# 168 Health Professional Burnout - Part II

FAST FACTS AND CONCEPTS #168 PDF


Author(s): Linda Blust MD

Background As described in Fast Fact #167, burnout is a “psychological syndrome in response to chronic interpersonal stressors on the job” (Maslach 1982). This Fast Fact will explore symptoms of burnout and its personal and professional consequences. Fast Facts #169 and 170 will describe avoidance and assessment of burnout.

Symptoms of each sequential stage of burnout

  • Stress Arousal: anxiety, irritability, hypertension, bruxism, insomnia, palpitations, forgetfulness, and headaches.
  • Energy Conservation: Work tardiness, procrastination, resentment, morning fatigue, social withdrawal, increased alcohol or caffeine consumption, and apathy.
  • Exhaustion: Chronic sadness, depression, chronic heartburn, diarrhea, constipation, chronic mental and physical fatigue, the desire to “drop out” of society.

Consequences

  • Personal
    • Depletion of emotional and physical resources.
    • Negative self-image: feelings of incompetence and lack of achievement.
    • Self-neglect: 35% of Johns Hopkins’ medical graduates had no a regular source of health care.
    • Questioning of previously held spiritual beliefs.
    • Neglect of family and social obligations.
    • Mental Illness: anxiety, depression, substance abuse, suicide.
      • Substance Abuse: MD lifetime risk is 10-14%.
      • MD suicide rates similar to general population for both genders
      • Relative Risk of MD suicide versus other professionals
        • Male MDs: 1.1-3.4
        • Female MDs: 2.5-5.7
        • Female MDs complete suicide as often as male MDs
  • Professional
    • Longer Work hours: If I work harder, it will get better.
    • Withdrawal, absenteeism, and reduced productivity.
    • Depersonalization: attempt to create distance between self and patients/trainees by ignoring the qualities that make them unique individuals.
    • Loss of professional boundaries leading to inappropriate relationships with patients/trainees.
    • Compromised patient care.
    • 45% of University of Washington residents who self-report burnout also report providing “suboptimal care.”

References:

  1. Booth JV, Grossman D, Moore J, et al. Substance abuse among physicians: a survey of academic anesthesiology programs. Anesthesia Analg. 2002; 95: 1024-1030.
  2. Center C, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003; 289:3161-3166.
  3. Gross CP, et al. Physician heal thyself? Regular source of care and use of preventive health services among physicians. Arch Int Med. 2000; 160:3209-3214.
  4. Linzer M, et al. Predicting and preventing physician burnout: results from the United States and the Netherlands. Am J Med. 2001; 111:170-175.
  5. Maslach C. Burnout: The Cost of Caring. Englewood Cliffs, NJ: Prentice-Hall; 1982.
  6. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Ann Rev Psychology. 2001; 52:397-422.
  7. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Int Med. 2002; 136:358-367.

Fast Facts and Concepts are edited by Drew A Rosielle MD, Palliative Care Center, Medical College of Wisconsin. For more information write to: drosiell@mcw.edu. More information, as well as the complete set of Fast Facts, are available at EPERC: www.eperc.mcw.edu.

Version History: This Fast Fact was originally edited by David E Weissman MD and published in November 2006. Current version re-copy-edited in April 2009.

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Blust L. Health Professional Burnout – Part II. Fast Facts and Concepts. November 2006; 168. Available at: http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_168.htm.

Disclaimer: Fast Facts and Concepts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

ACGME Competencies: Professionalism

Keyword(s): Psychosocial and Spiritual Experience: Patients, Families, and Clinicians