Burnout redux?

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pseudoknot

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I'm surprised this hasn't been discussed here yet. I'd started to think the whole burnout thing was a nonissue and then found this in my ACEP news email:

CQ (2/11, Attias) reports that nearly a third emergency physicians "show signs of career burnout primarily caused by anxiety that their patients will fare badly, according to a new study published online in the Annals of Emergency Medicine." The study, based on a random sample of members of the American College of Emergency Physicians, "characterized burnout by feelings of low personal accomplishment, depersonalization and emotional exhaustion. Nearly three-quarters (72.5 percent) of the sample comprised male physicians with an average age of 41 and an average of 12 years practicing emergency medicine." According to the findings, "32.1 percent of emergency physicians showed at least one component of burnout, most commonly emotional exhaustion." In addition, the study found that "high anxiety, caused by a strong emotional involvement with patients and a concern that they will not have a good outcome, is the single biggest predictor of career burnout."

The article is here and the conclusion in the abstract reads:
A large percentage of emergency physicians in this study, 32.1%, exhibited emotional exhaustion, which is the core symptom of burnout. Emotional exhaustion was not related to age or type of practice and was not mitigated by training in emergency medicine. Physicians studied did not feel anxiety because of general uncertainty, difficulty in disclosing uncertainty to patients, or admitting errors to other physicians. High anxiety caused by concern for bad outcomes was the strongest predictor of burnout. Despite exhibiting emotional exhaustion, the majority of respondents are satisfied with the career of emergency medicine.

I guess my first question is, how does this compare to other specialties? Especially with the disconnect between career satisfaction and burnout, I'd speculate it could be even worse in some other fields.
 
"Burnout" is an issue in every specialty and every job. Do you think plumbers and bus drivers don't get tired and pissed off? The difference is that nobody is asking these questions of physiatrists and surgeons as often because we're all told that "Emergency Medicine is the burnout specialty". The bigger and more important questions are "What is the burnout rate among physicians as a whole? What can we do to change this?"

The numbers look eerily similar from other surveys:

National Study of Burnout Among American Transplant Surgeons
Transplantation Proceedings, Volume 37, Issue 2, Pages 1399-1401
W. Bertges Yost, A. Eshelman, M. Raoufi, M. Abouljoud

Abstract

This study examines burnout in a national sample of transplant surgeons. Data analyses were conducted on a sample of 209 actively practicing transplant surgeons. Measures included the Maslach Burnout Inventory, a demographic survey, and the Surgeon Coping Inventory. Burnout was reflected in 38% of surgeons scoring high on the Emotional Exhaustion dimension, whereas 27% showed high levels of Depersonalization, and 16% had low levels of Personal Accomplishment. Several significant predictors of emotional exhaustion were identified and included questioning one's career choice, giving up activities, and perceiving oneself as having limited control over the delivery of medical services (R2 = 0.43). Those who perceived themselves as having a higher ability to control delivery of medical services and who felt more appreciated by patients had lower levels of depersonalization and were less likely to question their career choice (R2 = 0.16). Surgeons with high personal accomplishment experienced greater professional growth opportunities, perceived their institution as supportive, felt more appreciated by patients, and were less likely to question their career (R2 = 0.24). The prioritization of goals to reflect both professional and personal values accounted for a significant amount of the variance in predicting both emotional exhaustion and personal accomplishment in separate regression equations. Recommendations to decrease burnout would include greater institutional support, increased opportunities for professional growth, and greater surgeon control over important services to facilitate efficient work. Coping strategies to moderate stress and burnout are also beneficial and should include prioritizing goals to reflect both professional and personal values.

and

1: Surgery. 2001 Oct;130(4):696-702; discussion 702-5. Links
Burnout among American surgeons.

Campbell DA Jr, Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ.
Department of Surgery, University of Michigan Health System, Ann Arbor, Mich 48109-0331, USA.
BACKGROUND: The long-term consequences of stress on the surgeon are unknown. One manifestation of stress is burnout. The purpose of this study was to measure the prevalence of burnout in actively practicing American surgeons. METHODS: The Maslach Burnout Inventory and a questionnaire of our own design were sent to 1706 graduates of various University of Michigan surgical residencies (1222) and members of the Midwest Surgical Association (484). The response rate was 44%. Responses from 582 actively practicing surgeons were the sample used for analysis. RESULTS: Thirty-two percent of actively practicing surgeons showed "high" levels of emotional exhaustion, 13% showed "high" levels of depersonalization, and 4% showed evidence for low personal accomplishment. Younger surgeons were more susceptible to burnout (r = -0.28, P <.01). Burnout was not related to caseload, practice setting, or percent of patients insured by a health maintenance organization. Important etiologic factors were a sense that work was "overwhelming" (r = 0.61, P <.01), a perceived imbalance between career, family, and personal growth (r = -0.56), P <.01), perceptions that career was unrewarding (r = -0.42, P <.01), and lack of autonomy or decision involvement (r = -0.39, P <.01). A strong association was noted between burnout elements and a desire to retire early (r = 0.50, P <.01). CONCLUSIONS: Burnout is an important problem for actively practicing American surgeons. These data could be used to modify existing surgical training curricula or as an aid to surgical leadership when negotiating about the surgical work environment.
 
I thought shift work was a major factor in burnout. Is that not true?
 
I thought shift work was a major factor in burnout. Is that not true?

