Jack is an emergency physician at a busy community hospital. You have been friends for years, and you occasionally catch a drink together. Things have been stressful at work with a new electronic health record (EHR) in the past year, which has productivity down and wait times up. Jack is a known clinical machine, so the productivity drain has been particularly frustrating for him. He considered the assistant director position that opened up six months ago, but he decided he was too busy already.
Over drinks recently, you caught up on home life as well, and he says things are going well with his wife and two kids, although the kids’ schedule conflicts with his work hours, which has been tough on everyone. He laments that the new opioid regulations have made caring for drug seekers even more painful. After a drink, you headed out, but Jack said he was going to have another.
Are you and Jack on the road to burnout? Technically, yes. The data show burnout rates of up to 65% percent in emergency medicine, more than any other specialty, and they’re increasing.1,2 We are all, by being emergency physicians, on the road to burnout; the question is: How far down that road are you? We are also all on the road to satisfaction, cynicism, happiness, prosperity, and compassion. In emergency medicine, we experience all of life amplified. Whatever resources we started with will dwindle if not replenished. Operationally, Christina Maslach and her colleagues have quantified this depleted burned-out state as a triad of emotional exhaustion, depersonalization, and reduced sense of personal accomplishment.3 Their social science research let to the Maslach Burnout Inventory, a scale that is currently regarded as the gold standard to assess workplace burnout.
Let’s look at the specifics. Jack is a clinical machine. Burnout is associated with high clinical load.4 The more emotionally taxing cases we see, the less time we have to process them, and the more at risk for emotional exhaustion we become.5 Although Jack is mid-career, burnout seems well-distributed among different-aged physicians, and it occurs at higher rates than in the general population.6 Jack is bothered by the EHR. He considered becoming more involved in decision making. Inefficacy, or lack of control, is a risk factor for burnout in physicians and may be why emergency physicians score so high on burnout surveys. Lack of career or workplace involvement is also a risk factor for burnout. Niche development or career diversification may be somewhat protective, combating a sense of depersonalization.