II. Epidemiology
- Affects up to 50% of U.S. physicians
III. Risk Factors
- Emotional and physical exhaustion
- High patient morbidity and mortality
- Litigation risk
- Circadian rhythm disturbance (i.e. night shifts)
- Depersonalization (e.g. cynicism)
- Decreased personal accomplishment Perception
- Decreased work-life balance satisfaction (i.e. general surgery, OB/Gyn, surgical specialties)
IV. Risk factors: Specialty
- Positive risks (higher burnout rates)
- Family Medicine
- General Internal Medicine
- Emergency Medicine
- Negative risks (lower burnout rates)
- Dermatology
- Pathology
- Pediatrics
V. Pathophysiology
- Emotional Stress stimulates Corticotropin releasing Hormone to ACTH release
-
ACTH stimulates adrenal release of Cortisol and Catecholamines (Epinephrine, Norepinephrine)
- Short-term adrenal Hormones work to succeed in serious fight or flight events
- Long-term Catecholamine and Cortisol release results in somatic symptoms and comorbidities
VI. Complications
- Decreased quality of patient care
- Decreased professionalism
- Decreased empathy
- Increased medical errors
- Self-destructive behaviors (e.g. Alcoholism or Drug Abuse)
VII. Management: Instituting Change despite Fear
- Create a mental model of what a positive change would look like
- Ask "what if I were to..."
- Make a list of the fears that are a barrier to change
- For each fear, address a preventive strategy to overcome that fear from coming true
- Identify a repair strategy, in case a worst fear does come true
- Identify the potential benefits of success
- Consider the costs of not making a change (status quo)
- References
- Herbert and Rosh in Herbert (2018) EM:Rap 19(2): 10-1
VIII. Prevention: Individual
- Self Actualization pyramid (Kurt Goldstein)
- Physiologic Needs
- Air, water, food, clothing, shelter and sleep
- Safety Needs
- Personal security, financial security, health security
- Love and Belonging
- Group embraces you and loves you for who you are
- Esteem
- Respect and Self Esteem
- Self Actualization (Wikipedia)
- Physiologic Needs
- Life balance strategy
- Plan pleasurable activities for yourself and with family and friends
- Schedule pleasurable activities on your life calendar
- Coping
- Vacation
- Make time for enjoyable activities and hobbies
- Stress Reduction (yoga, Mindfulness)
- Support groups among colleagues
- Socialize with colleagues
- Spend time with family and friends
- Healthy behaviors including regular Exercise and Healthy Diet
- Engage in adjunctive activities that increase job satisfaction
- Leadership roles
- Ensure job security and appropriate compensation (e.g. night shifts should receive fair pay)
- Encourage a supportive environment
- Teaching or consulting
IX. Prevention: Organization
- Job Satisfaction Surveys
- Use standardized surveys that can be compared to other regional and national organizations
- Prioritize change in low scoring areas relative to national benchmarks
- Repeat the survey on a periodic basis (e.g. yearly)
- Identify specific units in the organization that are at the highest stress and risk of burnout
- Train and maintain competent and effective leaders within the organization
- Encourage an environment for peer support and interpersonal connections
- Shared meals and outings
- Salary-based compensation and quality-based incentives may be less stressful than productivity-based models
- Incorporate work-life balance into the schedule (vacation, flexible hours, emergency time-off)
- Encourage healthy life styles (e.g. work benefit programs that discount fitness programs, access to healthy meals at work)
- References
- Gips and Welsh (2019) Crit Dec Emerg Med 33(3): 14
X. Resources
- Shawn Achor: The happy secret to better work | TED Talk
XI. References
- Orman, Herbert and Drummond in Herbert (2016) EM:Rap 16(8):8
- Kalantari in Herbert (2018) EM:Rap 18(8): 14-5
- Bright and Shoenberger in Majoewsky (2013) EM:Rap 13(6): 10
- Cydulka (2008) Ann Emerg Med 51(6): 714-22 [PubMed]
- Shanafelt (2012) Arch Intern Med 172(18):1377-85 [PubMed]