by Elizabeth Ansert.
Physician burnout is defined as a state of mental and physical exhaustion precipitated from work-related stress. Commonly the syndrome is described as a triad of:
1) Emotional exhaustion
3) Low personal achievement.
Work has been done in the medical field on physician burnout. Physicians have a higher rate of burn out than the general public, and surgeons have the highest rates among physicians. Recently, Lindemann et al. began working on creating a profile for which surgical residents are more likely to experience burnout. This article’s aim was to determine if the higher rates of burnout in surgical residents is related to emotional intelligence, personality characteristics, and work experiences. Ultimately, the authors hoped to predict who would be most likely to burn out among surgical residents.
A survey was sent to 143 surgical residents between two programs. The study had a 52% response rate. The survey was completed 3 times over the course of one year. Results indicated that 51% of the surgical residents surveyed showed signs and symptoms of burnout. Trends showed that the female gender and certain times of the year (the beginning and end of the academic year) increased the risk for burnout. However, higher emotional intelligence, stability, and positive work experiences were protective against burnout. Authors concluded that higher emotional intelligence and increased positive work experience interventions can optimize the work environment, lessen burnout, and prevent even burnout among surgical residents.
higher emotional intelligence and increased positive work experience interventions can optimize the work environment, lessen burnout
For decades, the podiatric profession did not appear particularly concerned with the topic of burnout, and podiatric processionals have been excluded from all large-scale survey-based research studies conducted on burnout across a number of medical specialties. In recent years, however, the phenomenon has continued to gain increasing recognition and concern from major podiatric medical societies. To date, only a single burnout study entitled “Perceptions of Burnout, Personal Achievement, and Anxiety Among US Podiatric Medicine and Surgery Residents: A Cross-Sectional Analysis” (manuscript accepted, J Foot Ankle Surg.) has been completed for the podiatric profession. I had the opportunity to interview the lead author of the study, Dr. Calvin J. Rushing, to gain perspective through his unique first-hand look at podiatric burnout. Dr. Rushing is a fellow in advanced surgical reconstruction at the Orthopedic Foot and Ankle Center in Worthington, Ohio.
An obvious question with respect to burnout is whether there is a point during our careers when we are most predisposed to burnout. For Dr. Rushing, his first year of residency is when he felt most predisposed for a multitude of reasons. The transition from the routine of podiatric medical school into the hectic life of a resident, tasked with juggling an ever-changing schedule, inpatient census, operating room responsibilities, and trauma call can be a big hurdle for many. Coupled with poor resident leadership at the chief level, negative interpersonal relationships, clerical duties offering little to no educational value to residents, and/or a stagnate residency program; the stressors become compounded. Generally speaking in such an environment, overly self-critical individuals who over-commit themselves to tasks and projects, neglect to maintain some semblance of a “work-life balance”, and who have little or no emotional support at home may be particularly predisposed for burnout. Dr. Rushing’s research suggests unmarried, male, PGY-1 residents with higher baseline levels of anxiety, as determined by the HADS-A questionnaire, maybe most predisposed for burnout. Similarly, other studies from other specialties have suggested residents and younger physicians are more predisposed compared to attending faculty and older physicians.
With regards to predicting and recognizing burnout within ourselves and others, Dr. Rushing acknowledges that future research is needed to better discern and help who is more or less likely to burnout. Creating a risk assessment profile could hold future potential; as approximately half (46%) of all residents who responded to his survey reported severe burnout. Therefore, the problem may be bigger than originally believed by many. However, no model can perfectly account for all factors, nor predict all persons; and it is unclear exactly how prevalent burnout is throughout the entire podiatric profession (student, resident, fellow, attending). Although Dr. Rushing feels that interest, enthusiasm, and motivation will naturally wax and wane for everyone at during the course of their professional careers, the syndrome of burnout is not typical, nor normal. It is a gradual process that manifests with early signs and symptoms, which are important red flags that should not go unnoticed or ignored. This is easier said than done, however, as it is common for physicians to neglect their own physical and mental health, while masking obvious signs (irritability, cynicism, decreased concentration, depression, anxiety, & suicidal ideation) around colleagues and friends. Although physical symptoms such as insomnia, fatigue, headache, colds/flu, and appetite changes may also manifest, Dr. Rushing most often relies on the psychological symptoms in recognizing burnout among his colleagues.
it is common for physicians to neglect their own physical and mental health
When a physician is experiencing burn out, the most important thing is that they (or those around them) acknowledge it and get help immediately. Dr. Rushing believes approaching physicians in distress and creating an open dialogue with genuine emotional support, although uncomfortable, is essential to reversing the snowball effect or cycle of burnout before the physician spirals out of control. A number of resources are currently available at apma.org/wellbeing, including a “Well Being Index” (WBI) and podcast series, which will include an upcoming episode featuring the topic of physician burnout. For those trying to avoid burnout, Dr. Rushing recommends that maintaining some semblance of a work-life balance, positive lifestyle habits, and removing toxic negative people or unnecessary stressors are key. He acknowledges that the definition of “work-life balance” will obviously vary from person to person, but emphasizes the importance of positive lifestyle habits/hobbies and removing toxic influences for minimizing and/or eliminating stress long-term.
work-life balance, positive lifestyle habits, and removing toxic negative people or unnecessary stressors are key.
Physician burnout is finally coming to light and being openly discussed within the profession. Dr. Rushing believes there has been a lack of formal education in podiatric medicine for many years, in part, due to the unsubstantiated, purported perceptions that podiatrists “don’t burnout”. Over the last decade, the DPM model has seen major advancements in the academic curriculum, residency training model, and competition for fellowships; which have translated to more sub-specialization within the field, a higher number of multispecialty and orthopedic job opportunities, and an ever-changing perception in the public eye. Undoubtedly, one could argue there are more stress and pressure on today’s podiatrists than ever before. Therefore, more efforts should be directed towards understanding physician burnout within this profession. Although Dr. Rushing acknowledges his role in starting research on the topic of burnout for the profession, he is hopeful that other enthusiastic young minds will also take a swing at the problem. After all, it truly is big enough for all of us.
by Elizabeth Ansert
Lindeman, Brenessa, et al. “Association of burnout with emotional intelligence and personality in surgical residents: can we predict who is most at risk?.” Journal of surgical education 74.6 (2017): e22-e30.
Rushing, C. J., et al. “Perceptions of Burnout, Personal Achievement, and Anxiety Among US Podiatric Medicine and Surgery Residents: A Cross-Sectional Analysis.” Journal of Foot and Ankle Surgery (2019). Manuscript Accepted.
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