Clinician burnout: evidence-based strategies to improve wellbeing

The pandemic is behind us, yet clinician burnout persists. Recent surveys in Australia show clinician rates of burnout around 60% with higher rates in the specialities of ED and psychiatry, and more likely in women and younger clinicians.

This occupational phenomenon is talked about more widely than before; however, it continues to challenge individuals, teams and organisations to come up with strategies to address burnout that are effective.

The impact of burnout in health care includes higher rates of attrition and diminished productivity with effects on the organisation’s bottom line.

In health care, burnout doubles the risk of doctors making a medical error, and makes doctors more likely to make poor decisions regarding patient care as well as showing disinterest towards patients. This reflects the cumulative state of burnout with the three main features of emotional exhaustion, cynicism and depersonalisation.

When doctors notice they are not able to reach their high expectations of themselves, and struggle to focus, prioritise and complete tasks, there is a sense of disappointment and despondency.

There are shifts in their relationships not only with themselves, but also with their spouses and families, colleagues and peers.

Individuals in burnout often withdraw from contributing in team meetings, isolate themselves and reduce the leadership they once had.

Burnout has impacts on our cognitive abilities with changes in short-term memory, focus and attention. Research shows people have challenges with verbal skills and impulse control when in burnout. Persistently raised cortisol levels in burnout disrupt neurotransmitters, shrink the hippocampus and reduce neuroplasticity.

It can be helpful for individuals, team leaders and management to be aware of the spectrum of burnout so early intervention measures can occur.

Below are the signs and symptoms of burnout, the contributors to this occupational phenomenon and evidence-based strategies for burnout prevention and recovery.

Signs and symptoms of burnout include:

Physical symptoms	Emotional symptoms	Behavioural signs
Headaches	Cynicism	Withdrawal or isolation
Stomach aches	Helplessness	Procrastination
Fatigue	Self-doubt	Use of substance to cope
Changes in sleep	Feeling detached	Reduced performance
Appetite changes	Loss of motivation	Emotional outbursts

 
Contributors to burnout include:

Workplace factors that increase vulnerability to burnout	Lifestyle factors	Personality factors
Workload overload	Lack of sleep	Perfectionistic tendencies
Perceived lack of control	Too many responsibilities	Black and white mentality
Lack of reward	Lack of close relationships	High expectations of self
Lack of community		People-pleasing in nature
Values mismatch
Absence of fairness

With awareness of the range of symptoms one can notice if they are drifting into burnout, and the contributing factors that increase the risk of burnout, let’s address what we can do about it. As with any approach to a problem, it is recommended to start with one solution and assess how things shift.

Below are four foundational elements of self-care that can start from home or in the workplace and reduce the burnout burden in a short amount of time.

Evidence-based strategies to address burnout

Sleep

Studies in medical workers who slept less than 7 hours during workdays and days off had a higher risk of experiencing burnout.¹

• Like we set an alarm to wake, set an alarm to go to bed and aim for more than 7 hours per night.
• Keep a regular sleep routine.
• Avoid alcohol and substances to cope.

Movement

• Any form of movement can act as stress relief.
• Reducing the level of cortisol and adrenaline in our bodies through movement is beneficial every day.
• Movement also increases our endorphins — our natural painkillers and mood elevators.
• The behavioural shift in regular exercise has emotional impacts in growing self-confidence and energy levels.

Mindset

• Defining what activities are meaningful to you are has been shown to reduce the risk of burnout in healthcare professionals. Individuals who have less than 20% of activities which they determine as meaningful, are 50% more likely to have burnout.²
• Growing awareness of how we perceive the world around us can help with developing mindset shifts inside and out of the workplace.
• Having a gratitude practice helps counteract our inbuilt negativity bias.
• Develop your own boundaries so you have time to move, rest and say no to additional tasks.

Support

• Building positive relationships is an antidote to life’s challenges.
• Finding a colleague, mentor, psychologist or coach can be a solution to reduce the risk or address clinician burnout.³
• Grow the culture in the workplace to be one of recognition of the contribution of the team individually and collectively.
   

Burnout will continue to be a workplace risk factor in health care for the foreseeable future and using strategies for individuals, teams and organisations that work is essential to minimise fallout from this occupational phenomenon. Participation in wellbeing strategies from executive and leadership levels influences the culture on the ground in health care, and is a great place to start implementation. Burnout affects workers at all levels and with the right approach, recovery is 100% possible.

For more evidence-based solutions for burnout prevention and recovery, visit The Burnout Recovery podcast by Dr Jo Braid.

References:
<sup>1. 22. Lin YL, Chen CH, Chu WM, Hu SY, Liou YS, Yang YC, et al.. Modifiable risk factors related to burnout levels in the medical workplace in Taiwan: cross-sectional study. B Med J Open. (2019) 9:32779. 10.1136/bmjopen-2019-032779 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]
2. Shanafelt TD, West CP, Sloan JA, Novotny PJ, Poland GA, Menaker R, Rummans TA, Dyrbye LN. Career fit and burnout among academic faculty. Arch Intern Med. 2009 May 25;169(10):990-5. doi: 10.1001/archinternmed.2009.70. PMID: 19468093.
3. Fainstad T, Mann A, Suresh K, et al. Effect of a Novel Online Group-Coaching Program to Reduce Burnout in Female Resident Physicians: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(5):e2210752. doi:10.1001/jamanetworkopen.2022.10752</sup>

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