How to beat burnout

Being a healer is a rewarding profession, but it also comes at a cost. Physicians have some of the highest rates of professional burnout, and a new study picks apart what is contributing to burnout, job and life satisfaction, and perceptions of work-life balance among pediatricians.

The study, published in Pediatrics, polled 840 early career pediatricians who completed residencies between 2002 and 2004 on the balance they achieve between personal and professional obligations, their current level of burnout in their work, and their satisfaction with life in general. Using data from the American Academy of Pediatrics Pediatrician Life and Career Experience Study (PLACES), researchers found that while the results were generally positive, more pediatricians reported satisfaction with their work than their life, with 83% reporting career satisfaction compared to 71% reporting life satisfaction. A mere 43% reported achieving work-life balance, and 30% were already reporting burnout in their careers.

Medical professionals have long been known to experience high rates of burnout in their careers due to the demands of their profession. Compassion fatigue, long hours, high stress, workforce shortages, increased patient complexity, use of electronic health technology, and more all contribute and can lead to burnout and medical errors.

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The report notes that previous studies have suggested that the prevalence of burnout is highest in early- to mid-career phases, adding that early-career pediatricians are particularly vulnerable because they experience so many transitions personally, from multiple job changes earlier in their career, to adding marriage and children in their personal lives.

The majority of the study participants-44.4% general pediatricians and 36.1% subspecialists-were female (60%), non-Hispanic white (64%), married (89%), in good health (71%), and had children (86%). Seven percent reported frequently feeling sad or depressed and 38% experienced a negative life event in the previous year.

In terms of their careers, 82.4% of respondents reported feeling as though they had autonomy in their clinical decision-making and 68.3% felt that they had access to adequate resources for patient care. More than half of pediatricians polled (58.2%) reported working less than 50 hours per week.

Those that reported higher rates of burnout had several factors in common, according to the study. Pediatricians at risk for burnout had experienced negative life events, reported feeling sad or depressed, worked in chaotic work settings, or had worked in their current position for 4 or more years. In comparison, pediatricians who were in excellent or very good health; had support from colleagues; and reported access to adequate resources for patient care were at lower risk of burnout.

In terms of work-life balance, the study identified physician health, adequate exercise, personal support from colleagues, autonomy in clinical decision-making, and adequate resources for patient care among the factors associated with higher perceptions of work-life balance. Female pediatricians and those reporting less sleep, more chaotic work environments, and working more than 50 hours per week negatively affected work-life balance, according to the report.

Similar factors were reported in terms of career satisfaction, with working 4 or more years in their current position, support from colleagues, autonomy, and adequate resources associated with greater career satisfaction, while female gender and depression contributed to lower satisfaction levels.

Life satisfaction was similar, with 4 or more years in their position, adequate patient care resources, and support from colleagues ranking high among contributors to high satisfaction, along with advance notice of work schedules. Inadequate sleep, negative life events, and feelings of sadness or depression contributed negatively to feelings of life satisfaction, according to the report.

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Another factor to consider is the demographic change that is underway in pediatrics, according to the report, with the majority of new early-career pediatricians consisting of women with young children. The authors note that the findings of this study reveal that female pediatricians-or pediatricians with children-are not predisposed to burnout or low levels of life satisfaction, but they are more likely to struggle with work-life balance and report less career satisfaction.

“Burnout and struggles with work–life balance were common, and dissatisfaction

with life and career was a concern for some. Several factors were found to be associated with all of the outcomes of interest, including potentially modifiable factors of excellent or very good health, personal support from physician colleagues, and adequate resources for patient care,” the report notes. “Importantly, the nonmodifiable factor

of race and the potentially modifiable factor of having children were not associated with a higher likelihood of burnout, struggles with work–life balance, or dissatisfaction with life or career.”

Physician burnout rates vary widely across the spectrum-30% to 65%-with general pediatrics falling among the lowest reported rates at 35% and subspecialty pediatrics at 40%. Although the study focused on early career pediatricians, its authors plan to continue to study this cohort as they move into mid career to determine whether burnout rates change over the course of their careers.

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While burnout rates among pediatricians may not be the highest across physician specialties, more focus needs to be directed to early identification and prevention, according to the report.

Amy Starmer, MD, MPH, a pediatric researcher at Boston Children’s Hospital in Massachusetts, says although the study didn’t specifically address interventions to combat burnout, it does confirm the importance of better self-care.

“Our findings suggest that taking steps towards physically active healthy lifestyles and developing personal support networks are particularly important factors necessary to achieve career and life satisfaction as well as work-life balance,” Starmer says. “Pediatrician Life and Career Experience Study participants have shared a wide variety of strategies that have resulted in increased satisfaction and reduced burnout including not hesitating to hire help for things like childcare and cleaning as well as learning how to tactfully say ‘no’ to career related projects.”

Additional research should also focus on some of the factors that contribute to physician burnout, according to the report, such as what aspects of a chaotic work environment lead to burnout. In dealing with factors related to burnout that occur outside the clinical setting-such as negative life events and poor health-the study suggests that a greater emphasis needs to be placed on clinical guidelines that focus on prevention tactics rather than treatment such as early recognition and avoidance of stressor that lead to burnout.

“We need to establish a greater understanding of the ability to prevent and anticipate predictable stressors and factors that are barriers to personal and career satisfaction, achievement of appropriate work–life balance, and avoiding burnout,” according to the report.

The American Medical Association has published guidance on recognizing burnout, and also offers online modules to help physicians gauge their risk of burnout with suggestions for interventions to improve provider wellness.