From the President: Ah, Summer...A Good Season to Readdress Work-Life Balance
There is something about the summertime that promotes appreciation for slower pace and reflection. Whether it’s the cool sand between your toes, an amazing vista after a vigorous hike, or the midmorning laughter of your kids on vacation – these joyful activities help reinvigorate. Reflecting back on 30 summers as an academic pulmonary and critical care physician, I think it may be more important than ever for us to take a moment to contemplate work-life balance in medicine, and, perhaps, our specialty in particular.
We all work hard, and most of us would enter a career in medicine again, and even sign up for the same specialty again. We value the work we do, particularly, the opportunity to improve the lives of our patients and generally find the work stimulating, rewarding, and even exciting. Additionally, we in pulmonary and critical care, and related fields, are accustomed to the stresses of high intensity, fast-pace, high-stakes work, as well as long and often undesirable work hours, including weekends and nights. There are certainly many more individuals in the hospital at night than a decade ago. Additionally, recent years have brought a rapid increase in the proportion of our time working as clinicians devoted to documentation and other non-patient care tasks. All told, the potential for work-related stress is certainly not decreasing.
Individuals who work in the ICU and similar work environments are accustomed to stress. It is part of the territory. To a point, short-term stress can actually be useful, as it tends to enhance focus and efficiency. Burnout, however, is a maladaptive response to excessive stress in the workplace and is characterized by emotional, mental, and physical exhaustion. Classically, burnout is defined as having three dimensions: emotional exhaustion, depersonalization, and diminished personal accomplishment. Importantly, development of burnout in a health-care worker has potential adverse consequences for the individual, the work environment, and our patients. Workers with burnout are more likely to have depression, alcohol and substance abuse, and various health disorders, and, often, leave the profession early. Behaviors of a burned out individual can be disruptive, contributing to staff dissatisfaction and excessive turnover. Finally, burnout has been associated with increased rates of medical errors, lower patient satisfaction, and reduced quality of care. Clearly, preventing and ameliorating burnout is an important target.
There is a growing body of evidence1-4 that serious burnout is commonplace among ICU workers. From a broad perspective, burnout is more common, and satisfaction with work/life balance less common, among physicians compared with the general population. Not surprisingly, among both physicians and nurses, the ICU as a workplace is associated with higher-than-average rates of burnout. There are now numerous survey-based multicenter studies that indicate approximately one-third to one-half of ICU workers have severe burnout.1-4 Look to your left. Look to your right. Chances are that one of you has significant burnout.
Particularly noteworthy is a recent online survey of physicians performed by Medscape4 in which 52% of intensivists described themselves as having serious burnout – the largest proportion among all 25 medical specialties reported. Perhaps more distressing, intensivists had among the lowest proportion of respondents who described themselves as “very happy” when describing their satisfaction at work and home. Finally, intensivists had the lowest proportion, among 25 medical specialties, of self-described health as “excellent” or “very good.”
We should all be concerned that these findings collectively paint a picture of a specialty at risk. It is important for us to consider why burnout occurs and what can be done about it. Specifically, which individuals are at increased risk? Are there identifiable factors that might be modified to reduce the likelihood of developing burnout? Are there individual and organizational approaches to identify individuals with burnout syndrome and mitigate its effects? Finally, are there opportunities for key stakeholders, including administrators and policymakers, to become better informed as to this emerging epidemic?
Several studies1,3 have now identified independent, potentially modifiable risk factors for burnout of intensivists, as well as ICU nurses. Common themes have emerged and include the following: (a) the quality of working relationships; (b) end-of-life issues; (c) organizational factors; and (d) personal characteristics. Perhaps the most consistently noted factor is that of interpersonal conflicts, those among physicians, nurses, and patients and family members. ICU physicians and nurses with burnout more commonly described conflict with their colleagues and with the other key members of the ICU team. Suboptimal communication is often at the root of conflict, and there are opportunities for enhancing communications and creating a supportive and trusting environment among ICU health-care workers.
