The problem with burnout is its complexity. It may be emotional exhaustion, disengagement, or a low opinion of our work. The “job demands-job resources” model of burnout provides a framework to think about the key system-based drivers of burnout in our workplace. (J App Psych 2001;86:499.) Let's take a look at the demands of our job: high workload, time pressure, patient expectations, challenging physical environments, and shift work. It is no surprise that the outcome is physical exhaustion.
Likewise, we feel disengagement when the necessary resources in our work — meaningful feedback, personal satisfaction, appropriate degree of autonomy, support from the EM team, job security, and supervisor support — are unbalanced. Sadly, our work environment often drifts into these imbalances; too many demands and too few resources mean burnout is the understandable and unfortunate outcome.
We know from prevalence studies that more than half of all emergency physicians are experiencing burnout. (Medscape. Jan. 26, 2015; http://wb.md/2rwqzQh.) The problem does not lie solely with the individual, but is a system-based issue that requires systemic and organizational solutions as well as individual efforts.
Unfortunately, system-based changes are difficult to effect, and many of the systems in place are beyond our control. A shift toward focusing on workplace interventions to address physician burnout is occurring, however. (JAMA Intern Med 2017;177:195.) Encouragingly, hospital leadership at prominent health care organizations is starting to acknowledge these workplace drivers, and are instituting the initial steps at their institutions to start addressing these issues. (Health Aff March 28, 2017; http://bit.ly/2rwc4fs.)
Too many institutions, however, remain blind to these system-based problems, and it may be a long time before most physicians actually see meaningful changes in their work environment. We need to be the voice advocating for change within our own institutions.
The Part We Play
It is tempting to point solely at the system as the cause of burnout, and we must consider the role of the individual and our unique specialty. We must acknowledge our own life experiences and conditions that contribute to burnout and being unwell. Anyone who has struggled with depression, anxiety, suicidal thoughts, a divorce, compassion fatigue, or second victim syndrome can attest that some primary drivers of burnout are unique to us as individuals.
The nature of emergency medicine contributes substantially: dealing with the public, caring for abused children and vulnerable adults, working to save victims of horrific acts of violence, including mass casualty and mass shootings, and bearing witness to untimely deaths. Repeated exposure to this suffering contributes to burnout and compassion fatigue. And too few of us take self-care as seriously as we should. The way forward must be a comprehensive approach that encompasses individual, societal, and institutional factors, as well as the unique challenges of our specialty.
We can't possibly control every aspect of our environment, but we can control how we experience it and how we respond. Being resilient is the art of training to bend and not break in the face of adversity. It means cultivating the emotional, spiritual, and intellectual flexibility that allows us to recover and go on. It is learning how we can use evidence-based practices like mindfulness, yoga, and physical exercise to bounce back from a stressful job and difficult work environment. It is striving to be well, to be your best, by being intentional about self-care. It is this intentional cultivation of holistic self-care and wellness that will allow us to continue to be compassionate and engaged physicians. It is exploring how art and the humanities can help us come together in our shared experiences as emergency physicians and humans.
Telling our stories of the joys and perils of emergency medicine can help us remember why we do the difficult work that we do and that we are never alone, no matter how difficult life becomes. We will shed light and awareness on the epidemic of physician suicide and how we can advocate to save the lives of those suffering in silence.
The first step toward resiliency starts with self-assessment. Start with the anonymous burnout inventory tools available on the American Academy of Emergency Medicine's Wellness Page. (http://bit.ly/2rA9W6r.) What key drivers of burnout are under your control? Is there a better balance in the amount of work that you take on with regard to your longevity? Can you shift your career to include new directions that add interest?
You could dive into your subspecialty interest in emergency medicine, such as wilderness medicine, or take on educational tasks. Would starting something new outside of work relating to your hobbies or interests refresh your mind? Do you need to engage in a better self-care plan? Do you need to take a hard look at the institution you work for? Does your workplace give you the appropriate amount of autonomy, transparency, and fairness? Are the mission and values of your institution aligned with your own? The American Medical Association has a nice tool to help you start your own resiliency plan. (http://bit.ly/2rzVMCl.)
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Be Resilient, Be Well
Bouncing Back is devoted to the art and science of being resilient and well. Emergency physicians inevitably face challenges and adversity, and resiliency is the art of learning to bend and not break. This column hopes to equip, encourage, and inspire EPs not just to survive but to flourish.