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    Clinicians have some of the most stressful jobs on earth.  Immense pressure, long hours, limited interaction time with patients, unfulfilling bureaucratic tasks, and a stressful environment all create a recipe for high occupational burnout in the healthcare profession.  Add the stress, anxiety and anger from the Covid-19 Pandemic, and it this burnout rate climbs.  In 2020, it was difficult to imagine that things could get worse for clinicians, yet data suggests burnout rates are soaring.

    Brief History of “Burnout Culture”

    I was burned out from exhaustion, buried in the hail
    Poisoned in the bushes an’ blown out on the trail
    Hunted like a crocodile, ravaged in the corn

    Come in, she said, I’ll give you shelter from the storm

    Bob Dylan, “Shelter from the Storm” 1974

    “Burnout” as a legitimate scientific health concern first gained public attention in the 1970s.  New York psychologist and researcher Herbert Freudenberger first coined the term “Burnout Syndrome” in 1974 and was the first researcher to publish research on the syndrome in a scientific journal.  He characterized burnout by a set of symptoms, including exhaustion from work’s excessive demands, as well as physical symptoms such as headaches, sleeplessness, irritability and closed thinking.  Freudenberger observed that the burned-out employee “looks, acts, and seems depressed.”  Around this same time, researcher Christina Maslach studied burnout and began to look at the impacts specifically on the human services and health services industries.  She described burnout in terms of emotional exhaustion, depersonalization and reduced feelings of work-related personal accomplishment.  “Burnout” suddenly became widely discussed and acknowledged; a pop culture term showing up in books and music in this era as well.

    In 1981, Maslach published the Maslach Burnout Inventory to assess the syndrome, still the most widely used burnout instrument today.  In 2019, the World Health Organization (WHO) classified occupational burnout as a “syndrome” resulting from chronic work-related stress, with symptoms characterized by feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.  The WHO does not classify burnout as a disorder in the International Classification of Diseases.  The American Psychiatric Association’s Diagnostic and Statistical Manual also does not recognize burnout as a disorder.

    As Jonathan Malesic explains in his new novel, “The End of Burnout: Why Work Drains Us and How to Build Better Lives” (University of California Press, 2022), even as awareness of burnout has grown over the past 50 years, public and scientific understanding of the condition has not progressed much.  There is still little agreement on how to measure burnout, let alone how (or if) to diagnose and treat it.  Malesic offers a detailed history of burnout and provides meaningful insight into overcoming burnout culture, resisting a “total work” environment and seeking “moral significance” in our lives beyond work.  Malesic does mention Neil Young in his book, but doesn’t directly quote: “It’s better to burn out, than fade away.”  He later mentions this quote on his website, saying that well, maybe….it isn’t?

    Impact of Burnout on Clinicians in 2022

    Medscape’s National Burnout and Depression Report of 2022 found that, as quarantines lifted, physicians returned to work and children returned to school, physicians are actually struggling to maintain their own well-being even more now[1].  The survey asked over 13,000 US based, practicing physicians from 29 specialties to share the details of their lives and struggles with burnout and depression over the past year.

    In 2020, 42% overall of physicians said they were burned out.  In 2021, that number increased to 47% overall.  Burnout among ER physicians took the biggest jump from 43% in 2020 to 60% in 2021.  The top 5, including ER physicians, of those reporting burnout were critical care (56%), ob-gyn (53%), infectious disease (51%) and family medicine (51%).  56% of female physicians surveyed reported burnout, compared to 41% of male physicians surveyed for the recent study.  Work setting also seems to be a factor in those experiencing burnout.  46% of physicians working in outpatient clinics reported burnout last year; that number jumped to 58% in 2021.

    Of the physicians surveyed, some described work conditions as follows:

    • “I barely spend enough time with most patients, just running from one to the next; and then after work, I spend hours documenting, charting, dealing with reports. I feel like an overpaid clerk.”
    • “Staff calls in sick, we’re all running around trying to find things and get things done. It never ends.”
    • “Where’s the relationships with patients that used to make this worthwhile? Everyone is in a foul mood.”
    • “Home is just as busy and chaotic as work; I can never relax.”

    Of the physicians who reported experiencing burnout this past year, 24% reported that it was minor; 22% reported that it was moderately impacting their lives, and a whopping 54% reported that the burnout was having a strong/severe impact on most aspects of their lives.  68% of burned-out physicians reported a negative effect on their relationships.  Physicians described the impact of burnout in profound ways:

    • “I have little motivation to reach out to others; my patience is decreased and my irritability has increased.”
    • “I’m grumpy and unpleasant to be around, I don’t care about anyone anymore, I don’t care about my hobbies anymore.”

    Exercise was the number one coping mechanism to respond to burnout, and spending time with family and doing hobbies was at the top for keeping up with happiness in general.

    In our own legal profession, we have seen similar issues with burnout, particularly over the past several years. In addition to exercise, one powerful way we have discovered to lessen the effects of stress at Adler Giersch is to express gratitude often – publicly, privately, and one-on-one. Some of our team members even keep a “gratitude journal” to help them focus on of all the positive things that can get overlooked or forgotten in times of stress. These journals can be bought from booksellers, and often take less than 5 minutes a day to complete. Practicing mindfulness and meditation has also been very effective.

    [1] Physician Burnout, Depression Compounded by COVID: Survey (medscape.com)


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