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Reviewing the signs and symptoms of burnout is similar to listening to those terrible commercials advertising the latest psychotropic medication. Are you feeling tired, fatigued, depressed, anxious, irritable, or restless? Do you have unexplained physical symptoms or difficulty concentrating or sleeping? If so, we have the quick-fix solution for you. Unfortunately, most of us will not find a miracle pill that alleviates the impact of chronic stress or reduces our susceptibility to burnout. It can be a daunting task to identify and address burnout for several reasons. However, with studies estimating that over half of physicians and a third of nurses experience burnout, it is imperative that we take active steps to preserve and protect our well-being.
Why it can be difficult to recognize
One potential reason limiting our ability to recognize burnout is American values surrounding work. L. Robert Kohls outlined American values in The Values Americans Live By. He believed that Americans value time, competition, and action over inaction. If you find yourself feeling guilty for engaging in leisurely activities because your time feels squandered or worry others will think less of you, it is likely these social values are influencing your decision-making. Creating and maintaining a healthy work-life balance is challenging when we are constantly competing with our colleagues.
Leon Festinger’s (1954) social comparison theory provides insight into how competition influences behavior. He theorized that competitive behavior is guided by self-evaluation and comparing our own abilities and successes with others’. In theory, we push ourselves to match or surpass our colleagues to protect our perceived superiority. It certainly would be a challenge to make changes to our workload if we suspect that this will create a greater performance gap between ourselves and our colleagues. This also increases the likelihood that we will agree to take on roles and projects in our limited capacity leading to a more pronounced imbalance between work and life.
Moreover, provider burnout may fly under the radar as it does not necessarily lead to reduced quality of patient care. A study by Rabatin and colleagues (2016) surveyed providers and patients in a primary care clinic and found no relationship between self-reported provider burnout and patient health outcomes such as diabetes or blood pressure control or receipt of preventative services like depression screening or tobacco cessation services. The study did find, however, that burned out providers were 35% more likely to have intentions to leave the practice. This suggests that while burnout may not adversely impact patient care, it likely leads to increased provider turnover instead (and, in turn need for increased resources devoted to recruitment and training).
For assistance with identifying burnout as well as compassion satisfaction and secondary traumatic stress, consider completing the Professional Quality of Life Measure (ProQOL).
Causes of burnout
The Agency for Healthcare Research and Quality (AHRQ) identified family responsibilities, time pressure for visits and documentation, electronic health records, chaotic environment, and low control of pace as primary causes for stress amongst family physicians and internists through their Minimizing Error, Maximizing Outcome (MEMO) Study. The sources of burnout may vary across disciplines. For instance, medical providers tend to become burned out by excessive time at the workplace and mental health providers become burned out by emotional exhaustion. Emotional exhaustion is the depletion of emotional resources and/or the presence of negative feelings about patients (Reith, 2018). However, both medical and mental health providers cite workload and specifically a disproportionate amount of administrative tasks relative to direct patient care as a primary cause of burnout (Reith, 2018).
Unfortunately, most of us will not find a miracle pill that alleviates the impact of chronic stress or reduces our susceptibility to burnout. Addressing burnout will likely require you to be vulnerable or assertive which does not always come easily.
In addition to social norms, certain personality traits may increase vulnerability to burnout. Simpson et al. (2018) believed that unrelenting standards and self-sacrifice are the two strongest predictors of burnout among psychologists. While a rigorous work ethic and a propensity to put others’ needs before your own are obviously good qualities for a healthcare provider, they may be problematic when taken to the extreme. Providers who trend towards these traits may take exceptional care to attend to their experience at work and to be intentional about stress management.
Maybe you have now come to the realization that you are feeling burned out, but how do you address it? While there are many options for increasing self-care (and self-care is largely idiosyncratic!), we offer a few options for you to get started:
First, consider trying the following exercise:
- Start by writing a list of reasons you suspect are contributing to feeling burned out.
- Label each reason based on its type
- Work issue (e.g., working too much, problem with co-worker, addressing multiple complex issues in a day)
- Personal issue (e.g., parenting stress, grief, marital problems, family stress, symptoms related to a history of psychological trauma)
- Personality issue (e.g., self-sacrifice, unrelenting standards, history of challenging interpersonal relationships)
- Next, label each reason based on your ability to control it
- Ability to control (e.g., not engaging in self-care activities, taking work home, avoiding personal matters)
- Potentially able to control (e.g., reducing hours, changing shifts, limiting sessions)
- Inability to control (e.g., use of EHR, chaotic environment, patients’ presenting issues)
- Assign a value to each reason on a scale from 1-5 with 5 being the most stressful
- Create a plan for addressing the issues identified as being within your control and most stressful
A second option is practicing mindfulness. Mindfulness is a useful tool for noticing, moment-to-moment how you are relating to stressful events, thoughts, and feelings. A study by Krasner and colleagues (2009) found that physicians who participated in a mindfulness-based education program exhibited decreased burnout and improved empathy and mood. The study utilized a within-subjects design and caution should be exercised in inferring causality. Nevertheless, the results are encouraging. Consider incorporating a mindfulness practice into your routine. This can be beneficial whether you practice formal meditation daily (try Sam Harris’ Waking Up app for a daily 10-minute sitting meditation) or a simple intention to engage in daily tasks mindfully.
Finally, consider advocating for yourself at the workplace. Provide feedback to supervisors about changes that you think may reduce burnout and increase workplace satisfaction. For instance, request “flex time” or ability to complete documentation and other administrative tasks from home during the work week. Consider requesting time to attend counseling or an exercise class during the week and ensure the lunch hour is protected. If pay is related to the number of billable encounters, advocate for salaries that are independent of productivity.
Addressing burnout will likely require you to be vulnerable or assertive which does not always come easily. You may face situations that evoke feelings of guilt or inadequacy preventing you from being an advocate for yourself. It is also not uncommon to find ourselves focusing on factors that we have limited to no ability to manipulate resulting in feelings of hopelessness and helplessness. If you find your list consisting of multiple items you are unable to change, you still have options. Although we, as psychologists, are biased, you could consider seeing a psychotherapist. You may be surprised by how much a safe, supportive environment can provide symptom relief.
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