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Burnout

The document discusses the high incidence of burnout and depression among medical professionals, particularly residents, highlighting the significant pressures and challenges they face. It outlines the causes of burnout, its consequences, and suggests solutions for both institutional support and personal wellness. The document emphasizes the importance of self-care and maintaining physical activity to combat burnout.

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AJ Rush
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22 views22 pages

Burnout

The document discusses the high incidence of burnout and depression among medical professionals, particularly residents, highlighting the significant pressures and challenges they face. It outlines the causes of burnout, its consequences, and suggests solutions for both institutional support and personal wellness. The document emphasizes the importance of self-care and maintaining physical activity to combat burnout.

Uploaded by

AJ Rush
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

WELLNESS VS

BURNOUT
A.J. Rush, MD
Over the last 2 weeks, how many 0 1- 8+ 12
days have you been bothered by… 7 +

Feeling nervous, anxious, or on edge?

Not being able to stop or control


worrying?
Little interest or pleasure in doing
things?
Feeling down, depressed, or hopeless?
I think the medical profession provides a “perfect storm”
for burnout. The barriers to get into the profession are
high—years of school and training, expensive tuition.
Once a physician, the pressures are great—patients,
hospitals, insurance companies, and even ourselves. To
move into a different field is difficult. Let’s face it, it
would be hard to find a job that remunerates as well—and
many of us carry significant debt. And so, most burned
out physicians do not quit but rather soldier on—
emotionally exhausted, stressed out, disengaged with
patients, and wondering what it all means.

Benjamin Doolittle, MD
SCOPE OF THE PROBLEM
 Incidence of depression:  Every year, 3 medical
 ~12% of medical schools’ graduates go
students & residents just to replacing
have major depression physician suicides.
(2x nat’l average)  Physician suicide relative
 9.4% of residents risk
contemplated suicide
within past 2 weeks  1.41
 Risk explodes from 4%
before to >25%
immediately after
intern year
 28% of residents

2.27 !
experience a major
depressive episode  Prevalence of burnout
during training (vs 7-  Attendings: 44%
8% of general
population)  Residents: ~50%
MASLACH BURNOUT INVENTORY
1. I feel emotionally drained from 8. I feel burned out from my happens to some patients.
my work. work. 16.Working with people directly
2. I feel used up at the end of the 9. I feel I’m positively influencing puts too much stress on me.
workday. other people’s lives through my 17. I can easily create a relaxed
3. I feel fatigued when I get up in work. atmosphere with my patients.
the morning and have to face 10.I’ve become more callous 18. I feel exhilarated after working
another day on the job. toward people since I took this closely with my patients.
4. I can easily understand how my job. 19. I have accomplished many
patients feel about things. 11.I worry that this job is worthwhile things in this job.
5. I feel I treat some patients as if hardening me emotionally. 20.I feel like I’m at the end of my
they were impersonal objects. 12. I feel very energetic. rope.
6. Working with people all day is 13.I feel frustrated by my job. 21. In my work, I deal with emotional
really a strain for me. 14.I feel I’m working too hard on problems very calmly.
7. I deal very effectively with the my job. 22.I feel patients blame me for
problems of my patients. 15.I don’t really care what some of their problems.
#
3
CAUSES
 Length of training and  Grief/guilt re patient
delayed gratification death/bad outcome
 Limited control over the  Sex- or age-related issues
provision of care  Inefficient/hostile workplace
 Long working hours,
 Unrealistic goals (externally
enormous workloads or internally imposed)
 Career/family imbalance
 Isolation
Balch, Arch Surg, 2009
 Financial
“Every cynic is a frustrated
idealist.”
Guy Rush

CAUSES
“Burnout is caused by an
imbalance between control and
responsibility.”
Thomas Fuller, PhD
CONSEQUENCES
 Professional  Personal
 Poor clinical judgement  Depression & anxiety
 Hostility towards patients  Insomnia
 Medical errors  Fatigue
 Adverse patient events  Broken relationships, marital
 Difficult co-worker dysfunction & divorce
relationships  Alcohol & drug abuse
 Disengagement  Suicide

Balch, Arch Surg, 2009


 Connections
 Patients
SOLUTIONS Colleagues
 Look out for each other
 Engage with leadership—help me help
you
 Good C-suite level leadership reduces
burnout
 Measure individuals’ burnout
 Measure costs on institution
 Create interventions
 Focus on meaningful aspect of our work
 CBT alone halves risk of suicidal ideation
 CBT & meds even better
SELF-SUPPORT
 Personal vs professional needs
 List & rank personal & professional
priorities
 Integrate lists: Identify
compatibilities & incompatibilities
 Based on priorities, deal with
incompatibilities
 Personally meaningful work
 Make opportunities to reflect with
colleagues on stresses & rewards
 Plan to reassess what you find
meaningful
SELF-SUPPORT
 Personal Wellness
 Relationships
 Religion/Spirituality
 Hobbies
 Vacations
 Sleep, exercise & nutrition
 Define & protect personal time at
least monthly
 See your PCP

Balch, Arch Surg, 2009


PHYSIATRISTS,
PLEASE EXERCISE!
 41% residents are physically active
(2.5 hours moderate aerobics,
resistance exercise 2/week)
 79% have less physical activity since
they started medical training
 Residents who are physically active
are less likely to be burned out (odds
ratio, 0.38; 95% confidence interval,
0.147-0.99)

Olson 2014
MFB RESOURCES
RX
 Diet
 The Obesity Code
 The Keto Reset Diet
 Exercise
 Get your steps in every day
 Lift weights intensely for 15’ 2/week
 HIIT for 20’ every 7-10 days
 Schedule
 Healthy ritual every day
 Create protected time
 Mindfulness
TAKE HOME  There’s 44% chance one
of you eight will struggle
with major depression
(F33.2) this year.
A.J. Rush, MD 616.780.73
 There’s >90% chance
89
that at least one of you
Kelly Armstrong, 517.388.28 four is depressed (F33.0)
MD 83 right now.
Carolyn Vollmer, 989.225.00  Medicine is hard. Training
MD 40 in medicine is harder.
Employee 800.442.08  Take care of yourself.
Assistance 09
 Take care of each other.
REFERENCES
 Connection and Meaning: Resident Leadership to Combat Burnout. resident360.nejm.org/content_items/connection-
and-meaning-resident-leadership-to-combat-burnout
 Resident Burnout and Well-Being: A Q&A with Educator Benjamin R. Doolittle, MD.
knowledgeplus.nejm.org/blog/resident-burnout-well-being/
 Combating Burn Out, Promoting Physician Well‐Being: Building Blocks for a Healthy Learning Environment in GME.
acgme.org/Portals/0/PDFs/Webinars/July_13_Powerpoint.pdf
 Sen et al. A Prospective Cohort Study Investigating Factors Associated With Depression During Medical Internship. Arch
Gen Psychiatry. 2010;67(6):557-565.
 Guille et al. Web-Bsed Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical
Interns. JAMA Psychiatry. 2015;72(12):1-7.
 Beating burnout: Confidential access to health services for trainees. wire.ama-assn.org/life-career/beating-burnout-
confidential-access-health-services-trainees
 Center et al. Confronting Depression and Suicide in Physicians. JAMA (2003), 289 (23), 3161.
 Schernhammer ES & Colditz GA. Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-
Analysis). American Journal of Psychiatry, 2004;161(12): 2295-2302.
 Mata DA et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians. JAMA (2015), 314 (22),
2373.
 Olson SM et al. Burnout and Physical Activity in Minnesota Internal Medicine Resident Physicians. Journal of Graduate
Medical Education, 2014;6(4): 669-674.

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