________________________________________________________________________ Burnout in Physicians
POTENTIAL RISK FACTORS FOR BURNOUT
Dimension
Risk Factor
Work environment
Work overload Lack of control over one’s work Insufficient reward for one’s contributions Absence of community Lack of fairness Conflict in values
Demographic variables
Younger age Early in career Lack of life partner or children Higher level of education Low self-esteem or confidence No recognition of personal limits Need for approval Overachieving Need for autonomy
Personality traits
Impatience Intolerance High empathy Extreme conscientiousness Perfectionism Self-giving Type D personality
Source: [6]
Table 1
associated with a higher risk of burnout, whereas a Bachelor’s degree, Master’s degree, or doctoral degree (other than MD or DO) was associated with a lower risk [11]. Studies have also been done to explore the relationships between personality traits and the risk of burnout. Maslach noted that characteristics such as low self-esteem or lack of confidence, failure to recognize personal limits, need for approval, drive to overachieve, need for autonomy, impatience, intolerance, and empathy increased susceptibility to burnout [6]. Others have postulated that extreme conscientiousness, perfectionism, and self-giving (selflessness) also increase sus- ceptibility, as does a type D personality (a joint tendency for negative emotions and social inhibition) [12; 13; 14]. Many of these personality traits are common among physicians; in fact, several are essential for success in this profession, which may explain, in part, the high levels of burnout among physicians. IDENTIFICATION AND MEASUREMENT OF BURNOUT Identifying the signs of stress and burnout is important to preserve the overall health and well-being of individuals. Burn- out is associated with many signs and symptoms. For accurate identification, care should be taken to distinguish burnout from other conditions, such as stress, prolonged fatigue, and depression ( Table 2 ) [6; 15; 16; 17; 18].
DISTINGUISHING BURNOUT FROM OTHER ENTITIES Stress can cause many of the same physical, psychological, and interpersonal/social symptoms as burnout. However, stress is distinct from burnout in that it is usually precipitated by isolated or situational instances, whereas burnout is the result of prolonged stress [6]. Prolonged fatigue often overlaps with burnout, but the precipitating factor differs for each; fatigue is usually associated with health-related causes, whereas burnout is caused by job-related factors [15; 16]. Depression and burnout may have a similar clinical presenta- tion, and signs of depression can be associated with burnout. However, depression is related to factors within every domain of an individual’s life and is not limited to specific factors in the work setting [17; 18]. Depression is more likely among individuals who have had a recent loss or a personal or family history of depression, but burnout is more likely if symptoms are worse in the work environment and if the individual works long hours and has no time for outside interests. The most important distinction between burnout and all of these entities is that only burnout is characterized by the col- lective features of emotional exhaustion, depersonalization, and lack of accomplishment, as measured on the MBI.
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