Doctor burnout: How to share the load

Senior, influential and experienced doctors must lead action to protect their younger colleagues from debilitating burnout, say the authors of a Perspective published in the Medical Journal of Australia.

‘Epidemic’, ‘crisis’ and ‘urgent need’ are words accompanying discussions of burnout and doctor suicides.

“Yet, despite this bombardment, there has been no sustained approach to achieve an effective national response,” say Flinders University Psychiatry professor and beyondblue board member Michael Baigent and GP Dr Ruth Baigent. adding perhaps older doctors looked back “on their pressurised junior years through rose-coloured glasses and see [burnout] as a rite of passage”.

Burnout is described via three concepts: exhaustion, cynicism (role negativity, feeling callous and detached) and professional efficacy (self-evaluation of competence and achievement).

“When the doctor has symptoms severe enough to also qualify for a mental illness, they are likely to be diagnosed; burnout is regarded as an aetiological factor. If the doctor falls short of a clinical diagnosis, burnout becomes the explanation and problem,” the Baigents say.

“Although not a diagnosis, the concept of burnout nevertheless resonates. Most doctors recognise it in a colleague’s uncharacteristic irritability, drowning fatalism and loss of belief in professional identity and efficacy.”

In the beyondblue national mental health survey of doctors and medical students, published in October 2013, it was reported that 32% of Australian doctors had high levels of exhaustion and 35% had high levels of cynicism, two of three domains of burnout, the third being loss of belief in professional identity and efficacy.

“The beyondblue survey found young doctors to be at greatest risk, with those aged under 30 years most likely to report burnout (high exhaustion, 48%; high cynicism, 46%),” the article says. “There was a steady reduction across older age bands, with 11% of doctors aged over 61 years reporting emotional exhaustion.

“Perhaps those who burn out, get out of the profession,” they say. “Also, in the life cycle of the doctor, the levels of external evaluation and autonomy also change favourably with years of experience … In burnout research generally, younger age is a more consistent variable than personality in determining burnout.”

Professor Michael Baigent, from Flinders University Psychiatry and a board member of beyondblue.

Avoiding burnout, they say is a “shared responsibility”.

‘Epidemic’, ‘crisis’ and ‘urgent need’ are words accompanying discussions of burnout and doctor suicides. “Yet, despite this bombardment, there has been no sustained approach to achieve an effective national response.

“It is too easy to blame the system and, likewise, for the system to blame the doctor. A certain amount of work-hardening and experience is necessary, but perhaps older doctors look back on their pressurised junior years through rose-coloured glasses and see it as a rite of passage.

“Is it not time for senior, influential and experienced doctors to lead action on behalf of our young apprentices?” they conclude.

The Medical Journal of Australia is a publication of the Australian Medical Association.

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