Report: U.S. Doctors Face Job Burnout More Than Any Other Workers

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K. Ashworth (left) takes a moment to talk with a colleague in the Surgical and Burn Intensive Care Unit at the Wexner Medical Center at Ohio State. Ashworth, who oversees the unit's nurses, watches for signs of burnout.(Photo: Mandie Trimble, WOSU News Reporter)
K. Ashworth (left) takes a moment to talk with a colleague in the Surgical and Burn Intensive Care Unit at the Wexner Medical Center at Ohio State. Ashworth, who oversees the unit's nurses, watches for signs of burnout.(Photo: Mandie Trimble, WOSU News Reporter)

We’ve likely all had stressful days when we wanted to leave the office and never return. Usually a day off or a vacation helps us recharge. But prolonged stress can lead to burnout.

New studies show medical professionals experience more burnout than other workers. WOSU sat down with some local medical workers to discuss the issue.

(WARNING: The beginning of this story is graphic.)

K. Ashworth remembers the first time she saw medical burnout. She was a young nurse assisting in a New York hospital operating room.

“He was surgical oncologist who was so distraught finding breast cancer in an 18-year-old girl that he threw the breast that he just removed across the room. It hit the wall. He finished his surgery. Put his scalpel down, walked out and never came back,” Ashworth recalled.

Thirty years later, the details of that moment remain clear in Ashworth’s memory. Today, she manages Ohio State Medical Center’s Surgical and Burn Intensive Care Unit.

“He left the profession. He was done. When I asked him what happened, he said, ‘You don’t know what it’s like to have to find this all the time in young women who did nothing to deserve it.’ He could take no more.”

Obviously, that was an extreme case. But studies show nearly half of all physicians will suffer burnout at some point in their career. They can develop feelings of cynicism; experience low sense of personal accomplishment; and lose interest in work. Doctors face the risk of burnout more than any other worker in the country.

As she walks through the surgical and burn ICU, Ashworth’s affection for her staff shows through.

“These are my pharmacy peeps. I love my pharmacy peeps,” she exclaims.

Ashworth keeps a close eye on them, watching for signs of burnout.

“In the high stress area like a critical care you probably witness more of it than any place else because patients literally put their lives your in hands. And many days your very best is not good enough and you lose somebody,” she said. “And that gives you a feeling of failure, not achieving your goal, not doing what you promised that patient and family which usually is ‘I’ll protect you and keep you alive.’”

In October, the Journal of American Medical Association reported burnout among U.S. doctors reached an “alarming level.”

Emergency room doctors, general practitioners and neurologists face the most burnout. Nearly 30 percent of the study’s doctors expressed high levels of depersonalization, the feeling of having lost one’s sense of self or the feeling of being in a robotic state. Another 38 percent showed signs of depression; 6 percent had considered suicide in the past year.

“When I met with physicians who were facing this challenge, I asked them this question: do you feel like you’ve come to the end of your rope?” The Wexner Medical Center at Ohio State University CEO Dr. Steven Gabbe said. “And when you ask someone that and they just sort of nod and smile, you know you’ve found the problem.”

Gabbe has researched burnout for years. He found a number of factors lead to medical burnout, including a lack of autonomy.

“If you look at what really gets people, it’s the call schedule that I don’t have control of. It’s the demands that government rules and regulations put on me, it’s keeping me from spending time with my patients that I would like. It’s the imbalance in my work and my life,” Gabbe said.

Gabbe’s own experience with burnout in 1987 prompted his research. He was the new chair of OSU’s Obstetrics and Gynecology. And he wasn’t alone.

“I didn’t realize what it was at the time. Fortunately [I] had great family support and great support from mentors who helped me deal with that problem…I saw so many of my fellow chairs frustrated, disappointed, angry, looking forward to when they could leave their positions,” he remembered.

Debilitating stress can happen in any job, but the consequences in medicine are grave. When a doctor is burned out, the quality of care can decline, professionalism can deteriorate and patients are at increased risk for medical errors.

