Recognizing and Addressing Burnout

First described in 1974, burnout describes the consequences of dissatisfaction in one’s work life. These consequences may include low mood, irritability, exhaustion, loss of occupational purpose, and diminished creativity. The stress created by burnout is insidious. Generally, it arises so gradually that its corrosive effects are unnoticed. It has been referred to as “depression lite.” Much of the contemporary literature on burnout emphasizes its genesis as consequent to the impact of technology on medical practice. At the same time, we recognize that burnout may also result from daily efforts inherent in the work of psychodynamic psychiatry.

Personal account: “A Clinician’s Experience of Burnout” – In a third person account, this contributing psychiatrist reports on the grinding crush of responsibilities encountered in a hospital system. Commentary by Douglas H. Ingram, M.D.

Personal account: “Burnout and Medical Scribe” – This private “out-of-network” private psychiatrist is progressively burdened with non-clinical, administrative, regulatory matter until he employs a medical scribe.

In his brief article on burnout inherent to work in psychodynamic psychiatry, Peter Olsson speaks of “soul-sadness” as a possible consequence of working with patients wounded by matters of character and circumstance. “Soul-sadness”

See the video in which burnout is regarded as “moral injury”

Much of the contemporary literature on burnout emphasizes its genesis as consequent to the impact of technology on medical practice. At the same time, we recognize that burnout may also result from daily efforts inherent in the work of psychodynamic psychiatry.

In Messias’ and Flynn’s article, “The Tired, Retired, and Recovered Physician: Professional Burnout Versus Major Depressive Disorder”, (Am J Psychiat 175:716-719), important distinctions are drawn between the two conditions. The significant areas of overlap deserve consideration.

John Tamerin writes in “Depression, Shame and Stigma in Therapists: To Share or Not to Share – That is the Question” (Connecticut Psychiatrist:55, Fall, 2016), considers the prevalence of depression and the stigma associated, and suicidality among physicians

Medical Student Burnout is considered by Amir, Olivetta, and Mansoor (unpublished). See attachment Medical Student Burnout.

The American Psychiatric Association reports that 2 out of 5 psychiatrists suffer from professional burnout. (Also see the Medscape poll referenced below.) The APA website includes a self-assessment tool, a video presented by Rick Summers, and wellbeing resources. Among others, these resources include TED talks and the APA toolkit for Wellbeing Ambassadors. See: here

The AMA offers an extensive CME program on physician burnout through a series of courses and modules. See: here

Medscape polled physicians about burnout. The poll showed that among physicians, psychiatrists (33%) were among the happiest in their work. Psychiatrists were less likely (38%) than all physicians (46%) to describe themselves as burned out. Female psychiatrists were more likely to report burnout than male psychiatrists (39% v 32%). More than for other disciplines, psychiatrists (50%) are more likely to manage burnout by talking with friends or family. The major reason (60%)for burnout was “bureaucratic tasks (e.g., charting, paperwork).” For the results of the full survey, see: here

Elsewhere, Medscape offers articles on burnout in medicine. Feeling burned-out, Dodell describes the help he found from a course on mindfulness. See here

Articles on burnout among physicians can be found here. Also, consider the professional network, Doximity.

Medical Bag’s writer Hannah Dellabella describes how a meditation technique that focuses on the power of sound can be helpful. See: here

Electronic Health Records (EHR) can contribute to burnout by requiring multiple daily sign-in’s by physicians. Yale Medicine is addressing the problem through advanced IT procedures. See: here

In “When Sparks Stop Flying: How is Clinician Burnout Tied to Patient Outcomes,” George Marzouka reports on a personal experience in which medical politics was the source of his feeling of burnout. See: here

AMA Wire’s Sara Berg itemizes 5 reasons that physicians are less likely to seek support. These include fear of licensure problems, “physician personality,” solitary aspects of professional life, a survival mentality, and a tendency to self-doubt. See: here

Beyond Burnout: A Physician Wellness Hierarchy Designed to Prioritize Interventions at the System Level. (Amer Journ of Medicine (2019) 132:556-563.) Utilizing Maslow’s hierarchy of needs, the authors seek through this model to direct attention to address those issues physicians encounter that can result in burnout. Most basic are physical needs, then safety, respect, appreciation, and resources to fulfill the identity of physician-as-healer. See here

Physician Burnout Costs the U.S. Billions of Dollars Each Year. (Time Magazine, May 28, 2019) See: This article cites a report by Han, Shanafelt, et. al.: Estimating the Attributable Cost of Physician Burnout in the United States (Ann of Internal Medicine 6/4/19) in which it is estimated that the cost of burnout is $4-6 billion. The authors conclude, “Together with previous evidence that burnout can effectively be reduced with moderate levels of investment, these findings suggest substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians.” See here

MSSNY Physician Wellness and Resilience Resources

The American College of Physicians Well Being and Professional Satisfaction Program

The Mayo Clinic Physician Well-Being Index

Burnout in the Medical Profession

How to beat burnout: 7 signs physicians should know

Physician Burnout and Wellness Resources

Physician Burnout – the Three Symptoms, Three Phases and Three Cures

Specialties with the highest burnout rates – New Publication for Healthcare Professionals in Recovery

Psychiatric Times Article on Addiction Treatment for Physicians