Job burnout is a ubiquitous challenge in the workplace; however, the affliction seems to be particularly prevalent among physicians. In a recent article published in the journal Academic Psychiatry Drs. MacKinnon and Murray argued that to inspire change advocates should reframe burnout as an organizational problem.1 Until now, most policies have focused on individual-level interventions to reduce burnout such as mindfulness, support groups, or exercise. Drs. MacKinnon and Murray do not discount these as valid strategies, but argue that treating the individual and ignoring the organizational environment is akin to treating cancer with chemotherapy rather than targeting the risk factors that give rise to the malignancy.
Fifty percent of physicians are burned out. And although physicians have the highest rates of burnout of any profession, doctors are far from the only profession affected by significant rates of burnout. In fact, the foundational research into burnout came from studies of the business world outside of medicine.
Job burnout is a syndrome characterized by emotional exhaustion, depersonalization or cynicism, and a decreased sense of personal accomplishment. Emotional exhaustion appears to be the first step in the burnout cascade that can lead to the development of depersonalization/cynicism and subsequent reduction in an individual’s sense of personal accomplishment.
Unfortunately, the repercussions of burnout extend beyond the workplace, impacting workers’ home lives as well. In fact, there is evidence that burnout may be a precursor syndrome to frank depression.
Many theories have been generated to model the development, maintenance, and resolution of the burnout syndrome. One such model is known as the job-demands resource theory (“J-DRT”). The J-DRT posits that demands such as work overload, emotional stress, and work-home interference push an individual towards burnout while resources such as autonomy, social support from colleagues/supervisors, and effective feedback pull individuals back from the brink. The J-DRT attempts to understand burnout by studying this dynamic between risk factors and protective factors.
Given the primacy of emotional exhaustion in the burnout cascade, this dimension has been the target of significant research aimed at preventing the development of burnout. Research from the J-DRT has identified the demand of work overload as being the strongest predictor for the development of emotional exhaustion.
At first glance, it may seem that the only way to reduce work overload would be to reduce hours worked or productivity requirements. However, work overload describes not just the quantity of work but also the quality. If the worker sees his or her work as appropriately challenging then it no longer places that worker at risk of developing burnout. It is only when the work is perceived as onerous that it places the worker at risk for burnout.
The J-DRT resources of autonomy and social support appear to be key mediators of the association between work overload, resultant emotional exhaustion, and burnout. Autonomy appears to allow workers to optimally match their current effortful reserves to task completion, improving the fit between their current level of exhaustion and productivity. Social support, and in particular leadership, has very strong protective characteristics. The leadership quality of one’s direct supervisor can dramatically increase or decrease a subordinate’s risk of burnout. In fact, for every 1 point decrease on a 60-point leadership scale of a subordinate’s direct superior, the subordinate’s risk for burnout increases by 3.3% and satisfaction decreases by 9%.2
Drs. MacKinnon and Murray end their article by suggesting that workplace advocates should attempt to fully quantify revenue losses and incurred costs related to burnout so as to properly incentivize organizations to support the change required to reduce the risk of burnout. For example, organizational quality improvement programs might attempt to identify and improve onerous tasks and reduce subjective and objective workload. Supervisors might provide more forums for work feedback and collaborative workplace improvement. Or organizational structure might be shifted to allow for more worker autonomy.
Despite the initial investment required for many burnout-mitigating initiatives, there is significant evidence to suggest that organizations would appreciate rewards that offset the investment in the form of decreased revenue loss and incurred costs related to burnout.
For more discussion and a full list of references please refer to Drs. MacKinnon and Murray’s article Reframing Physician Burnout as an Organizational Problem: A Novel Pragmatic Approach to Physician Burnout in the journal Academic Psychiatry.
- MacKinnon M, Murray S. Reframing Physician Burnout as an Organizational Problem: A Novel Pragmatic Approach to Physician Burnout. Acad Psychiatry. February 2017. doi:10.1007/s40596-017-0689-1.
- Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being. Mayo Clin Proc. 2017;92(1):129-146. doi:10.1016/j.mayocp.2016.10.004.