Authors: Baigenet M, Baigent R
Reference: Med J Aust. 2018;208(11):471-3
Summarised on: 9 August 2018
Increasing workloads, reduced medical autonomy and inefficiencies associated with new technologies create environments where burnout can flourish.
The authors of this Australian perspective say that burnout is highly prevalent in doctors and is a risk factor for mental illness. However, there has been no sustained, effective national response in Australia.
Psychiatrist Freudenberger first wrote about burnout in 1975 after observing himself and others at his workplace.
The Maslach Burnout Inventory: Human Services Survey measures burnout in health professionals and comprises three main domains: exhaustion, cynicism (role negativity, feeling callous and detached) and professional efficacy (self-evaluation of competence and achievement).
The authors explain that most doctors recognise burnout in a “colleague’s uncharacteristic irritability, drowning fatalism and loss of belief in professional identity and efficacy”.
The key accumulating chronic factor is work, which overwhelms emotional resilience and leads to physical and emotional exhaustion. Doctors may increase their distance from patients and others, to manage emotional exhaustion.
The emotional and behavioural responses can disappear with sufficient leave or following changes to the workplace and work practice.
The authors point to a United States survey, which found that 46% of 7,288 participating doctors (27% response rate) reported at least one symptom of burnout.
In another study in the United Kingdom, burnout rates among doctors ranged from 17% to 52%. beyondblue is an independent non-profit organisation working to address mental disorders.
Its mental health survey of Australian doctors and medical students reported high levels of cynicism (35%) and emotional exhaustion (32%). The most common sources of stress were ‘work-life imbalance’ (27%) and ‘too much to do at work’ (25%).
Those aged under 30 years were most likely to report burnout (high exhaustion 48%; high cynicism 46%), with a steady reduction across older age bands.
The authors also note that in research on burnout generally, younger age is a more consistent variable than personality in determining burnout.
Major risk factors include an external locus of control (seeing others as responsible), avoidant coping, resistance to change, and high levels of neuroticism. Both person and workplace contribute to burnout.
A mismatch in any or all of the following six areas is a predictor of burnout: workload, control, reward, community (workplace relationships), fairness and values.
The authors say that the comparative high rates at which doctors report burnout suggest that the work system rather than the person is the major causal factor.
The authors recommend psychological strategies and common sense approaches such as physical activity to address burnout.
They say supervisor support and regular catch-ups between peers to promote collegiality, discuss patients and debrief will protect against burnout. beyondblue’s Developing a workplace mental health strategy guide provides ways for organisations to create strategies to ensure the mental wellbeing of their staff.
The authors conclude that avoiding burnout is a shared responsibility. Workplace changes should be integrated with the individual’s own strategies. They call for senior, influential and experienced doctors to lead action on behalf of young apprentices.
Comment: The College’s 2017 general practice workforce survey revealed that 23% of GPs felt burnout.
- Respondents aged 40 to 64 years were more likely to state they were burnt out than were those aged up to 39 years and 65 years and over (27%, 17% and 13% respectively).
- Male GPs were more likely than female GPs to state they were burnt out (25% and 21% respectively).
- Practice owners or partners were more likely than long-term employees or contractors or short-term employees or contractors to state they were burnt out (30%, 20% and 15% respectively).
- Respondents who felt they had poor work–life balance were more likely than those who agreed they had good work–life balance to state they were burnt out (53% and 10% respectively).