Recognizing Burnout in Healthcare

A Pharmacy Intern’s Perspective

Burnout is under reported and rarely ever discussed in the health care profession. Unfortunately for most, it’s becoming increasingly prevalent as a year long pandemic continues to take place. As a pharmacy intern who has worked in the community setting for years across multiple companies, the amount of pharmacists who have asked me, “is this really the type of career you want to pursue?” was discouraging at times but the answer was always yes. I loved what I did so much and nobody would change my mind about that. Unfortunately I have worked alongside too many burnt out pharmacists at both very high and low volume stores in different states (especially those who have been in the profession for decades). I have seen first hand the effect burnout has had on quality of life and the stress it generates.

But at what point does burnout start to lead to medical errors and patient dissatisfaction in a country in desperate need of alert medical professionals? All in all, how can we start to change what we are doing to minimize burnout?

We should probably start by understanding exactly what leads to burnout? Burnout stems from emotionally intense work demands with not enough resources. With excessive workload and inefficient work processes, you start to feel emotional exhaustion, depersonalization and a reduced sense of personal accomplishment. Investigators of a recent study published in 2019 found that 53.2% of participants who were health-system pharmacists had a high degree of burnout on at least one sub scale of the Maslach Burnout Inventory Human Services Survey (MBI-HSS). This scale is designed for professionals in the human services working in a variety of occupations including nurses, physicians, social workers, therapists and more. When compared to physicians, pharmacists had similar burnout rates of 53%–61% (vs. 50% for physicians). Cross sectional studies have looked at the consequences of physician burnout with evidence of medical errors doubling and 17% increased odds of being in a medical malpractice suit. This is clearly a problem that warrants urgent attention.

The solution essentially becomes a two way street by developing organizational solutions and individual focused factors. Let’s talk about some of the drivers of burnout, and how changes could be made from both the organizational and individual level. Interventional studies have implemented solutions to some of the contributors of burnout and although they have only been studied in the physician population, they may be transferrable between different specialties and healthcare systems. Here, I summarize drivers and solutions from select key publications on physician burnout.

Excessive Workload

1. Organizational Level → creation of fair productivity targets, duty hour limits, and appropriate distribution of job roles
2. Individual Level → reduction to part time status, informed specialty choices, and informed practice choices

Work inefficiency and lack of work support

1. Organizational Level → optimization of EMRs, non physician staff support and appropriate interpretation of regulatory requirements
2. Individual Level → efficiency and skills training, prioritizing tasks and appropriately delegating work

Lack of work-home integration

1. Organizational Level → respect for home responsibilities in setting schedules for work and meetings, include all required work tasks within expected work hours, support more flexible work schedules (include part time employment)
2. Individual Level → reflection on life priorities and values and attention to self care

Loss of control and autonomy

1. Organizational Level → physician engagement with establishing work requirements and structure, physician leadership and shared decision making
2. Individual Level → stress management and resiliency training, positive coping strategies, and mindfulness

Loss of meaning from work

1. Organizational Level → promote shared core values, protection of time with patients, promote physician communities, offer opportunities for professional development, and provide leadership training and awareness around burnout
2. Individual Level → positive psychology, reflection/self awareness of most fulfilling work roles, mindfulness, and engagement in small-group activities around shared work experiences

While easier said than done, burnout is a real dilemma and awareness is fundamental for solutions to start to take place. Some solutions may be easier to implement than others. Would a health care professional be ok with reducing their full time hours to part time? Probably not in most cases. The data is there to show that burnout is a real issue and negative consequences will take place if changes do not occur. What are your thoughts and experiences with burnout in the workplace?