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Professional burnout: It can happen to you
Our Chief Medical Editor, Douglas W. Jackson, MD, asks Khaled J. Saleh, MD, and James Campbell Quick, PhD, how orthopedists can avoid the burnout of emotional exhaustion.
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Do you ever feel over worked and under appreciated? Do you ever feel so tired you wish you could just get away from it all? Do you ever think that nothing during a stressful day has been that enjoyable and it may be the same tomorrow? Emotional exhaustion in an orthopedic surgeon’s life can occur insidiously and interfere with the joys of a rewarding profession.
The American Institute of Stress has indicated that job stress has reached epidemic proportions within the United States, the United Kingdom, and other industrialized nations, and that Americans are overworked. But it is unclear whether there is sufficient evidence that stress and burnout are at epidemic proportions within medicine in general or orthopedic surgery in particular. Dr. Saleh and his team of investigators, with support from the American Orthopaedics Association and grant funding from the Orthopaedic Research and Education Foundation, have attempted to identify early risk factors for early warning signs of burnout and distress. Their data, published in the Journal of Bone and Joint Surgery, offer some important insights.
In this month’s interview, we turned to Drs. Khaled J. Saleh and James Campbell Quick to share some thoughts on professional burnout and help those who may experience it.
Douglas W. Jackson, MD
Chief Medical Editor
Douglas W. Jackson, MD: What is professional burnout?
Khaled J. Saleh, MD, MSc(HSRP), FRCSC, FACS: Professional burnout is the emotional exhaustion, cynicism, and depersonalization that result from a chronic process of energy expenditure without appropriate periods of energy recovery. It is a chronic condition in contrast to a periodic, acute condition. There is no standardized treatment or cure for professional burnout.
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People at the highest risk of professional burnout are those in care-giving professions, such as medicine and nursing, and in high-achievement arenas, such as business executives and world class performers in various fields. It is less common among professional athletes because of their training regimens that intersperse energy expenditure with periodic recovery and energy recovery cycles.
Chronic work overload is a key causal factor. Professional burnout is not a permanent condition in spite of the absence of a standardized protocol for treatment and recovery. It is not the same as psychological depression, so does not necessarily require pharmacological intervention. However, burnout and depression share some of the same symptoms and characteristics. While depression carries a risk of suicide, professional burnout has not been empirically linked to suicide.
Jackson: Can an orthopedic surgeon recognize burnout in him or herself?
James Campbell Quick, PhD, FAPA: Maybe, but not necessarily. Burnout is often best identified by those who know and observe the person, in this case the orthopedic surgeon. Self-diagnosed burnout is difficult. Education is the best form of diagnosis.
Jackson: What can happen with work-family conflicts in burnout?
Saleh: Burnout has adverse effects within family systems because of the spillover effects that professional burnout may have on spouses and other family members. There are work-to-family conflicts where factors in the workplace intrude upon the family.
Thus, professional burnout causes conflicts for family members because the professional is out of energy, cynical (that is, displays a negative attitude), and does not treat loved ones with the love and personal touch they deserve.
There are also family-to-work conflicts that arise when factors in the family spillover into the workplace. Thus, family conflicts and issues can cause emotional overload for the professional, such as an orthopedic surgeon, and result in a drain on energy otherwise available for work. Thus, burnout can be a two-way problem for the working professional with a family.
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Jackson: What are some generic suggestions to prevent and/or correct professional burnout?
Quick: Prevention is absolutely the best approach to professional burnout, vs. some kind of tertiary treatment or care giving. There are several levels of preventive actions that orthopedic surgeons can take. The first of these constitute primary prevention activities, such as insuring the maintenance of a healthy social system of relationships and a workload management system. Chronic work overload is determined on an individual basis such that some professionals simply work harder and longer than others, with no ill effects in burnout or otherwise. Whatever the work level is that is appropriate for the individual, this should be balanced with other loves, whether that be fishing or reading.
Secondary prevention activities are also helpful. The two best-tested of these are physical exercise and rest periods. Physical exercise, while being an energy expenditure activity in the short run, goes a long way in achieving higher energy levels over the longer term. Walking, jogging, swimming, various team sports and racquet sports as well as golf are all good forms of physical activity. Competition is not required.
The other secondary prevention activity is found in prayer, meditation, or just brief (10-15 minutes) periods of quiet time and relaxation. The idea is not to become lethargic, but to program in respites that lead to energy recovery for sustained levels of performance over the long haul.
For more information:
- Khaled J. Saleh MD, MSc(HSRP), FRCSC, FACS, can be reached at the University of Virginia Health System, PO Box 800159, Charlottesville VA 22908-0159; 434-243-0067; email: saleh@virginia.edu.
- James Campbell Quick, PhD, FAPA, can be reached at The University of Texas at Arlington, Goolsby Leadership Academy, and Lancaster University School of Management, UK, Box 19377, Arlington, TX 76019-0377; 817-272-3869; e-Mail: jquick@uta.edu.
Reference:
- Saleh KJ, Quick JC, Conaway M, Sime WE, Martin W, Hurwitz S, et al. The prevalence and severity of burnout among academic orthopaedic departmental leaders. J Bone Joint Surg. 2007;89-A(4);896-903.