Back at the Surgical and Burn ICU, K. Ashworth points to the area where staff can blow off steam.

“This is where I tell my staff, if you have to scream, shout, go into an office and do it,” Ashworth noted.

“We do whatever we do to not be in the environment that we can cause harm. I mean, that’s the oath in both the medical profession and nursing profession is cause no harm,” she said. “And I think all of us are very cognizant when we get to that point, and we’re all very smart enough to say, ‘OK, time out.’ And we back away.”

For staff that need more than a place to vent, there’s the medical center’s STAR program. STAR stands for Stress Trauma And Resilience. While the program provides mental health services for patients, it’s also there for employees.

Ashworth encourages her nurses to take time off. And if someone is overworked, she likely will send them home.

“As a manager I think it’s part of my job to say to the nurse, ‘no, you can’t work tonight.’ And I’ve said that to staff before, ‘isn’t this your fourth or fifth twelve-hour in a row?’ ‘Well yeah, why?’ ‘Well then you can’t because you’re tired and this is too high stress. And, no, we’ll figure out a way without you.’ I think it’s important that everyone know balance.”

In the long run, the stress ultimately can lead to unplanned early retirement.

But Dr. Gabbe said finding that balance can prevent or reverse it. And he said it’s crucial to get doctors early in their careers – engage medical students, residents, junior faculty – before they get on a path to burnout.

“I can’t ever remember a resident, or fellow, or faculty member in my training saying, ‘you know, keep things in perspective, Steve. Remember the balance between work and your family and work in your hobbies.’ We do that now. And I think it’s really important,” Gabbe reflected.

Comments
  • Beverly Potter

    Stress does NOT cause burnout and prolonged stress does NOT lead to burnout. Burnout is stressful but is it NOT a stress disorder. Burnout can be likened to job depression where is the person is DEpressed, DEspirited, DEmotivated. It is caused by feelings of powerlessness and helplessness caused by damned-if-you-do;damned-if-you-don’t and other impossible situations where the person can not “win”. Such situations damage motivation, making it ever harder to perform. It is characterized by increased negative emotions (frustration, anger, depression, despair), declining performance, interpersonal conflict and withdrawal, increased minor (colds, flu) and more serious health issues, feelings of meaninglessness, and substance abuse in an effort to self-medicate.

    As in pneumonia, the fever that accompanies it must be brought down to avoid brain damage, but when the fever is reduced, the pneumonia persists. Similarly in burnout, the stress that accompanies it can cause health issues and encourage substance abuse, must be reduced to preserve health; reducing stress does not “treat” the underlying causes of the burnout. Taking a vacation, developing work-home balance, eating better (and so forth) “treat” the stress, but do little to deal with the workplace problems causing the feelings of powerlessness.

    To prevent and over-come burnout, the person needs to develop a sense of empowerment, a feeling of I-Can-Do, a sense that one can perform and succeed. Doctors and other medical professionals working with the dying such as in hospice settings are particularly challenged – because as hard as they try, their patients die!!! Worries about malpractice suits, and dealing with bureaucracy can engender frustration and feeling powerless. Doctors, who are trained in medicine and not management or finance, who set up clinics or move up the ladder in hospitals can be overwhelmed with staff conflict – especially among nurses – that can lead to feeling helpless.

    Setting achievable goals and mapping out steps to reach them can help because the process builds confidence and a sense of control. Taking a workshop to learn to give directives can be more helpful than a vacation of lounging on the beach. Each person is different and must identify what factors are causing feelings of powerlessness – specifically and developing concrete goals and steps for increasing controllability in those areas – through bettering one’s skills, or changing how one thinks about the situations (such as half full glass instead of half empty), creating a support system, altering the job, changing jobs, and so forth. And, yes, taking specific steps to reduces stress is also important along with a change plan for situations in the workplace.

    For burnout quizzes: “Am I Burning Out?”, “What Is The Burnout Potential of My Job?, and “Is My Staff Burning Out?” as well as much content on burnout issues, visit my site at docpotter dot com.