Physician burnout - looking beyond occupational stressors

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It is generally believed that burnout is a serious problem among physicians, and work-related factors (i.e., long or irregular shifts, issues with co-workers, etc.) are often cited as culprits. A recent review by Panagioti et al. has found that about half of U.S. cardiologists suffer from burnout. The authors suggest that burnout among cardiologists may be best mitigated by stress-reduction actions taken at both the organisation and the physician level.

Panagioti et al.'s review is only one of the many studies conducted over the last years seeking to estimate the prevalence of burnout among physicians, across various specialities and geographic areas. However, the authors' review "raises important questions regarding the burnout construct itself and its use in occupational health research," according to an editorial published in the journal Trends in Cardiovascular Medicine.  

Most burnout studies, the editorial says, focus on the causal link assumed to exist between occupational adversity and burnout. While burnout has been regarded as a syndrome resulting from unresolvable work stress, the available measures of burnout (e.g., the Maslach Burnout Inventory or the Shirom-Melamed Burnout Measure) in fact provide limited information on the etiology of the symptoms that they aim to assess.

"Typically, respondents are questioned about how they feel at work, but the extent to which the reported feelings can be specifically imputed to occupational, as opposed to nonoccupational, stressors remains unclear. Thus, contrary to what is commonly believed, burnout measures may not allow us to confidently identify work-induced symptoms," explains the editorial written by Renzo Bianchi, PhD, Institute of Work and Organisational Psychology, University of Neuchâtel (Switzerland) and Eric Laurent, PhD, Laboratory of Psychology (EA 3188), Bourgogne Franche-Comté University (France).

Bianchi and Laurent have cited other studies indicating that factors (stressors) outside the workplace could play an important role in the development of burnout symptoms. For example, a recent survey of 2,115 Dutch medical residents showed that both job demands and resources and home demands and resources contributed to burnout. Such results are consistent with the finding that "off-job activities" affect daily levels of work engagement — a variable showing a strong negative correlation with burnout, the editorial points out.
 
"The implication of work-unrelated factors in the development of burnout symptoms may be particularly worth-examining in research on physicians," say Bianchi and Laurent. In a study conducted by the UK Medical Careers Research Group, Surman et al. surveyed UK-trained doctors up to 5 years after graduation for six graduation year cohorts (1996, 1999, 2002, 2005, 2008, and 2012). Physicians were found to report more satisfaction with their job than with their leisure time, both 1 year (ns > 16,000) and 5 years (ns > 11,000) after graduation. "These findings suggest that, among physicians, life outside work might be a greater source of discontent than life in the workplace," according to Bianchi and Laurent.

The editorialists also highlight evidence showing that, despite the adaptive challenges associated with the practice of medicine, a vast majority of physicians enjoy their work and are satisfied with their career in countries such as the U.S. and UK. For instance, in a study involving 6,590 U.S. physicians from various specialities, only 14% of respondents were found to be “somewhat dissatisfied” or “very dissatisfied” with their career (only 4% were found to be “very dissatisfied”). In a recent survey of 1,117 U.S. physicians, while 45% of respondents were concluded to be burnt out, 83% were satisfied with their career choice, and 80% with their medical speciality.

"Making sense of these concurrent results is challenging when reasoning within the framework of burnout research. Indeed, in focusing on variables such as job satisfaction or career achievement, investigators may be tempted to conclude that most physicians have a rather positive and fulfilling relationship with their work. Such conclusions would not align well with the view that burnout has become epidemic among physicians, given that burnout presumably describes 'a crisis in one’s relationship with work'," write Bianchi and Laurent.

Source: Trends in Cardiovascular Medicine
Image Credit: Pixabay

References:

Bianchi R, Laurent E (2018) Editorial commentary: Burnout in cardiology—Going to the heart of the misunderstanding.

Trends Cardiovasc Med 28 (2018) 8–9 DOI: https://doi.org/10.1016/j.tcm.2017.07.008 Panagioti M, Geraghty K, Johnson J (2018) How to prevent burnout in cardiologists? A review of the current evidence, gaps and future directions. Trends Cardiovasc Med, in press, http://dx.doi.org/10.1016/j.tcm.2017.06.018


Published on : Wed, 28 Feb 2018



cardiologists, physician burnout, occupational stressors, stress-reduction It is generally believed that burnout is a serious problem among physicians, and work-related factors (i.e., long or irregular shifts, issues with co-workers, etc.) are often cited as culprits. A recent review by Panagioti et al. has found that about half

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