“Psychological research has shown that the most reliable route to personal happiness is to make others happy. I have made many patients very happy with successful operations but there have been many terrible failures and most neurosurgeons’ lives are punctuated by periods of deep despair.” ~ Henry Marsh, Do No Harm: Stories of Life, Death, and Brain Surgery
One of my physician colleagues, and friend, recently posed the question about how long it takes to recover from burnout, even when positive changes have been made. I really wanted to tackle this question as I believe it impacts so many people, not just physicians. First, we have to look at what burnout means, what can be done to improve it, and if a longterm resolution exists. This is a significant topic to cover in one post so we will just touch on burnout and on how to recover, if possible.
What is burnout?
Physician burnout has come to the forefront of discussions in the medical community, for both physicians and organizations. With burnout cited as impacting over 50% of practising physicians in the United States, and similar figures expected here in Canada, it becomes apparent why a sense of urgency exists around this physician health concern.
But what really is burnout? You can find many variations of the definition of burnout, but they all contain the same 3 underpinnings – exhaustion, cynicism, and decreased effectiveness at work. I don’t know about you, but I find this definition difficult to put into a real-life context. I believe this is why burnout is so insidious and under-recognized before it goes on to more serious consequences such as mental illness, substance misuse, relationship breakdowns and tragically, suicide.
My husband Colin was quite burned out before we were able to put the pieces together. When does work stress reach that critical tipping point of too much, and our ability to cope becomes more difficult? From all of my work and research in this area, it really depends on the individual. The factors leading to burnout may be more generalizable, but our reaction to those stressors is so complex when you consider all of the other variables such as supports, health, self-awareness, stress relieving activities, etc.
What causes burnout?
Although work burnout impacts other professions as well, when it comes to physicians, many identifiable influences, all in the form of stressors, exist. Right now much of the research and intervention strategies are aimed at organizational causes such as regulatory metrics (output driven indicators, satisfaction measures), the time lost to clerical input (electronic medical records entry), and increasing complexity of medicine (continuous new guidelines and protocols), just to name a few.
The practice of medicine itself cannot be overlooked as a significant cause – continuous exposure to human suffering; patient expectations with internet searches and online doctor ratings; the ever increasing workload (often organizational driven). To narrow down the causes, I believe that lack of control and lack of autonomy are two of the more impactful ones.
How can burnout be managed?
Back to an individual approach to physician burnout, Colin and I both believe that the management of burnout has to be individualized as well. This may be contrary to some people’s way of thinking, especially given the push for the need for organizational changes. Although we agree that these changes need to happen, they are not likely to be the entire solution. Given that some people are more prone to burnout than others, a one-size fits all approach cannot be the sole answer.
An inevitable need to address emotional intelligence, self care, and dare I say resilience (it has become a bit overplayed in this discussion, but cannot be downplayed), exists in this context. For example, self-awareness, emotional regulation and empathy are highly adaptive qualities as a leader – both personal leadership and professional leadership. Setting boundaries, perspective taking, and taking care of one’s wellbeing are all very important parts of this conversation.
Can you fully recover from burnout?
So back to the question – can you fully recover from burnout? Burnout is a syndrome, or a constellation of symptoms, representative of a bigger problem. No true measure exists to diagnose burnout except for questionnaires often used for research such as the Maslach Burnout Inventory.
In a comprehensive article by Christina Maslach and Michael Lieter, Understanding the Burnout Experience: Recent Research and Its Implications for Psychiatry, they do touch on the treatment of burnout with the caveat that much work is to be done in the area. Some of the general themes that emerged include the following:
- Improving engagement
- Workload modifications
- Recovery initiatives
- Strategies to improve workplace civility
- Peer support
So, in an attempt to answer this question, I invite you to consider some other points:
- External variables will always be fluid and subject to change
- How do we tackle erosion of meaning in work except at an individual level? Doesn’t this fluctuate too?
- Building communities can work, but what does the impact of difficult community members have on it?
- The one thing we have control over is our internal environment and how we react to external forces
Physician burnout is dynamic and ever changing, on a day-to-day individual level, and on a broader systems/organizational level. We need to keep the conversation going, support one another and find creative ways to help each and every physician prevent and manage burnout.
Montgomery, A. (2014). The Inevitability of Physician Burnout: Implications for Interventions. Burnout Research. 1:50-56.
Shanafelt, T., Dyrbye, L. and West, C. (2017). Addressing Physician Burnout: The Way Forward. Journal of the American Medical Association. E1-E2.
Harvard Business Review – Why Some People Get Burned Out and Others Don’t
PubMed Health – Depression: What is Burnout?