________________________________________________________________________ Burnout in Physicians
interact with one another and perform their jobs [9]. She notes that burnout is more likely when there is a “major mismatch between the nature of the job and the nature of the person who does the job” [9]. These mismatches are at the core of the development of burnout. The term burnout is now usually limited to mean burnout as described by Maslach: a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment [6]. The World Health Organization (WHO) also now recognizes burnout as a “syndrome conceptualized as resulting from chronic workplace stress that has not been successfully man- aged” [119]. This definition, which appears in the 11th revision of the International Classification of Diseases (ICD-11), makes an important distinction from the definition of burnout from the ICD-11-CM, which did not list burnout as a syndrome, but rather a “state of vital exhaustion” [120]. Burnout can occur in any setting, and it has been studied most extensively in a wide range of occupations within the human services field, from healthcare professionals to teachers, police, and prison workers [6]. High levels of burnout among health- care professionals have been well documented. DEVELOPMENT OF BURNOUT In general, when an individual first enters a chosen career, he or she is motivated. If the work environment is not supportive of the individual’s efforts and concerns, the reality of the job and the individual’s expectations begin to diverge and frustra- tion and disappointment arise [6]. These feelings can lead to job dissatisfaction, resulting in decreased productivity, loss of confidence and enthusiasm, and behavior changes. If the situation is not addressed, stress accumulates and causes typi- cal stress-related symptoms. These physical symptoms, when coupled with emotional emptiness, signify the first stage of burnout: mental and physical exhaustion [8]. Left untreated, burnout will continue through four more stages: indifference, feelings of failure as a professional, feelings of failure as a per- son, and emotional numbness (being “dead inside”) ( Figure 1 ) [8]. CAUSES OF STRESS AND BURNOUT The specific factors within the work environment that lead to stress and subsequent burnout vary among occupations and among individuals within a single occupation. The root of burnout is in the work environment, but because not all individuals working in a single environment will experience burnout, personal risk factors must have a role in making an individual vulnerable. These personal risk factors include demographic variables and personality traits ( Table 1 ) [6]. Work Environment Factors Burnout is more likely when an individual’s experience (actual or perceived) does not match one or more situational factors in a work environment [9]. Among the mismatches that most commonly lead to burnout in any work environment are [9]:
INTRODUCTION Work is a significant source of stress in all occupations. Accord- ing to the American Institute of Stress, 83% of Americans report experiencing work-related stress, with as many as half saying they need help managing it [1]. A nationwide survey by the American Psychological Association (APA) reported in 2023 that 77% of employees have experienced work-related stress in the previous month [2]. Work-related stress that is left unaddressed has the potential to develop into burnout over a period of time. The costs of burnout are even higher than stress and affect not only the well-being of the individual but that of the individual’s family, friends, and colleagues. Burnout among physicians and other healthcare professionals carries the additional consequence of negatively affecting the quality of patient care and health outcomes. This consequence is even greater, given the high rates of burnout among physicians, rates that are higher than among the general U.S. population. This course provides an overview of burnout, addressing its development, characteristics, and measurement. The preva- lence of burnout according to several variables is discussed, as are the most common causes of stress and burnout. The effect of burnout on patient outcomes is noted, and strategies to cope with stress and avoid burnout are described. HISTORY AND DEFINITION OF BURNOUT The term “burnout” originated in the 1940s as a word to describe the point at which a jet or rocket engine stops oper- ating [3]. The word was first applied to humans in the 1970s by the psychiatrist Herbert Freudenberger, who used the term to describe the status of overworked volunteers in free mental health clinics [4]. He compared the loss of idealism in these volunteers to a building—once a vital structure—that had burned out, and he defined burnout as the “progressive loss of idealism, energy, and purpose experienced by people in the helping professions as a result of the condition of their work” [5]. The term burnout is used (perhaps overused) by many, and defi- nitions have varied since the time the word was first applied to humans. The word has been used to describe a mild degree of unhappiness caused by stress, as well as any degree of distress, from fatigue to major depression [6]. In the early 1980s, social psychologist Christina Maslach and her colleagues began to explore the loss of emotional feeling and concern for clients among human services professionals. Since then, she has researched burnout extensively, becoming the leading authority on the topic and the author of the criterion standard tool to assess burnout, the Maslach Burnout Inventory (MBI) [7; 8; 9]. Maslach emphasizes that burnout is not a problem related to an individual [9]. Instead, her research indicates that burnout is a problem of the social environment in which people work and is a function of how people within that environment
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