term burnout has actually been around since the 1970s, when it was first used to describe the psychological fallout occurring as society shifted away from an industrial economy and towards a service economy. Along with this radical societal transformation, social structures that previously supported the work of service professionals were increasingly being stripped away, leaving jobs that place greater demands and provide fewer personal rewards. All of which brings us to where we are today.

Burnout involves three main components:

Emotional exhaustion
A sense of depersonalization
Reduced perception of personal accomplishment

Two primary maladaptations result: cynicism about the value of one’s profession and uncertainty about one’s ability to perform to an acceptable standard. These produce a constellation of associated mental, emotional and physical signs and symptoms.

Why Physicians?

The culture within medical training and practice creates a perfect recipe for burnout. It is a system that takes individuals who are already proven high performers and tests the limits of those qualities with virtually impossible time and performance demands. Its quasi-military style, which some have asserted is exploitative and abusive, relies on strict hierarchy, including berating and humiliation of its trainees. As a result medical students, who suffer higher than average rates of depression associated with the pressures of medical school, graduate into 80-hour-per-week residencies, only to get into practice and discover the reality of ever-increasing patient loads combined with simultaneously burgeoning clerical duties.

Though the Maslach Burnout Inventory (MBI), a 22-question psychological survey, has been in use for more than 40 years it wasn’t until the first national study in 2011 that the epidemic of physician burnout that has been occurring for decades started to be widely acknowledged. Current data reveals that more than half of all physicians report experiencing symptoms of burnout on a daily or frequent basis. Those on the front lines of care—general and family practitioners and emergency care providers—are most likely to succumb, though rates in certain specialties, notably surgery, topping 70%. Nurses, ancillary care providers and administrators are, by all accounts, at similar risk.

The effects of burnout ripple through the system so that, inevitably, quality of care suffers. Burnt out healthcare professionals show poor judgment, resulting in increased clinical errors with costly repercussions to the health and lives of patients and healthcare dollars spent. Seemingly, the system has reached and exceeded its carrying capacity and fundamental changes are needed.

Physician holding head and very stressed

Stopping the Cycle

Growing public awareness is an important step toward fixing the problem, but institutions change slowly and medicine is no exception to that rule. For the time being, and it’s up to practicing physicians and healthcare professionals to look out for each other by learning to detect the early signs and acting on them.

The signs of physician burnout are essentially the same as those for other service professions and can be grouped around the three main components of the syndrome. Keep in mind that burnout exists along a continuum and some signs may overlap. Following is a checklist of important signs to look for in your colleagues, practice partners and associates.

Female physician resting her head on a window

Emotional Exhaustion

Your colleague is unable to recharge in between shifts or after a vacation and will start back to work still visibly drained.
Professional demeanor increasingly goes by the wayside, replaced by short-tempered, irritable, and/or argumentative behavior.
Your colleague begins to express feelings of dread about the workday or describes his or her workload as insurmountable.
Forgetfulness, poor focus or inattentiveness become more frequent, impacting job performance and making him or her more prone to injuries and accidents.
Emotional exhaustion leads to physical fatigue that is, paradoxically, combined with insomnia. Listen for complaints consistent with this sort of “wired and tired” phenomenon.
Emotional and physical exhaustion suppress the immune system. A stoic physician with no other outward signs of burnout may start to suffer illnesses more frequently or develop a chronic condition.

Depersonalization

Depersonalization leads to cynicism and detachment, which shows up initially as lack of enthusiasm and enjoyment, progressing to displays of anxiousness or pessimism.
As resentment or indifference toward patients, also known as “compassion fatigue” sets in your previously sympathetic colleague may to start to complain about patients in a callous way.
An unresolved sense of detachment gives way to issues of trust. In the medical practice setting signs may include uncooperativeness or an unwillingness to collaborate or share information.
Physically isolative or avoidant behaviors that reflect the individual's inner feelings of disconnectedness begin to emerge. He or she may opt out of office lunches or parties, habitually arrive early (or late) to avoid having to interact with others or fail to return correspondences.
When pressed even slightly to engage socially or be more responsive, a colleague who is experiencing depersonalization may respond with anger.

Reduced Perception of Personal Accomplishment

Pessimism gives way to hopelessness, apathy and a “why bother” attitude. Outwardly, this manifests as inaction, such as lack of appropriate follow up or inadequate record keeping.
In daily practice apathy or a sense of lack of accomplishment can also adversely impact clinical decision making. A physician in this phase of burnout may neglect to consider all diagnostic or treatment options, impairing patient outcomes.
Lack of motivation can cause your colleague to forego taking important steps toward career advancement.
Personal relationships suffer and your colleague may describe a current or recent divorce or breakup.

What To Do?

The good news is that burnout is preventable. One of the most important steps you can take is to refer someone to our program who you believe is burned out. Complete our online referral form or call us at 701-751-5090. Any contact remains anonymous until the physician enrolls.