Overview • 45 minutes reviewing the who, what, why, when, where, and how of burnout • 15‐20 minutes focusing on contributors to/interventions for burnout • Remainder of the time for Question/Answer/Open Discussion
Objectives • Learners will be able to define burnout. • Learners will be able to identify two reasons physician burnout is relevant to their practice. • Learners will craft an individualized guide to reducing personal burnout.
TIME, August 2015
History of Burnout • A Burnt‐Out Case (1960) is a novel by English author Graham Greene • American Psychologist Herbert J. Freudenberger first coined the term in 1974 in describing staff burnout • Maslach Burnout Inventory published in 1981
What is Burnout? • Specific Syndrome with three components: 1. Emotional exhaustion “I feel emotionally drained from my work.”
2. Depersonalization “I don't really care what happens to some patients”
3. Decreased sense of personal accomplishment – “I feel like I no longer make a big difference”
Maslach Burnout Inventory • Gold standard for measuring burnout • Copyright held by Mind Garden, Inc. • Likert‐scale rating of 22 statements – How often 0 (never)‐ 6 (every day) – 3 subscales: Emotional Exhaustion (EE), Depersonalization (DP), and Professional Accomplishment (PA) – Burnout = higher scores on EE, DP, or lower PA
Burnout vs Depression • Professional vs Global • Syndrome associated with professions that involve intense interactions with people (nurses, teachers, police, social workers, etc) • Resiliency and recovery
Why is Burn Out Important? • Patient Care – Association with medical errors – Burnout correlates to lower empathy – Burnout has been associated with decreased professionalism
• Physician Well‐Being – Association with higher rates of depression/suicide – Health care shortage Psychiatrists are being asked to intervene
Burnout and Medical Errors • “Burnout and Medical Errors Among American Surgeons” from 2010 Annals of Surgery • Electronic survey‐ 61 questions about a wide range of variables including demographic information, practice characteristics, and career satisfaction • Standardized survey tools: Burnout, Quality of life, and Symptoms of Depression • “Are you concerned you have made any major medical error in the last 3 months?”
Burnout and Medical Errors Among American Surgeons. Shanafelt, Tait; Balch, Charles; Bechamps, Gerald; Russell, Tom; Dyrbye, Lotte; Satele, Daniel; Collicott, Paul; Novotny, Paul; Sloan, Jeff; Freischlag, Julie Annals of Surgery. 251(6):995‐1000, June 2010. DOI: 10.1097/SLA.0b013e3181bfdab3
© 2010 Lippincott Williams & Wilkins, Inc. Published by Lippincott Williams & Wilkins, Inc.
Burnout and Medical Errors • Burnout and depression were among the strongest factors associated with reporting a recent major medical error • Shifting focus from fatigue and sleep deprivation towards burnout • Previous efforts targeted systems issues (communication, team‐work, electronic order entry), this focused on individual factors
Physician Suicide • Physicians compared to the general population have lower rates of deaths by modifiable factors (COPD, influenza, etc)
• Physicians have much higher rates of death by suicide and accident • Physicians have similar rates of depression
From: Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis) American Journal of Psychiatry
Impact of Loss • Over 400 physicians die from suicide each year‐ roughly the size of two graduating medical school classes • Estimated 1,000,000 patients/year lost their provider as a result of suicide • 1/15 physicians struggling with suicidal ideations
When Does Burnout Start?
Burnout in Medical School • “Burnout and Suicidal Ideation among U.S. Medical Students” from Annals of Internal Medicine in 2008 • Cross‐sectional survey of 7 medical schools in the spring of 2006 and 2007 • Various demographics, burnout, depression, quality of life and 2007 survey included suicidal ideation
Burnout in Medical School • 49.6% of medical students met one of the three areas of burnout • Medical students had a lower mental quality of life score as compared to the general population • 26.8% recovered from burnout between 2006‐ 2007 survey • 11.2% reported suicidal ideation within the last year (compared to 6.9% similar age gen. population)
Nature vs Nurture?
When Does Burnout Start? • “Distress among matriculating medical students relative to the general population.” from Academic Medicine in 2014 • E‐mail surveyed matriculating medical students (MMS) at 6 medical schools compared to age‐similar college graduate controls • Measured burnout, depression, quality of life, and various demographics in both groups
Distress Among Matriculating Medical Students Relative to the General Population. Brazeau, Chantal; Shanafelt, Tait; Durning, Steven; MD, PhD; Massie, F; Eacker, Anne; Moutier, Christine; Satele, Daniel; Sloan, Jeff; Dyrbye, Liselotte Academic Medicine. 89(11):1520‐1525, November 2014. DOI: 10.1097/ACM.0000000000000482 © 2014 by the Association of American Medical Colleges. Published by Lippincott Williams & Wilkins, Inc.
Medical Students • MMS had lower rates of burnout, higher quality of life scores, and better mental health scores • Medical students have higher rates of burnout, lower mental quality of life scores, and report suicidal ideation at higher rates than the general population
Burnout in Residency • Longer standing and wider known problem as compared to medical students • Literature review showed resident burnout to be between 50‐75% • Resident fatigue/distress leading to medical errors was the main motivation behind 2003 ACGME duty hours restrictions • Residents who experience burnout are at increased risk for motor vehicle accidents, substance abuse, depression, and suicide
Burnout in Residency • “Taking Care of Our Own: Investigating Resident Physician Burnout Across the Medical and Psychiatric Hospitals” work with Emily Holmes‐ 2014 at UNC Hospitals • Surveyed both residents and program directors across specialties about burnout • Demographics, burnout, depression, contributors and interventions to burnout
Burnout in Residency • 69% of residents met criteria for burnout • 17% screened positive for depression • 16% of residents were taking medication for depression or anxiety
Table 4. Mode and mean Likert scores to assess the perceived helpfulness of each potential burnout intervention in which the following scale was used: extremely unlikely (1), unlikely (2), neutral (3), likely (4), and very likely (5).
Burnout in Physicians • What happens when you graduate? • How does this change over a physician’s lifespan? • Where does psychiatry rank regarding burnout and work‐life balance? • How has this changed over the last few years?
Burnout in Physicians • “Burnout and Satisfaction With Work‐Life Balance Among US Physicians Relative to the General US Population” from 2011 Archives of Internal Medicine • National study of burnout in a large sample of US physicians from all specialty disciplines (AMA database) and surveyed a probability‐ based sample of the general US population for comparison.
BURNOUT BY SPECIALITY: Arch Intern Med. 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199
Arch Intern Med. 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199
Burnout in Physicians‐ 2011 • 45% of US physicians met at least one criteria for burnout • Higher rates were those in front line access to care fields (family medicine, general internal medicine, and emergency medicine) • Burnout varied over career stage, with the highest peek in mid‐career
Physicians vs General Population • 40.1% of physicians did not think their work schedule left enough time for personal or family life compared with 23.1% of controls • On the 2‐item screening for burnout (EE/DP) physician burnout (37.9%) was statistically higher than relative the population control (27.8%) • After adjusting for hours worked per week, higher levels of education and professional degrees seem to reduce the risk for burnout in fields outside of medicine, whereas a degree in medicine (MD or DO) increases the risk
Burnout in Physicians “Changes in Burnout and Satisfaction With Work‐Life Balance in Physicians and the General US Working Populations Between 2011 and 2014” from 2015 Mayo Clinic Proceedings • Gaps continues to widen for physicians compared to age‐matched controls • Burnout in physicians on the rise: 2014 (54.4%) vs 2011 (45.5%) • Satisfaction for work‐life balance in physicians declined over the three years, but improved in the general population
Where do we go from here?