Burnout in Psychiatrists

Compared to many of our peers (especially in family medicine, general internal medicine and emergency medicine), psychiatrist rates of burnout are quite low and our satisfaction with work-life balance is quite high ⁽¹⁾. That said, given the painfulness and complications of burnout, a quick review is in order.

Burnout has been called an erosion of the soul ⁽²⁾. It is commonly defined as a syndrome of emotional exhaustion (i.e. tiredness, somatic symptoms, decreased emotional resources, and a feeling that one has nothing left to give to others), depersonalization (i.e. developing negative, cynical attitudes, and impersonal feelings toward clients, treating them as objects), and lack of feelings of personal accomplishment (i.e. feelings of incompetence, inefficiency, and inadequacy) ⁽³⁾ .

A confluence of factors is felt to cause burnout in physicians. One is the loss of autonomy and independent decision-making in our work. Another is overwhelming responsibility—too many patients (or too many very sick or needy patients at one point in time), working days that are long, frequent on call shifts, and unrelenting   administrative, research, and teaching demands. Perfectionism, so common in physicians, can work against us when we cannot say “no”, when we don’t set limits on the hours we work each week, and when we obsess about our jobs while we’re not on duty. Any assault to our resilience, such as undue stress, ill health, divorce, and worries about our kids, can weaken our defenses and make it harder to function with a baseline of efficiency, satisfaction, meaning, and joy.

When burnout in psychiatrists is unrecognized and/or unaddressed, the implications are serious. Such individuals are vulnerable to unnecessary suffering, worsening morbidity (especially protracted and refractory illness), psychiatric co-morbidity (depression, anxiety and substance abuse), medical co-morbidities (flu, colds, headaches, and obesity), medical errors, diminished professionalism, poorer quality of care delivered to patients, and contamination of our personal and family life. At its worst, burnout combined with other risk factors, can lead to suicide.

Much has been written about prevention of burnout and early intervention. Miller and McGowan (2010) have made multiple salient recommendations. They include: taking back control (soliciting physician input in scheduling, session length, case mix, and flexible working hours); setting limits without guilt; making healthy behaviors a priority (booking time off, exercising, and relaxing); attacking perfectionism by using such cognitive strategies as accepting limitations, fallibility, and making errors; embracing interpersonal support; sharing feelings openly in a safe milieu with others; learning and practicing mindfulness meditation; journaling; and mentoring of younger physicians by older more seasoned physicians.

One final bit of wisdom in fighting burnout. Listen actively and non-defensively to loved ones (especially spouses, partners, children and other intimate others). Striving to meet their needs keeps us healthy and in balance.

References: 

1. Shanafelt TD, Boone S, Tan L et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172(18):1377-1385

2. Freudenberger HJ and Richelson G. Burnout: The High Cost of High Achievement. Doubleday, New York, 1980

3. Lee RT, Ashforth BE. On the meaning of Maslach’s three dimensions of burnout. J Appl Psychol 1990;75:743-747

4. Miller MN, McGowen R. Strategies to avoid burnout in professional practice: some practical suggestions. Psychiatric Times 2010;27(2):1-5

Dr. Myers is Professor of Clinical Psychiatry and immediate past Vice-Chair of Education and Director of Training in the Department of Psychiatry & Behavioral Sciences at SUNY-Downstate Medical Center in Brooklyn, NY. He is the author of seven books the most recent of which are “Touched by Suicide: Hope and Healing After Loss” (with Carla Fine) and “The Physician as Patient: A Clinical Handbook for Mental Health Professionals” (with Glen Gabbard, MD). He is a specialist in physician health and has written extensively on that subject. Currently, Dr Myers serves on the Advisory Board to the Committee for Physician Health of the Medical Society of the State of New York. He is a recent past president (and emeritus board member) of the New York City Chapter of the American Foundation for Suicide Prevention. 

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.