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   Table of Contents      
Year : 2018  |  Volume : 66  |  Issue : 4  |  Page : 489-490

Brace up or burnout

Editor, Indian Journal of Ophthalmology, Editorial Office: Centre for Sight, Road No 2, Banjara Hills, Hyderabad - 500 034, Telangana, India

Date of Web Publication26-Mar-2018

Correspondence Address:
Dr. Santosh G Honavar
Editor, Indian Journal of Ophthalmology, Editorial Office: Centre for Sight, Road No 2, Banjara Hills, Hyderabad - 500 034, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_424_18

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How to cite this article:
Honavar SG. Brace up or burnout. Indian J Ophthalmol 2018;66:489-90

How to cite this URL:
Honavar SG. Brace up or burnout. Indian J Ophthalmol [serial online] 2018 [cited 2020 May 28];66:489-90. Available from: http://www.ijo.in/text.asp?2018/66/4/489/228476

Over the past few decades, many aspects of medical practice have changed: autonomy of the doctor has declined with bureaucratization and corporatization of health-care management, patient–doctor relationship has been impersonalized, medical expertise has been trivialized, medical care has been commercialized to be a commodity that can be bought or sold at will, patient expectations have become unrealistic with potentially punitive implications, medicolegal concerns in patient care have prompted the practice of defensive medicine with a tendency to overinvestigate, paradigm changes in disease management protocols have resulted in an intense pressure on the physician to keep abreast of the same, and evolution of new investigative modalities and surgical techniques have necessitated investment of time and resources to be on the cutting edge and be on par with the peers, with an overall increase in work pressure and demand on time. One of the major collateral damages of these work environmental and societal changes has been physician burnout.

Burnout is a long-term stress reaction defined as a “psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment.”[1] The three key dimensions of burnout are an overwhelming mental and physical fatigue, feeling of detachment from the job, and a sense of ineffectiveness and poor work satisfaction.[2] Burned out physicians are described as angry, cynical, irritable, and impatient [1] and are characterized as less satisfied, more likely to want to reduce their time seeing patients, more likely to order needless tests or procedures, and more interested in an early retirement.[3]

  What Causes Burnout? Top

Burnout is a multifactorial problem stemming from high patient volume, financial pressure, extremely long work hours and a culture of physician self-sacrifice resulting in poor work–life balance, inefficiencies posed by patient documentation and management systems (computerization, regulation burdens, operational policies, practice inefficiencies, etc.), and the increasingly litigious work environment that has become characteristic of our modern medical system.[4] High patient volume leaves little time for doctors to get to know their patients and identify the underlying causes of disease.[4] The model of high-volume health-care short-changes patients, preventing them from getting the care they need and deserve.[4] This problem has left the doctors feeling disillusioned and helpless about their ability to truly help their patients.[4] Having to see more patients and perform enough to meet the financial target and also hit the sweet spot of performance incentive-based remuneration month after month can be a daunting task.[4] The long work hours disrupt the work–life balance, preventing physicians from spending time with their families and engaging in restorative pastimes and self-care practices.[4] Keeping up with time-intensive documentation and regulatory paperwork is a constant struggle for physicians and consumes the time that could be well spent with patients.[4] The current litigious environment has induced the practice of “liability/defensive medicine” where unnecessary tests and procedures are performed to protect against potential malpractice suits.[4] A recent publication by the World Medical Association has appropriately observed that “physicians in many countries are experiencing great frustration in practising their profession, whether because of limited resources, government and/or corporate micro-management of health care delivery, sensationalist media reports of medical errors and unethical physician conduct, or challenges to their authority and skills by patients and other health care providers.”[5]

  What Are the Implications? Top

Burnout negatively impacts not only the doctors and the patients, but also the overall efficiency and the viability of the health-care business. The implications are so significant that the phenomenon has been referred to as a public health crisis.[4] On a personal level, physician burnout is associated with an increased risk of depression, anxiety, sleep disturbances, fatigue, alcohol and drug abuse, marital dysfunction, and premature retirement.[4] Alarmingly, physician burnout has also been linked to suicidal ideations; in 2015, a Mayo Clinic study found that 7% of physicians surveyed had considered suicide within the past year and approximately 400 physicians went through with the act.[6] Doctors experiencing burnout are reported to be at a higher risk of making poor decisions; display hostile attitude toward patients; make more medical errors; and have difficult relationships with co-workers.[7]

  How Big Is the Problem? Top

In a survey, 46% of physicians in the United States reportedly suffered a burnout or depression.[8] A study from rural British Columbia reported that 80% of physicians suffered from emotional exhaustion, 61% suffered from depersonalization, and 44% had moderate-to-low feelings of personal accomplishment.[9] European General Practice Research Network Burnout Study Group found that 12% of participants suffered from burnout in all the three dimensions: 43% suffered emotional exhaustion, 35% depersonalization, and 32% low personal accomplishment.[10] In the United Kingdom, approximately one-third of the physicians had features of burnout.[11] High burnout levels were recorded in a survey of 482 Indian physicians –45% and 66% scored high on the emotional exhaustion and depersonalization scales respectively, whereas 87% scored low on the personal accomplishment scale and 75% had medium or low scores on the satisfaction with the medical practice scale.[12] The survey also elicited a sense of work overload, lack of professional development, neglect, and suboptimal satisfaction with the financial compensation.[12] All these values indicate high levels of burnout. About 37% of ophthalmologists from the United States reported burnout or depression in 2018.[8] Indian ophthalmologists may not be far behind.

