No longer is burnout unique to physicians; parental burnout is on the rise too.
EDITOR’S NOTE: H. Steven Moffic, MD, a nationally prominent psychiatrist and author, has co-authored a new book, the first of its kind on the subject of burnout, titled “Combating Physician Burnout: A Guide for Psychiatrists,” published by the American Psychiatric Association Press. Upon the book’s release, ICD10monitor publisher and Talk Ten Tuesdays host Chuck Buck conducted an interview with Dr. Moffic. What follows are excerpts from their conversation.
|BUCK:||Congratulations on your new book, Dr. Moffic. During your appearances on Talk Ten Tuesdays over the course of the last several years, your focus has been on identifying burnout among physicians and mental health providers. But burnout occurs in other industries as well; I’m thinking of law enforcement, as my nephew was once an officer. Yet, burnout must impact non-clinicians in healthcare. What are the early symptoms?|
|HSM:||Chuck, you have done a rare and extraordinary job of conveying concern and information for burnout among physicians and other healthcare professionals over recent years. You may even recall that we did a series on the “joys of coding” some years back. Actually, in the first chapter of the new book, Randall Levin, MD, an emergency physician, and I discuss the overall history of burnout in the USA. The term was coined in the 1970s, and applied first to various workplaces that were changing, as far as long-term job security and productivity demands. At that time, and up to about the year 2000, burnout was actually much lower in healthcare than most other workplaces. Since then, with the entrance of for-profit managed care and related businesses, the rate of burnout in physicians (including veterinarians) has skyrocketed, and came to double that of most other professions. Insightfully, however, you presented the example of law enforcement, in which burnout has also been increasing to epidemic rates. Not too far behind in this race that nobody wants to win are lawyers and clergy. The major early symptoms are some combination of emotional exhaustion, cynicism, and a sense of lowered accomplishment, though all of this needs more research. Psychiatrists, who have expertise in how the brain and mind works, both in individuals and groups, are ideally suited to further clarify what burnout is, and what may be counterintuitive about its presentation.|
Is the degree of burnout more severe among physicians than in non-clinicians?
|HSM:||Apparently, the degree of burnout is more severe among physicians than in other clinicians and non-clinicians. However, other than perhaps nurses, who have long talked about moral injury in their description of commonly burning out, the rate of burnout in these other clinicians has not been studied as well.|
|BUCK:||What are some of the contributing factors leading to burnout in non-clinicians?|
|HSM:||The contributing factors to burnout are similar in any workplace. Although there can be some individual vulnerability, such as a history of prior personal trauma. The main causative factors are systems that don’t engage the workers in the development of policies and procedures, and put obstacles in place of their achieving what is meaningful to them at work. When that happens, at best you often end up with workers who are like automatons.|
|BUCK:||What is unique about burnout among physicians, as compared to non-clinicians?|
|HSM:||Perhaps the rate of burnout in physicians is higher than other professions because we tend to feel we should be in charge; we are very perfectionistic, and have enough resilience to plow ahead despite the obstacles that have emerged as medicine has become more of a business.|
|BUCK:||What seems to be driving a sense of denial about burnout within the healthcare industry?|
|HSM:||Denial, conscious and/or unconscious, often occurs when there doesn’t’t seem to be a solution to the problem, and people feel a sense of learned helplessness. There is a legendary story about the frog who is put into a vat of lukewarm water. The frog feels quite comfortable in that bath, and just luxuriates. Then the temperature of the water is slowly increased until the frog is burning up, and doesn’t’t have the energy to try to jump out. By then, it is too late. The frog dies unless rescued – and sometimes, we die by suicide, which is at a higher rate than other professions. Such denial often allows the clinician, like the frog, to feel satisfied, at least temporarily. Those now in more control of the industry, which are often made up of for-profit businesses, hold the power to make the system as financially productive as possible, and while they do reduce some unnecessary and adverse care, it is also all too often at the expense of overall quality of care and the well-being of the clinicians.|
|BUCK:||Are there obvious telltale signs that we should be watching among our co-workers that would signify burnout, or the onset of burnout? If so, what are they, and what steps can be taken to at least mitigate burnout?|
|HSM:||Well, Chuck, it is any combination of those presentations we mentioned in the first question. However, those presentations also can occur with other problems, including some medical-illness onset or clinical depression. It is very important to know that burnout is distinguished by mainly being present at work, but not at home. So, as we should ethically be our brothers’ and sisters’ keepers, we need to compassionately ask how they are doing, because you notice such-and-such. Together, then, if it sounds like burnout, you might strategize as to wellness activities, and how working in the system might be addressed and adjusted, at least temporarily.|
|BUCK:||When you say that burnout is mainly being present at work, but not at home, I am struck by the fact that so many coders and other health information management (HIM) professionals are, in fact, working from home. I’m thinking of those who, in some cases, are single moms who have full-time jobs (albeit at home), yet they have children and all the other attendant responsibilities that come with being a mom.|
|HSM:||Chuck, I meant someone’s life outside of work, whether they worked away from home or at home. So, even if they are single moms at home, with or without children, if they are not feeling those “symptoms” with these other activities, that means they are likely suffering workplace (wherever that is) burnout. However, what complicates that further is that parental burnout is also rising, so that same single working mom could be burning out because of obstacles causing difficulty in being a mom: a double whammy! Of course, there can also be single physician moms with some related challenges, too. Although there are time constraints in being a working mom (or dad) and being a parent, it is crucial to find some pleasurable ways to unwind and recover from the stress. Also, ventilating with colleagues can be helpful. The best healthcare systems will take this into account and help their workers have a balanced and effective work and family life. Indeed, consider what Freud said long ago: successful work and love is what makes life meaningful and satisfying.|
|BUCK:||Any thought about how these people – women in particular – can deal with burnout? Are there self-diagnosing techniques?|
|HSM:||Yes, there are self-diagnosing techniques. There are scores of burnout rating scales that can be taken. The American Psychiatric Association, on its website, used the Oldenburg, but there are many others available online for free, that would give one a perspective of how much they are burning up. They should be taken periodically, at least every few months. Both administrators and clinicians at work should also be monitored with such rating scales, or any new valid mobile phone apps that emerge to track burnout. Although healthcare coders and other HIM professionals tend to have less overt power in their organizations, there is still the opportunity to do “edge leadership,” as we discussed in Talk Ten Tuesdays on Nov. 19. That means to use creative ways to help bridge the gap between formal leadership and workers, when that seems necessary.|
|BUCK:||You and I have been talking about burnout among non-clinicians, but why is there so much attention paid to physician burnout?|
|HSM:||Why the focus on physicians, and more research on their burning out than the rest of the team? The “buck” stops with us. We know that ultimately, that the outcome of patient care generally depends upon and lies with us (legally, ethically, and practically), and if we are compromised by external forces, our ability to heal and lead the team is impaired.
But funny thing is, Chuck, I am watching the local news and what is a featured story? Burnout in high school students! Are we having a burning up society?