Circadian stress is a factor which comes both in the form of shift work related issues and from REM sleep deprivation from getting woken up multiple times during the night by your pager when you're on call. But if it shifts were the major contributor then non-shift work physicians would never burn out. We know this to be far from the truth.
 
I thought shift work was a major factor in burnout. Is that not true?

It doesn't sound like it according to what was posted above. I think part of the confusion here is that "burnout" has a pretty specific meaning having to do with emotional exhaustion and loss of a sense of purpose, but people use it in all sorts of ways including just not liking one's job.
 
My dad was a maintenance mechanic at a coal-burning power-plant for 30 years. He hated it with a passion for thirty years. He dreaded every day of work, especially the 5 month long hellish southern nevada summers. He never quit because he needed the pay-check, and because you don't become a mechanic with the idea that it is going to be a picnic.

People get burned out in medicine when they have inappropriate expectations about what their jobs will be like.

A med student who thinks that ERs are all about saving lives, and people thanking you all day long for saving their loved ones is in for a rude awakening. People who expect every patient to be an intellectually stimulating warm fuzzy generating interaction are going to be very unsatisfied very quickly. Their are 10-15 percent of patients that are a real pain to deal with, probably because there are 10-15 percent of the general public that are either drug addicts or have personality disorders. I think my mother has a personality disorder and have spent my entire life cringing as I witness waitresses, airline attendants, cashiers, fellow church members, etc. deal with her ridiculous demands, false perceptions, and emotional out-bursts.

I think that a lot of people might also get disastisfied if their performance isn't quite as stellar as they like. I think everyone who goes into ER thinks that they are going to be the doc who generates massive amounts of thankyou letters from patients, and gets stellar Press-Ganey comments. You think that you are going to be the "cool" doc that all the nurses like, and want to bring their family members to. You think that you will be intubating the impossible intubation and throwing down central-lines in no time flat. When you get out on your own and drop a lung, miss a tube, or feel utterly helpless as you and the nurses can't get an IV in a sick little kid, your self image is shattered.

I know of a doc that started out as a brand-new surgeon in the mid-west, had a few bad cases (out-comes) and got ran out of his hospital. A few bad patients will go a long way to ruining your reputation, and making you not satisfied with your job.

I agree with above, that ER has no worse burn out than any other job in medicine, or in related fields. You guys have been through college and med school and have seen the drama, and politics associated with academia. Imagine being a stock-broker right now, a real estate agent, or a financial planner. My good friend went into construction management with the dream of building houses for a living. Needless, to say, he is not currently building houses due to the crappy market.

This is a weird thought, but every time I go to a really busy fast-food restaurant, I think, "These guys are busier than the busiest ER, and have to deal with even more complaining and BS than we have to put up with in the ER, but get paid a fraction of the wage. You couldn't pay me to work at McDonald's."
 
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I think that the heart of the problem with people who are disatisfied with their career in ER is a lack of gratitude.

We get paid a ridiculous amount of money, work few hours, and at times, get to do and see some pretty cool things.

We live a life-style that 99.9% of the people who have ever lived on this planet could never dream of. We have more access to knowledge, travel, and good food than anyone in the history of modern civilization. The price? Dealing with weird people, nurses, and losing a night's sleep here and there.

I can't think of another career that is as fun, as intellectually stimulating, with as much free time, and that could bring in the cash as consistently as ER.
 
with his/her head on straight!!
People. Look at how the rest of the world lives. OK...now go back to work and thank the gods that you are in the place you are



I think that the heart of the problem with people who are disatisfied with their career in ER is a lack of gratitude.

We get paid a ridiculous amount of money, work few hours, and at times, get to do and see some pretty cool things.

We live a life-style that 99.9% of the people who have ever lived on this planet could never dream of. We have more access to knowledge, travel, and good food than anyone in the history of modern civilization. The price? Dealing with weird people, nurses, and losing a night's sleep here and there.

I can't think of another career that is as fun, as intellectually stimulating, with as much free time, and that could bring in the cash as consistently as ER.
 
I knew it and acted on it.....now I am happy that I made the change....if you do not like, even dread coming to the ER......don't make your life miserable, you will be a better person....remember "to thine own self be true".😀
 
I knew it and acted on it.....now I am happy that I made the change....if you do not like, even dread coming to the ER......don't make your life miserable, you will be a better person....remember "to thine own self be true".😀

So, you were an ER doctor, and quit, and are now happy? Were you a nurse, a tech? Just curious.
 
I think one of the keys to avoiding burnout is to try and keep from putting on the "golden handcuffs" in the first place. If you're living well within your means, you have the breathing room to adjust your shift count depending on how hot your shorts are getting. Feeling like work totally sucks these days? Work a few months where you've only got to go in 10 days a month.

Will
 
The price? Dealing with weird people, nurses, and losing a night's sleep here and there. Is that bad if that excites me?

I think that the heart of the problem with people who are disatisfied with their career in ER is a lack of gratitude.

We get paid a ridiculous amount of money, work few hours, and at times, get to do and see some pretty cool things.

We live a life-style that 99.9% of the people who have ever lived on this planet could never dream of. We have more access to knowledge, travel, and good food than anyone in the history of modern civilization. The price? Dealing with weird people, nurses, and losing a night's sleep here and there.

I can't think of another career that is as fun, as intellectually stimulating, with as much free time, and that could bring in the cash as consistently as ER.
 
I was burnt out on school by about 10th grade. Now I'm debating getting an MBA after residency.
 
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