Healthcare burnout has become a problem of epic proportions facing out healthcare system today. A 2022 Medscape survey reported that approximately 50% of physicians are experiencing some degree of burnout. Another article that I ran across suggested that nurses are no longer flocking toward traveling nursing jobs because they are just plain done. And like many illnesses, burnout doesn’t just affect the person suffering, but everyone around them. Families, patients and hospitals are all affected by the depersonalization, lack of efficacy and loss of passion that is caused by burnout.
In this book, Emergency Physician, Dr. Thom Mayer, discusses burnout and seeks to outline solutions to burnout that range from individual action items to systemic issues with hospitals and the healthcare system that need changing. He defines burnout as a “Mismatch between job stressors and the adaptive capacity to deal with those stressors, which results in three cardinal symptoms:
1. Emotional exhaustion
2. Cynicism
3. Loss of sense of meaning in work.”
In other words, we as individuals, and members of larger organizations have an innate ability to manage some degree of stress and adapt to that. This is the premise behind resistance training in the gym and surge planning in an capacity system. We experience things on a routine basis that will challenge our resting state. If these challenges are within our physical capacity to respond and adapt we meet the challenges with no difficulty. There are some challenges, however, that exceed out capability to adapt. If sufficiently short and if there is enough time for recovery after, these challenges allow us to grow. Again, think back to the gym. When we fail the last rep, we have found and exceeded our physical capacity. But this stressor beyond our present ability combined with a recovery period before the next set allows us to grow, build muscle and strength. Problems arise when we continually push reps and sets beyond our failure point without sufficient rest. In gym, this leads to injuries. In healthcare, this leads to burnout.
Mayer goes on to describe the six Maslach domains that are causes of burnout. These are:
1. Mismatch of job stressors with adaptive capacity
2. Loss of control
3. Lack of rewards and recognition
4. Loss of community
5. Lack of fairness
6. Loss of values
As healthcare has become increasingly corporatized and managed by non-healthcare providers, there is an increasing focus on efficiency. While these LEAN principles have their place and can help find inefficiencies in the system, the net effect is producing a healthcare system who’s primary fidelity is to the excel spreadsheet and no longer to patients and providers. So, the healthcare system that we find ourselves with is the direct product of the policies and procedures that have been created. Mayer asks the question “Do the words on the walls match the happenings in the halls?”
Personally, I found this book very insightful as one who has been battling burnout. Many resources that I have seen previously have described burnout as an imbalance between eustress and distress and have recommended strategies like sleep, exercise, and mindfulness as the solution to wellness. Organizational solutions to date have included making sure the computers are working, the chairs are comfortable and pizza on difficult days. Frankly, I have found these solutions frustrating, namely because either I am doing them to the best of my ability (sleep and exercise) or they don’t actually strike at the root causes of burnout. I appreciated that Mayer in this book recommends individual solutions to manage burnout for providers, but really focuses on the systems problems that drive burnout.
Burnout, and its solution, is a healthcare system problem, requiring systems-based solutions. It is not just a problem with individual providers. For years I thought that being burnt out was a reflection on me and that I had some unfortunate deficit of resilience. This book was helpful to show that to be a myopic perspective on provider burnout. To borrow the language of medicine, provider burnout is a symptom of an illness of the system. Recognizing and treating burnout needs to be a priority for members of the health care system and particularly at the highest levels of leadership.
Book Information:
Title: Battling Healthcare Burnout: Learning to Love the Job You Have, While Creating the Job You Love.
Author: Thom Mayer, MD
ISBN: 978-1-5230-8991-8
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