THE HOPE
I’ve painted a challenging picture for in Part 1 of this piece. The question now is: is there any hope?
I believe that there is. If 55 % of us report mod-severe levels of burnout, what about the remaining 45% who don’t?
Side note: as I was preparing for this talk, I shared this observation with my 18 year old daughter. When I told her that I was super curious to know what the “well” 45% were doing, she said, “they’re probably lying, either to the researchers or to themselves”.
And I think this scepticism is shared by many of us. But what if at least some of those remaining 45% are actually surviving more effectively than others; what if some of them may even be – dare I say it – thriving? What’s going on for them?
I made three ENCOURAGING observations from the data regarding the overall picture for physicians:
1) The physician burnout rate may be dropping
The American Medical Association biopsy showed that after years of a steady rising trend (even before Covid), the reported rate of burnout actually DECREASED. The number of respondents reporting at least one symptom of burnout dropped from 53% in 2022 to 43% in 2023.
2) Get this – Those who are burning the most are also reporting high job satisfaction
In the AMA biopsy, the same six specialties that reported the highest levels of burnout and job stress ALSO REPORTED THE HIGHEST LEVELS OF JOB SATISFACTION!
Which made me wonder: do physicians wear strain as a badge of honour…? Are there cultural factors (particularly in the US), where productivity is so inextricably linked with value that we may deny our struggles, particularly when asked? Could my daughter be onto something?
But the same paradox appears in our own ACEM 2022 survey — remember 55% reported moderate-high burnout scroes, yet 65% reported being satisfied with overall work.
The reasons for this satisfaction were listed as:
1. interaction with colleagues 78% (Across studies, in emergency medicine, teamwork is consistently cited as the factor that most contributes to reward and satisfaction)
2. career progression 69%
3. renumeration 67%
4. variety of work
Why is patient care not on this list, you may ask (as I did)?! It was simply not one of the 11 finite options given as the survey looked mostly at the operational aspects of work
3) This paradox aligns with my very crude analysis that when the MBI is used in research, typically the pattern of results for those reporting burnout is:
Emotional exhaustion high; Depersonalisation high; Low personal accomplishment … relatively LOW, meaning that personal accomplishment is somewhat preserved.
Is it part of our denial? Or Is this related our strong sense of meaning and purpose?
An article published in the New England Journal of Medicine during the Covid surge in 2020 made the following statement:
“While a huge number of studies globally have emphasised the mental health impacts of pandemic (anxiety, depression, PTSD) on healthcare workers,the need for a crisis response by physicians may also have had protective effects with an astounding display of selflessness by HC professionals”.
(Hartzband et al, 2020)
Given these encouraging observations, when we look at an individual level, what’s going on for those who thrive?
Who are these clinicians who feel engaged, fulfilled, and even optimistic about their work; who can say, “This is hard — but it’s still worth it.”
Meredith’s same systematic review that gave us the predictors for burnout showed the following to be protective:
Professional and practice characteristics:
– Clear job purpose with value alignment between physician and organisation
– Workplace engagement and experience/years in practice;
– Supportive teams with strong leadership: mutual respect, collegial culture, social connectedness, safe debriefing
– Job autonomy: work schedule flexibility, agency in decisions
– Being engaged in teaching/academics/mentorship
– Having protected time for non-clinical work: Several researchers have described that enabling physicians to focus one-fifth of work time on pursuits that they see as important/valuable significantly increases engagement (Shanafelt, 2019)
Health behaviours:
Sleep, exercise and mindfulness/meditation including work towards increasing self-awareness and reflective practice
Psychosocial variables:
Humour, emotional intelligence, perspective and social supports
I have taken all of the above from the AMA, ACEM and Meredith and summarised them into a Triad of Thriving: meaning, connection and control, and then reflected upon how this has applied to my own journey.
Read on for Part 3: The Triad of Thriving (includes bibliography)
