Beating Burnout
If Katy H. Goldsborough, MD, a
hematologist/oncologist with EdwardElmhurst Healthcare in Naperville,
Illinois, started to feel “burned out,” no
one would blame her: Dr. Goldsborough
has been a full-time practicing physician
with her current group since 2009, and
she and her husband are parents to four
children under age 10.
Add to that reimbursement
challenges, the looming switch to more
complicated ICD-10 billing codes, the
emotional toll of caring for seriously
ill patients, the rollout of cumbersome
electronic medical record (EMR) systems,
and the increasing number of patients
now eligible for health care under the
Affordable Care Act, and you have
a prescription for widespread
burnout and dissatisfaction.
Burnout is a clinical
condition characterized
by physical and
emotional exhaustion,
depersonalization, and
little sense of personal
accomplishment.
While burnout is
not a phenomenon
unique to clinicians,
they are particularly
susceptible to it.
And the problem
is only getting worse:
In 2002, 22 percent
of internal medicine
physicians reported
experiencing burnout;1 more recent data
show 46 percent of physicians stating they
have experienced burnout.2
ASH Clinical News spoke with several
clinicians about what constitutes burnout,
its prevalence in medicine, and how
physicians can best avoid it – or at least
manage it.
A Complex and Multifaceted
Problem
Tait D. Shanafelt, MD, professor of
medical education and medicine and
a hematologist at the Mayo Clinic in
Rochester, Minnesota, has been studying
physician burnout for more than a decade.
“Burnout is a complex and
multifaceted phenomena,” Dr. Shanafelt
told ASH Clinical News. “The main factors
causing this physical and emotional
exhaustion are related to workload,
work efficiency, autonomy and a sense of
control over work, work-life integration,
and meaning at work. Individual,
organizational, and national factors
contribute to each of these dimensions.”
What are the most common
complaints among today’s practicing
hematologists? In a 2013 “Survey of
Practice-Based Hematology” conducted
by ASH, 25 percent of respondents
named delayed, inadequate, and
reduced reimbursement as a major
practice-affecting issue. Twenty-three
percent listed high staff turnover, poor
recruitment and retention, understaffing,
and other staffing issues as major
concerns, followed by insurance problems
(15%), drug and practice costs (13%), and
EMR and documentation (12%).3
“Professionally, burnout can
contribute to cynicism, unprofessional
behavior, medical errors, and staff
attrition,” Dr. Shanafelt added. “On a
personal level, studies suggest burnout is
related to broken relationships, substance
abuse, and suicide.”
Much of Dr. Shanafelt’s work utilizes
the Maslach Burnout Inventory, a tool
developed by Christina Maslach, PhD,
from the University of California at
Berkeley. The Maslach Inventory measures
three general scales to calculate burnout:
emotional exhaustion, depersonalization,
and general accomplishment.
In one study, Dr. Shanafelt and
colleagues found that burnout seems to
be a common manifestation of distress
among oncologists: 35 percent of medical
oncologists, 38 percent of radiation
oncologists, and 28 to 36 percent of
surgical oncologists reported experiencing
burnout.4
To better characterize the prevalence
of burnout among health-care workers,
Dr. Shanafelt and his colleagues also
compared the frequency of work-related
mental and physical exhaustion among
physicians with the general population.
In a survey of 7,288 physicians assessed
using the Maslach Burnout Inventory,
45.8 percent of physicians reported at least
one symptom of burnout.5 Compared
with a probability-based sa \Hو