Could we be thinking about burnout wrong?
“In critical care medicine, periods of extreme stress can contribute to high burnout. Our study shows that organizations can implement new strategies, such as shorter staffing rotations, that have a real impact on burnout rates and job fulfillment — both of which can be extremely influential to the shape and direction of ones’ career,” said the study’s lead author, Mark E. Mikkelsen, MD, MSCE, chief of Medical Critical Care and an associate professor of Medicine. “Based on our findings, we changed our scheduling approach to limit the number of consecutive days per rotation, and ensure adequate non-clinical time between rotations.”
At first glance of the study results, I was like “Well, duh.” Working 14 days in a row is quite difficult, and it is not surprising that physicians would feel burned out if they worked 2 weeks straight without rest. That got me thinking: is the way we think about and measure burnout wrong?
I was speaking to one of my colleagues, and he told me that it may be that “burnout” can come when one’s expectations are not the same as his or her reality. For example, when we hire a physician or APP and tell them, “We are quite busy,” it is hard to gauge what that means to that doctor or APP. And if what that doctor or APP thinks is “busy” is different than what we think is busy, that may lead to “burnout.”
Another thing I wonder about is how we measure burnout. The most widely used inventory to measure burnout is the Maslach Burnout Inventory (MBI). It measures three things on a scale:
- Emotional Exhaustion, which measures feelings of being emotionally overextended and exhausted by one’s work.
- Depersonalization, which measures an unfeeling and impersonal response toward recipients of one’s service, care treatment, or instruction.
- Personal Accomplishment, which measures feelings of competence and successful achievement in one’s work.
I wonder whether the timing of these inventories in studies of physician burnout may affect the results.
For example, if I had to fill out an MBI at the end of a 14 day stretch, I probably would rate “emotional exhaustion” quite highly. This is to be expected, though. I would be quite physically (and emotionally) exhausted at the end of 14 days in a row. That does not necessarily mean that I’m “burned out.” I’m just tired. Give me that same survey after a week off, and I would probably not be exhausted at all.
Could the same be true about the other parts of the MBI? If this is administered to physicians and APPs at the end of a long stretch of shifts, would their ratings be higher? Do the studies of physician burnout account for this?
Now, this is not to say — by any stretch of the imagination — that burnout is not a real phenomenon among physicians, nurses, and APPs. Burnout is real— an official medical diagnosis, in fact — and it is a healthcare crisis. The suicide rate among physicians is higher than the general population (I personally knew a physician who took his own life). So, I am not calling into question the presence of burnout. I am just wondering whether the timing of asking questions about exhaustion, depersonalization, and personal accomplishment makes a difference in the results of the surveys.
If, after a vacation, a physician feels emotionally exhausted, has complete detachment from his patients, and feels no professional accomplishment at work, that physician is burned out and needs help. We need to make sure that we do everything we can to make the work environment as accommodating as possible to a healthy work-life balance.
In fact, I was surprised that the ICU doctors at Penn worked 14 days in a row. That is a tough schedule, and I would feel very “burned out” at the end of that stretch. Typically, many shift-based physicians such as hospitalists, intensivists, and EM physicians work 7 days on and then have 7 days off. It is good that physician leaders at Penn learned that changing these schedules around can help make their doctors happier and more fulfilled, which goes a long way at helping patients get better care. And taking good care of our patients is what healthcare is all about.