Moral Injury (Burnout) resulting from chronic workplace stress is a serious issue that costs billions of dollars in losses to the medical industry. So, it is important to understand its causes, implications, and the ways to alleviate it.
Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
1) feelings of energy depletion or exhaustion
2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job
3) a sense of ineffectiveness and lack of accomplishment
Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life. (1)
Physician Burnout: A Global Crisis
Physician burnout, defined as a work-related syndrome involving emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment, is not only a serious concern in China but also has reached global epidemic levels.
The 2018 Survey of America's Physicians Practice Patterns and Perspectives reported that 78% of physicians had burnout, an increase of 4% since 2016. Furthermore, 80% of doctors in a British Medical Association 2019 survey were at high or very high risk of burnout, with junior doctors most at risk. (2)
Moral Injury & Not Burnout
It's preferable to use the word moral injury instead of burnout because burnout basically means that a person has some intrinsic problem and because of which he/she is ineffective whereas the word moral injury redefines the problem as external i.e. due to workplace, employer, colleagues, etc.
Reframing Clinician Distress: Moral Injury Not Burnout
The Physicians Foundation 2021 Physician Survey:
COVID-19 Impact Edition: A Year Later
Increased workforce turnover and pressures straining provider operations
COVID-19 challenges respondents still face
National Academy of Medicine-2019
35-54% of the country’s doctors and nurses experience substantial symptoms of burnout.
Resulting in increased risks to patients, malpractice claims, worker absenteeism and turnover, as well as billions of dollars in losses to the medical industry each year. (4)
How Burnout Affects You?
Burnout can affect both your personal as well as professional life and is represented in the below image.
Impact of Burnout on your Choice of Medical Specialty
Burnout has a significant impact on our personal relationships and it's reported that millennials have a major impact as compared to Gen X or baby boomers.
How Has Burnout Affected Your Life?
The following are some statements of physicians explaining how burnout affected their life.
Which Physicians are most Burned Out?
These Medscape studies change year-to-year, but the following are some of the important reasons why certain sub-specialties are the most burned out.
1) For the last 3 years, critical care has been at the top because physicians need to deal with acute care patients, unhappy families and also need to respond to life-threatening issues.
2) And there are certain specialties where physicians need to see patients whom they can't do much to help them. For example, dementia, multiple sclerosis, etc.
3) In addition to that, there are certain specialties where the pay is significantly low, for example, internal medicine, pediatrics, etc.
What Contributes Most to your Burnout?
Physicians really hate spending more time in front of the computer screen as compared to taking care of the patient. And working as an ICU physician for 12 hour shifts is extremely exhausting.
How Severe is Your Burnout?
Another survey done by Medscape has shown that about 50% of respondents have had a severe impact on their work-life because of burnout.
Which Would Help Most to Reduce Your Burnout?
Financial compensation seems to be the best option for reducing burnout and there is no doubt that nurses are underpaid the most.
Which Workplace Issues Concern You Most?
Work-life balance seems to concern most of the respondents and the survey clearly shows that women have a better work-life balance as compared to men.
What Have You Done at Work to Try to Alleviate Burnout?
The key problem is the work hours and physicians work an average of 65 to 70 hours. Sometimes the work setting itself needs to be adjusted. And because of which I moved away from in-person sitting to virtual care so that I can spend more time with my family.
Patients Over Paperwork [Burden Reduction]
The government is taking steps to address this issue. Patients Over Paperwork is an initiative by CMS (Centers for Medicare & Medicaid Services) to curb the documentation burden. However, too little and too late! (9)