It Could Happen to You: Study Results Will Be Used to Address Professional BurnoutBy OSCAR DE LEON-CASASOLA, MD Jan 5, 2017
In November 2015, I wrote in the ASRA News about Dr. Tiffany Ingham, an anesthesiologist found guilty of defamation and malpractice after being recorded making offensive comments while a patient was under sedation receiving a colonoscopy. Although her behavior was in no way justifiable, in my view, Dr. Ingham may be have been experiencing professional burnout – and this is something we are all at risk for.
“a landmark study found that physicians were more likely to have symptoms of burnout and be dissatisfied with work-life balance compared to other working U.S. adults”
Burnout syndrome was first described by Freudenberger in 1974. It arises when other strategies fail to overcome occupational stress. The syndrome consists of three dimensions: emotional exhaustion, depersonalization or dehumanization, and low personal accomplishment at work.3 Emotional exhaustion occurs when there is no energy left to carry out daily work activities. Depersonalization manifests with emotional detachment from people for whom the professional should be caring; this behavior also may extend to coworkers. Interactions become impersonal, insensitive, and uncaring, including demeaning, harsh, cynical, or ironic behaviors when dealing with patients. The last dimension—personal achievement—usually reflects a decrease in satisfaction and efficiency at work.
The Maslach Burnout Inventory has been recognized for more than a decade as the best instrument to measure the probability of burnout. The incidence of burnout among professionals experiencing high levels of stress has been reported at around 10%.[5,6] However, a landmark study found that physicians were more likely to have symptoms of burnout and be dissatisfied with work-life balance compared to other working U.S. adults. Anesthesiologists scored just above the mean for rates of burnout.
Institutions are encouraged to make burnout intervention programs available to their employees. Research provides little consensus on the best way to treat this problem. Cognitive behavioral therapy and changes in work schedules have been shown to have little effect. Experts agree that prevention is key and recognition is vital.
Previous studies have documented that the most affected domain among anesthesiologists is personal achievement.[5,6] Reduced staffing in the face of increasing workload and external pressures to increase productivity have been identified as the main culprits for the low scores in this area. Thus, burnout can lead to musculoskeletal disorders and cerebrovascular disease. Employees experiencing burnout have more sick-leave absences, disabilities, admissions for mental health issues, back pain, and lack of restful sleep.[11,12]
The ASRA Board of Directors suspects that physician burnout may be significant among our members. Although a literature search for burnout among regional anesthesiologists and pain specialists did not yield any studies reporting incidence, when we consider our work conditions, the problem may be significant and could even get worse.
To determine the prevalence of burnout among physicians practicing regional anesthesia and pain management, ASRA, along with several other subspecialty societies, is conducting a survey. The results will be used to assess the need for educational resources on prevention and management of physician burnout. All ASRA members were sent an email to complete the survey on December 21st.
Thank you for helping us to advance our understanding and develop solutions to address this critical problem.
- Freudenberger H. Staff burnout. J Soc Issues. 1974;30:159-165.
- Nyssen A, Hansez I. Stress and burnout in anesthesia. Curr Opin Anesthesiol. 2008;21:406-411.
- Maslach C, Schaufeli B, Leiter P. Job burnout. Annu Rev Psychol. 2001;52:397-422.
- Maslach C, Jackson SE. The measurement of experienced burnout. J Organ Behav. 1981;2:99–113.
- Kluger MT, Townend K, Laidlaw T. Job satisfaction, stress, and burnout in Australian specialist anaesthetists. 2003;58:339-345.
- Magalhães E, Machado de Sousa Oliveira AC, Sousa Govêia C, et al. Prevalence of burnout syndrome among anesthesiologist in the federal district. Rev Braz Anesthesiol. 2015;65:104-110.
- Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the US population. Arch Int Med. 2012;172:1377-1385.
- Awa WL, Plaumann M, Walter U. Burnout prevention: a review of intervention programs. Patient Educ Couns. 2010;78:184-190.
- Ruotsalainen JH, Vereek JH, Marine A, et al. Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev. 2014 Dec 8;12:CD002892.
- Honkonen T, Ahola K, Pertovaara M, et al. The association between burnout and physical illness in the general population—results from the Finnish Health 2000 Study. J Psychosom Res. 2006;61(1):59–66.
- Shirom A. Burnout and health: expanding our knowledge. Stress Health. 2009;25(4):281–285.
- Söderström M, Jeding K, Ekstedt M, Perski A, Akerstedt T. Insufficient sleep predicts clinical burnout. J Occup Health Psychol. 2012;17(2):175-183.
Dr. de Leon-Casasola is the president of the ASRA Board of Directors. He is also the Senior Vice-Chair and Professor of Anesthesiology (Tenure Track), Department of Anesthesiology, and Professor of Medicine at the University at Buffalo, School of Medicine and Biomedical Sciences and Chief of the Division of Pain Medicine and Professor of Oncology at Roswell Park Cancer Institute, both in Buffalo, NY.