  How Are Ophthalmologists Affected? Top

Here are ten key statistics on physician burnout in ophthalmology from Medscape's Ophthalmologist Lifestyle Report 2018:[8]

  1. Thirty-seven percentage of ophthalmologists in the United States are considered “burned out”
  2. The top causes of ophthalmologist burnout are too many bureaucratic tasks (59%), increasing computerization of practice (35%), government regulations (33%), longer hours at work (31%), decreasing reimbursements (27%), insufficient compensation (24%), lack of respect from patients (18%), lack of respect from employers/bureaucrats/administrators (15%), feeling like “cog in the wheel” (13%), lack of control/autonomy (12%), emphasis on profits over patients (10%), and maintenance of certification requirements (7%)
  3. Female ophthalmologists are more likely to be burned out (43%) over their male counterparts (27%)
  4. Ophthalmologists cope with burnout by indulging in exercise (51%), talking to family and friends (48%), sleep (36%), or listen to music (30%). Negative cope up mechanisms include junk food (27%), alcohol (26%), isolation of self (21%), binge eating (15%), or use of drugs/tobacco (1–3%)
  5. About a quarter (23%) of ophthalmologists seek professional psychiatric help for depression or burnout
  6. Nearly half (46%) of burned-out ophthalmologists give vent by expressing frustration in front of staff/peers, 33% were exasperated with colleagues, and 33% were less friendly with staff and colleagues
  7. About 46% of burned-out ophthalmologists felt that they were exasperated by patients, 38% were less friendly to patients, and 20% admitted that they may make medical errors which otherwise they would not have made
  8. Most (77%) workplaces did not offer stress management programs
  9. Support mechanisms and stress busters include marriage (82%), religious belief (68%), three or more close friends (47%), 3–4 weeks of vacation a year (50%), exercise 2–3 times a week (35%), and five or more drinks of alcohol each week (20%).

  Are You Affected? Top

We would leave it to the readers to contemplate and wonder if they have any element of workplace burnout which is creeping into their own lives, and if so, how would they dust the rust, stem the tide, and polish their professional lives. The Maslach Burnout Inventory has been the most widely used questionnaire in the evaluation of burnout.[13] The new Physician Burnout Questionnaire (PhBQ) assesses three main components: exhaustion, disengagement, and loss of expectations.[14] The PhBQ process model includes four subscales: antecedents, syndrome, consequences, and positive personal resources. One of these questionnaires can be used to assess burnout, or the readers can simply take any of the following self-tests and see how well are they doing with their professional psychological well-being: https://www.scientificamerican.com/article/quiz-are-you-on-the-path-to-burnout/ or https://www.stepsforward.org/modules/physician-burnout-survey. We will address some of the issues related to “re-greening” and burnout prevention strategies in the next issue of Indian Journal of Ophthalmology.

  References Top

Linzer M, Visser MR, Oort FJ, Smets EM, McMurray JE, de Haes HC, et al. Predicting and preventing physician burnout: Results from the United States and the Netherlands. Am J Med 2001;111:170-5.  Back to cited text no. 1
Maslach C, Leiter MP. Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry 2016;15:103-11.  Back to cited text no. 2
Schmoldt RA, Freeborn DK, Klevit HD. Physician burnout: Recommendations for HMO managers. HMO Pract 1994;8:58-63.  Back to cited text no. 3
Epidemic of Physician Burnout. Available from: https://www.kresserinstitute.com/epidemic-physician-burnout/. [Last accessed on 2018 Mar 20].  Back to cited text no. 4
World Medical Association Medical Ethics Manual. 2nd ed. Available from: http://www.wma.net/en/30publications/30ethicsmanual/pdf/chap_6_en.pdf. [Last accessed on 2018 Mar 20].  Back to cited text no. 5
Schernhammer ES, Colditz GA. Suicide rates among physicians: A quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004;161:2295-302.  Back to cited text no. 6
Kumar S. Burnout and doctors: Prevalence, prevention and intervention. Healthcare (Basel) 2016;4. pii: E37.  Back to cited text no. 7
Medscape Ophthalmologist Lifestyle Report 2018: Personal Happiness vs. Work Burnout. Available from: https://www.medscape.com/slideshow/2018-lifestyle-ophthalmologist-6009233#1. [Last accessed on 2018 Mar 20].  Back to cited text no. 8
Thommasen HV, Lavanchy M, Connelly I, Berkowitz J, Grzybowski S. Mental health, job satisfaction, and intention to relocate. Opinions of physicians in rural British Columbia. Can Fam Physician 2001;47:737-44.  Back to cited text no. 9
Soler JK, Yaman H, Esteva M, Dobbs F, Asenova RS, Katic M, et al. Burnout in European family doctors: The EGPRN study. Fam Pract 2008;25:245-65.  Back to cited text no. 10
Sharma A, Sharp DM, Walker LG, Monson JR. Stress and burnout in colorectal and vascular surgical consultants working in the UK National Health Service. Psychooncology 2008;17:570-6.  Back to cited text no. 11
Langade D, Modi PD, Sidhwa YF, Hishikar NA, Gharpure AS, Wankhade K, et al. Burnout syndrome among medical practitioners across India: A Questionnaire-based survey. Cureus 2016;8:e771.  Back to cited text no. 12
Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996.  Back to cited text no. 13
Moreno-Jimenez B, Barbaranelli C, Gálvez-Herrer M, Garrosa E. The physician burnout questionnaire: A new definition and measure. TPM 2012;19:325-44.  Back to cited text no. 14


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What Causes Burnout?
What Are the Imp...
How Big Is the P...
How Are Ophthalm...
Are You Affected?

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