Work Overload: Sense of achievement key to combating professional burnout

Strategies

How can burnout among otolaryngologists be alleviated? Part of the challenge, Dr. Teknos said, is the fact that the level of burnout, and the reasons for it, vary depending on the level of a physician’s career. "Based on this and other studies that have been done, we can see that residents are in the worst shape. Essentially, 86 percent of residents in otolaryngology are either highly or moderately burnt out," he explained. "Next are the chairs, followed by microvascular surgeons, followed by academic faculty."

For residents, the biggest determinant of burnout is emotional exhaustion, caused primarily by a lack of balance between personal and professional life. "The number one thing that residents say really affects their burnout level is insufficient time for exercise and insufficient extracurricular time."

Chairs, on the other hand, report that their biggest stressors relate to departmental budgets and deficits, billing audits, disputes with the dean and loss of faculty. "Theirs are more global, high-level issues," Dr. Teknos said. "For faculty in general, their biggest stressors are inadequate research time and low collections, then departmental budgets and inadequate administrative time. Microvascular surgeons are most stressed by excess workload and work invading family life."

With all these varied stressors, why is it that residents in otolaryngology are the most burnt out of all? It’s what they don’t have, Dr. Teknos said. "For most faculty, what balances off the emotional exhaustion and depersonalization of their careers is that they have a high sense of personal accomplishment. Residents, because of where they are professionally, don’t have that sense of achievement."

This particular insight may point to useful interventions for combating burnout, said Michael Johns III, MD, director of the Emory Voice Center and associate professor of otolaryngology at Emory University School of Medicine in Atlanta and a author of both studies. "Medicine is a flow experience; if you really enjoy what you’re doing and have a strong sense of personal accomplishment, you’re not worried about hours spent doing it. Across the board, the less control you have over your own destiny, the more burnt out you’re going to be. So trying to create situations where residents, faculty and chairs have some control over what they’re doing is key."

In an academic medical center setting, that might mean building in a certain amount of discretionary "clinical-academic" time for faculty members. "I’ve got some of that time, and it’s my choice as to whether I see patients, take on a teaching role in the school of medicine or apply for more research grants," Dr. Johns said. "It gives me a certain autonomy." For residents, that’s harder to do, Dr. Johns acknowledged. "You can give them some elective time, but they’re already overloaded."