High risk of burnout among residents and senior physicians

The January issue of the journal Anesthesiology examines the issue of burnout among anesthesiologists. Two studies provide significant burnout statistics among these highly trained medical specialists, and editorials offer personal perspective on the issue as well as advice on how best to avoid professional burnout. Physicians at both ends of their career are at high risk for burnout. In particular, more research is needed to better understand why so many young physicians are suffering burnout early in their careers.

Burnout in a Perioperative Unit
In one study, researchers at Vanderbilt University School of Medicine developed an online survey given to all medical personnel in a perioperative unit.

"We found that physicians, particularly residents, had less job satisfaction and personal support than nurses or nurse anesthetists," said Steve A. Hyman, M.D., M.M., Vanderbilt University School of Medicine. "The results showed that physicians, especially younger ones, had higher levels of cynicism and emotional exhaustion and are at a high risk of burnout. This is a particularly troubling finding as we look to the future of America's health care system. We need a strong young physician base."

The online survey included demographics, a modified version of the Maslach Burnout Inventory-Human Services Survey, and the Social Support and Personal Coping Survey. Of the 145 responses, 46 percent were physicians (23 percent residents), 44 percent were nurses or nurse anesthetists and 10 percent were other personnel.

"More research is needed to identify the highest-risk groups and contributory factors, and to evaluate prevention and treatment interventions," said Dr. Hyman. "As in other professions where burnout can affect quality of work, burnout in health care workers has a huge potential financial impact as well as affecting the quality of patient care."

A Personal Journey
One of the editorial writers, Carol Wiley Cassella, M.D., Virginia Mason Medical Center in Seattle, shares her own experience with burnout along with how she managed her way through the challenge as a young physician. Dr. Cassella thought she might find relief moving from Internal Medicine to Anesthesiology.

"When I left internal medicine to practice anesthesia, I was too inexperienced to foresee that the inexorable changes grinding me toward emotional exhaustion were not unique to my clinic or my specialty," said Dr. Cassella. "A productive, efficient medical system depends on a healthy physician population; we cannot afford to lose these highly trained professionals early in their careers. But unless we begin to consider burnout a serious issue, one as worthy of study as insurance rates or hospital grading, we have little chance to stop burnout's erosion of our ranks.

Burnout Among Senior Physicians Also a Problem
Another study completed at Northwestern University Feinberg School of Medicine showed a high percentage of senior physicians are also struggling with burnout.

"Our data suggest that burnout is evident in approximately one half of the chairs of academic anesthesiology departments," said Robert J. McCarthy, PharmD, Northwestern University Feinberg School of Medicine and lead study author. "This has substantial implications not only on the individual physician and his/her patients, but also the functioning of the department and the training of future anesthesiologists."

Dr. McCarthy surveyed 102 anesthesiology department chairs (the departments' most senior physician) using an instrument that included the Maslach Burnout Inventory. The survey examined the participants' job satisfaction compared with one and five years prior to the survey, the likelihood of stepping down as chair in the next two years and a high risk of burnout.

Of those surveyed:
•Thirty-four percent reported high job satisfaction currently. (This was a significant decline compared to job satisfaction reports one and five years prior to the survey.)
•Twenty-eight percent reported extreme likelihood of stepping down as a chair in one to two years.
•Twenty-eight percent also met the criteria for high burnout, and an additional 31 percent were in the moderately-high burnout category.

The study found that age, gender, years as a chair, hours worked and perceived effectiveness were not associated with high burnout. Low job satisfaction and reduced self-reported spouse/significant other support, however, significantly increased the risk.

More Studies Needed to Find Solutions
A second editorial reinforces the fact that solutions to the burnout issue among anesthesiologists are not simple.

"While much has been written about personal strategies physicians can employ to maintain balance and promote resilience, the prevalence of burnout and the professional factors that are its origin suggest that organizational and policy changes are necessary," said Tait Shanafelt, M.D., with Mayo Clinic and editorial author. "Studies evaluating system level interventions (institutional, organizational, national) designed to optimize workload, improve efficiency, reduce the administrative burden on physicians, and promote a culture of compassion, engagement, meaning and support are desperately needed to reduce the negative consequences of burnout both for physicians and the patients they care for."