Chances are good that either you, or someone you work with, are suffering from some degree of burnout. Chances are even better that you don’t know it.
Burnout isn’t the same as stress. It’s not about being tired, and it’s not about being depressed. Burnout is a state of emotional and mental exhaustion in your professional life, manifest by a loss of joy and meaning in your work, a tendency to withdraw and depersonalize patients and colleagues as objects or obstacles, and a lowered sense of personal accomplishment or self-worth. If burnout were just a result of exceeding a certain threshold of exposure to the accumulated stresses and failures in one’s professional life, then we might expect burnout to increase in prevalence over the course of a career. Medicine is a stressful job. So maybe we physicians should come to expect a certain amount of burnout, which will increase over time as a career hazard, the way we’ve come to recognize the risks of higher rates of divorce, depression and suicide within our profession?
But that’s not what’s going on. Something’s not right out there. Burnout is being reported in excess of 50 percent among physicians — and the rates may be highest in young physicians, with even residents and medical students reporting burnout rates of 30 to 40 percent. The consequences of burnout include increased rates of medical errors, decreased patient satisfaction, decreased physician leadership and innovation, and increased rates in physician suicide, depression and substance abuse, as well as exodus from the work force. This has generated tremendous concern over the burnout phenomenon among medical schools, training programs, hospitals and health care systems.
The AGA Institute Education and Training Committee surveyed gastroenterologists to gain an understanding of how burnout was specifically impacting our specialty, with special attention to gender, career stage, contributors to burnout and the consequences of burnout on our lives. Over 600 gastroenterologists answered the survey. The results are profound and deeply troubling. What follows is a mere overview of the results, but I hope it serves to further discussions and awareness around this quiet epidemic.
We found over half (54 percent) of all gastroenterologists responding to the survey identified themselves as burned out. Our female colleagues were significantly more likely (62 percent versus 51 percent) to be burned out. We’ve not yet developed further data on this, but there are points worth raising for discussion. Women gastroenterologists may have a greater vulnerability under the burnout domain of a lower sense of personal accomplishment. There are well recognized challenges around issues such as the respect afforded to female physicians, wage gaps and a greater sense of conflict in competing demands between work and family. Time spent in pregnancy, maternity leave and raising children can ultimately impact career direction and productivity, with downstream implications for the pace of career development, promotion or even vesting in a partnership.
We found no significant differences in the prevalence of burnout throughout the different career stages. Shockingly, 50 percent of GI fellows reported burnout, which was not statistically different than rates reported by attending physicians at any stage of their career. This is among the more counter-intuitive (and yet consistent) findings in burnout research. We require a greater understanding of why our trainees would report such a high rate of burnout. Do we cast another stone at the tired and overplayed millennial generation explanation? Or is there something more insidious that has changed in the process of medical education? Is it possible that our trainees are now so over-supervised that they have been relieved of taking responsibility for decision making, which includes the positive consequences of building confidence and self-affirmation? Have their work hour limitations created shift workers without ownership of the patient? Have we deflected and deformed patient interactions to a computer documentation work flow? Have we been robbing trainees of their sense of accomplishment and self-worth, and the joy in medical practice? Food forthought and discussion.
We also explored the degree to which our professional activities impacted burnout. The time spent on clinic appointments or endoscopic procedures did not vary at all between groups reporting themselves as burned out or not burned out, but there appears to be a protective effect from teaching and research. This appears consistent with our understanding of burnout, as these are the very activities that routinely stimulate curiosity and passion, and are rewarded by respect and a sense of accomplishment.
Although a lot has been published on the drivers of burnout, very little information published has been subspecialty specific. Among gastroenterologists, we found the top drivers of burnout to be 1) the increasing sacrifice of personal time for work-related activities (50 percent of respondents), a complaint which I suspect has increased due to electronic medical records, and 2) the increasing imposition of external regulatory burdens (42 percent). Those factors least likely to be associated with driving burnout were any sense of difficulty or stresses associated with mastering and performing endoscopic procedures (6 percent of respondents), as well as the medical knowledge component of practice (9 percent).
Lastly, we wanted to examine the impact of burnout on our professional and personal lives. We found that burnout had the greatest detrimental impact on our overall quality of life, as well as our likelihood to exercise, pursue personally satisfying hobbies and volunteer activities. Gastroenterologists were most likely to preserve and protect their family relationships in the face of burnout. Two very important observations arise from this — faced with the stresses leading to burnout, 1) we are prone to preserve and value our family relationships, but at the expense of sacrificing activities that also likely protect
us to some degree from burnout as well as depression, and 2) any threats or disruptions to the safety lines symbolized by these family bonds (relationship discord, divorce, illness, death) may threaten a more abrupt collapse of those supports that protect us from burnout and depression.
Dr. DeCross has no conflicts to disclose.