There’s a vast body of research showing that physicians and other health care professionals experience high rates of burnout, their roles leaving them exhausted, overworked, or detached. But a new study makes the case that it’s difficult to capture how common burnout actually is because how it’s defined varies so widely.
The research, published Wednesday in JAMA Surgery, surveyed nearly 7,000 general surgery residents in the U.S. about whether they experienced symptoms of burnout and if so, how often. When the researchers parsed the definition of burnout differently, they found significant differences in how prevalent burnout was among participants.
“If we’re going to talk about the condition of burnout, then we need to be much more rigorous about applying a strict definition and measure so that everybody’s talking about the same thing using the same scale,” said Wendy Dean, a psychiatrist and the co-founder of the nonprofit organization Moral Injury of Healthcare. Dean was not involved in the new research.
Burnout has drawn considerable attention in the health care field, given that it impacts mental and physical health and has been associated with self-reported medical errors among physicians. Burnout is also to blame for some share of physicians leaving their roles or scaling back their clinical hours.
Past studies have suggested more than half of practicing physicians have at least one symptom of burnout. Those symptoms generally fall into one of three buckets: emotional exhaustion, impact to personal accomplishment, and depersonalization, or feeling disconnected from one’s self.
In the new study, the researchers focused only on emotional exhaustion and depersonalization, which they said are the strongest and most consistent indicators of burnout.
The survey first asked the residents if they experienced either one of the symptoms and if so, whether they experienced those symptoms on a daily, weekly, monthly, or annual basis. Next, they had to report if they experienced both symptoms and if so, how frequent they were.
If burnout was defined as having either of the symptoms a few times a year, 91% of residents met the definition for burnout. If it was defined as being a daily symptom, the burnout rates reduced to 11%. By comparison, 90% of residents reported experiencing both symptoms at least once a year, while 3% reported having them on a daily basis.
“You could have a pretty broad range depending on how you defined burnout,” said Karl Bilimoria, an author of the study and the director of the Surgical Outcomes and Quality Improvement Center of Northwestern University.
No matter what the symptoms, residents who reported symptoms of burnout were also more likely to have thoughts of attrition and suicidal thoughts, which experts said is particularly concerning.
“The fact that attrition and suicidality are linked to burnout in this study is incredibly important and adds to the strength of the paper,” said Simon Talbot, a reconstructive plastic surgeon at Brigham and Women’s Hospital and the co-founder of Moral Injury of Healthcare, who was not involved in the research.
There are still a number of questions that need to be answered about what causes burnout and the role of health systems and the environment around physicians. The study didn’t look at the causes of burnout.
Moving forward, the researchers are trying to reduce burnout by giving training programs and toolkits to general surgery residents. But experts say there are broader changes that need to happen, too. Talbot and Dean argue that burnout is a symptom of a deeper structural dysfunction in the health care system. To them, the problem is one of “moral injury,” which occurs when clinicians find it hard to do their job well and take care of their patients.
“When as a doctor you’ve taken an oath to take care of your patients and care of your patients gets more difficult, that is the essence of moral injury. And if you continue to suffer moral injury unabated, eventually you burn out,” said Talbot.