Article review: Physician burnout in Emergency Medicine

Medical students considering a career in Emergency Medicine frequently ask about "burnout". Emergency physicians function in a high-stress, interruption-based, and intense work environment day in and day out. Back when Emergency Departments were staffed by non-board certified emergency physicians (such as moonlighting rheumatologists or surgeons), burnout rate was indeed very high. This was understandable because EM wasn't what they had selected as their profession.

What is burnout?
There are lots of definitions but all revolve around some “state of physical, emotional, and mental exhaustion caused by long-term involvement in situations that are emotionally demanding."

In this survey-based study, a random sample of American College of Emergency Physicians (ACEP) members answered questions of burnout. With a sub-optimal response rate of 43%, there was still some information to glean from the results.

Survey instrument
The survey was broken into 3 parts. Each looked at a particular facet of burnout:
  1. Career Satisfaction Survey of Emergency Physicians - a validated 79 question (!) survey on work-life satisfaction
  2. Physicians' Reactions to Uncertainty: Refining the Constructs and Scales - 15-question, copyrighted measurement tool used initially for internal medicine physicians
  3. Maslach Burnout Inventory - widely used instrument to measure burnout in the human service and health care settings.
  • 193 of 450 surveys were returned
  • 32% of emergency physicians experienced at least 1 aspect of "burnout" - specifically emotional exhaustion.
  • Greatest predictor of career burnout = high anxiety caused by concern for bad outcomes (odds ratios = 6.35). There was actually no correlation with physician age, the type of practice, or EM training.
  • Despite 32% of emergency physicians experiencing emotional exhaustion, most were satisfied with their career in EM.
It would be interesting to see how physician burnout and emotional exhaustion contribute to the quality of patient care. Similar to educational studies, this study's next step would be to look at more global patient outcomes.

My take on the bottom-line
The silver lining in this study is that emergency physicians are passionate about what we do and emotionally invest in our patients. I'd be a little worried if we weren't a little anxious about bad outcomes for our patients, to tell you the truth.

How do we, as emergency physicians, avoid crossing the line from "appropriately worried for our patients" to "emotionally drained because we are so worried for our patients".
Everyone has different coping mechanisms. I think the first step towards career longevity is to understand and appreciate that burnout stems from emotional exhaustion. The second step is to build time into your annual schedule to "re-charge your emotional battery". This year I took a month-long "stay-vacation". Worked wonders. Will be taking another one next year. Who's with me?

Thanks, Gloria, for a great article.

Kuhn G, Goldberg R, Compton S. Tolerance for Uncertainty, Burnout, and Satisfaction With the Career of Emergency Medicine. Ann Emerg Med. 2009;54:106-13.
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