“It was singularly the worst day of my career, and the best day of my career” Those were the words of Trauma Surgeon, Dr. Chadwick Smith as he and his colleagues talked to reporters about what it was like to confront the deadliest mass shooting in American history. Dr Smith recounted the calls he made to his colleagues after 2:00 am, all of whom answered, “I’ll be right there.” He told of how nurses and technicians also arrived to help, many without being asked to come. The doctors recalled how members of the healthcare team were moved to tears by what looked like a “war zone.” The team of surgeons described leaving one operating room, moving to the next and the next to save the lives of the victims, some of whom arrived in the back of pick-up trucks.
What Dr. Smith described is not uncommon to many physicians and other members of the healthcare team - a job that is emotionally and physically demanding but also very rewarding, meaningful, and personally fulfilling. It is not just these rare events that create stress and lead to burnout on healthcare teams. Everyday, physicians, nurses, and technicians deal with an incredible amount of work stress as they confront the issues with the American healthcare system: growing regulatory burdens, litigation stress, rising operational costs, new technology, pay-for-performance payment reimbursement models, and increasing expectations from patients. Studies show that burnout is more common among physicians than among other U.S. workers. Physicians in specialties at the front line of care access such as emergency medicine, general internal medicine, neurology, and family medicine are at even higher risk.[i] Another study showed that in 2013, physician burnout of family doctors under age 35 was 10%. In 2015, it had increased significantly to 43%. The burnout rate among family physicians is similar to that of internists, general surgeons, and infectious disease specialists. It is lower than only two specialties: critical care (53%) and emergency medicine (52%).[ii]
The study showed that burned-out physicians were more likely to report being overweight or obese and to avoid exercise than non-burned-out physicians. Remarkably, 46% of burned-out family physicians report taking 2 weeks or less vacation per year, and 7% take none, compared with 34% and 3% of their non-burned-out peers.[iii]
In a study on nurse burnout, researchers found that a 10% increase in a hospital's proportion of burned-out nurses raised urinary tract infections about the same amount but surgical site infections more than 50%, from 4.2 per 1,000 patients to more than six.[iv] Aside from the obvious health and well-being of healthcare workers, burnout can lead to inadequate care and medical errors.
Can You Spot the Warning Signs of Burnout?
Spotting the warning signs are not always easy. According to the Maslach Burnout Inventory[v], there are three classic symptoms of burnout for those working in human service professions:
- Emotional exhaustion – You’re completely worn out after work and can’t seem to recover at all in your time away.
- Depersonalization – You’re having trouble connecting with patients, and find yourself constantly blaming others. Your general attitude has turned negative and cynical.
- Reduced accomplishment – You’ve lost confidence in your skills and start to believe your care won’t do any good.
Take Care of Yourself and Watch Out for Your Colleagues
The healthcare profession has a time-honored tradition of self-sacrifice and demands nothing less than perfection. As a result, caregivers often find themselves burned out and emotionally drained. In many cases, they don’t seek help. In fact, one in 16 physicians reported having contemplated suicide, according to a study published in the Archives of Surgery. This rate is higher than the general public (6.3 percent vs. 3.3 percent). Only 26 percent sought out help.[vi]
In his book, Cutting for Stone, Surgeon Abraham Verghese said, “We come unbidden into this life, and if we are lucky we find a purpose beyond starvation, misery, and early death which, lest we forget, is the common lot. I grew up and I found my purpose and it was to become a physician. My intent wasn't to save the world as much as to heal myself. Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. But it can also deepen the wound.”
As we listened to the poignant description of the events that took place in Orlando, we are reminded of the challenges that many healthcare workers face on a daily basis. We salute the physicians, nurses, and technicians who answered Dr. Smith’s call. They not only took care of the physical wounds, but also the emotional wounds of their patients. There is little doubt that in the coming days, the healthcare team will have some of their own wounds to heal.
We also salute the healthcare workers on the front lines every day who work exhausting hours under stressful conditions. We urge you to take advantage of some of these resources to assess your own level of stress and resilience so that you can fully enjoy the rewarding and meaningful work you have chosen.
AMA Steps Forward (the online practice transformation series launched last June, is offering new online modules that help physicians learn their risk factors for burnout and adopt real-life strategies to reignite professional fulfillment and resilience)
ANA’s, Self-Care and YOU, provides an integrated approach to the practice of self-care. It has examples, guidelines, tips, techniques, and insights about pathways to help you assess and guide your life long journey to self-care.
Drummond, Dike. Stop Physician Burnout: What to Do When Working Harding Isn't Working. Collinsville, MS: Heritage Press Publications, LLC, 2014.
Fitch, Starla. Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine. Minneapolis, MN: Langdon Street Press, 2014.
Murphy, Tom. Physician Burnout: A Guide to Recogntion and Recovery. Eagle, ID: Aloha Publishing, 2015.
Teresa. "Physician Burnout: Can Doctor's Do Anything to Prevent It?" Medscape, Feb 3, 2015.
Wayne M. Sotile, Ph.D, and Mary O. Sotile. The Medical Marriage: Sustaining Healthy Relationships for Physicians and Their Families. Chicago, IL: American Medical Association, 2000.
[i] Shanafelt, Tait, et al. "Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population." Archives of Internal Medicine, 2012: 1377-1385.
[ii] Medscape. "Medscape Physician Lifestyle Report." 2016.
[iii] Medscape, 2016.
[iv] Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursin. "Nurse Staffing, Burnout Linked to Hospital Infections." American Journal of Infection Control, 2012.
[v] The original measure that was designed for professionals in the human services. Copyright in 1981 by Christina Maslach & Susan E. Jackson.
[vi] McCoy, K.L., and S. E, Carty. "Failure is Not a Fate Worse Than Death." Archives of Surgery 146, no. 1 (2011): 62-63.