West et al., (2018) asserts that physician burnout is a global problem that presents with a trident of factors including emotional exhaustion, reduced personal accomplishment, and depersonalization. In furthering the effects of physician burnout, the authors say, "Rates of burnout symptoms that have been associated with adverse effects on patients, the healthcare workforce, costs, and physician health exceed 50% in studies of both physicians-in-training and practicing physicians" (West et al., 2018). Wiederhold et al., (2018) provide a more comprehensive assessment of the problem by noting that burnout is a significant problem for physicians which affects their quality of life and contributes to a deteriorating quality of care. The authors define burnout as a prolonged response to severe interpersonal and emotional stressors in one's occupation. It stems from a significantly strong asymmetrical relationship displayed between the giver and the receiver. Some of the most common signs of burnout as described by the authors include disillusionment, loss of work meaning, and a sense of hopelessness.
Wiederhold et al. go ahead to provide statistical evidence as part of the process of proving the extent and severity of the issue. They say, "An estimated 22% of physicians in the USA, 27% of physicians in Great Britain, 20% of physicians in Germany and between 22% and 32% of physicians in Italy, are estimated to suffer from burnout" (Wiederhold et al., 2018). The authors believe that burnout has a wide range of associated problems, including absenteeism, lowered productivity, job turnover, and most fundamentally, reduced quality of patient care. The article closes by suggesting organization-directed interventions that seek to eliminate job stressors, thus contributing to long-term results. Fred & Scheid (2018) further the discussion on physician burnout. The authors describe the problem as emotional exhaustion where a professional no longer draws a sense of meaningfulness in their work and view patients and colleagues as mere objects rather than human beings. The physicians at the highest risk of the burnout include the ones working in family medicine, emergency medicine, and general internal medicine.
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Fred & Scheid delve into the statistical implications of the issue by identifying the monetary ramifications of the burnout. The two asserts, "When physicians leave the field, the practice loses $500,000 to $1,000,000 of revenue. This loss is even greater in high-paying specialties. To recruit a replacement costs an additional $90,000" (Fred & Scheid, 2018). The authors believe that solution, as regards the problem of burnout, requires a stress-reduction training program. Based on research conducted between 2011 and 2014, Fred & Scheid (2018) assert that approximately 28% of the general physician population experience burnout problems. Several personal initiatives must be taken to prevent the severity of the physician burnout. They include improving wellness and resilience, mindfulness, self-care practices such as exercise, and an increased sense of self-awareness (Singh & Marlowe, 2019). Patel et al. (2018) continue with the comprehensive coverage of the problem. According to the authors, emotional exhaustion characterizes the problem. An individual feels that both their physical and emotional resources are depleted.
As a result, it is easier for an individual to develop cynical, negative, and hostile attitudes that are, in turn, directed to the patients. The authors provide a statistical outlook of the problem when they say, "Numerous studies have shown that 25%–60% of physicians report exhaustion across various specialties" (Patel et al., 2018). A recent survey conducted in the US showed that out of the 6880 physicians aged between 35 and 40 years, 54.4% had at least one symptom of burnout (Patel et al., 2018). The article supports change interventions, including assertive training, mindfulness training, and overall creation of a healthy environment. Kumar, (2016) asserts that physicians are continuously exposed to high levels of stress in their daily endeavors, which could ultimately lead mental disorders, suicide, substance abuse, and the impairment in function. The author goes ahead to indicate that burnout can be as a result of the straining relationship between the patient and the doctor. Statistically, the author concludes that the prevalence of the physician burnout is around 46% based on studies conducted in the US. Kumar (2016) outlines several interventions that could be used to stop the problem, including modifying the organizational structure and stress reduction among doctors.
Dewa et al. (2017) focuses on the impacts of physician burnout on the patient through the lenses of safety and acceptability. Collier (2017) asserts that the physician burnout costs the US about $200 million every year. Despite this, physician burnout is one of the most reversible psychological problems that could affect the doctors in their care setting. Collier believes that the single most important attribute that physicians should have as regards dealing with the problem of burnout is self-awareness. Drummond (2015) believes that physician burnout is an epidemic in the US that cannot be underestimated. In discussing the prevalence of the disease, Drummond, (2015) says, "Numerous global studies involving nearly every medical and surgical specialty indicate that one in every three physicians is experiencing burnout at any given time." Some of the consequences of burnout that the author identifies include lower patient satisfaction, deteriorated quality, higher medical errors, staff turnover, and physician suicide. In further delving into the epidemiology of the problem, Drummond (2015) explains that the rate of suicide among physicians is greater than in the general population.
Drummond (2015) concludes by providing a rationale for prevention. The author suggests two fundamental factors that could limit the burnout, including lowering the stress levels and improving one's ability to recharge energy accounts. Rodrigues et al. (2018) continue with the comprehensive insights into the problem. Just like the other authors, they define the burnout as "A psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA)" (Rodrigues et al., 2018). In the research conducted by the authors, they conclude that the rates of burnout syndrome tend to be higher in the surgical and urgency residencies compared to the clinical specialties. According to the article, the level of prevalence has reached epidemic levels with an estimated rate of 50%. Secondly, the authors delve into the economic toll of the healthcare industry as the associated costs of replacing a physician is about three times their annual salary (Rodrigues et al., 2018).
Several risk factors are associated with the occurrence of the physician burnout. Other than interpersonal skills such as resilience, self-awareness, and emotional intelligence, age can also be a fundamental issue. Hoffman & Bonney (2018) have fronted research that seeks to analyze the severity of the problem among junior doctors. It is common knowledge that less experienced medical practitioners can experience a host of challenges, especially as regards coping in their new work environment. The research focused on junior doctors living in Australia. According to the study, junior doctors experienced significant levels of stress and burnout. The causes of stress and burnout were multifactorial. Hoffman & Bonney (2018) say, "The junior doctors were aware of burnout prevention strategies but were not always effectively undertaking them." The research focuses on some of the effects of physician burnout, including absenteeism and the reckless use of alcohol. The authors devote to address some of the common causes of the burnout, including the long working hours, excessive patient overload, and difficulty in rostering. It is therefore incumbent upon the healthcare industry to look for amicable solutions to the external factors that might lead to the psychological toll that sets the center-stage for the occurrence of the burnout (Shanafelt et al., 2017).
Theoretical Overview
The theory that can best solve the problem of physician burnout is known as the Self-Determination Theory (SDT). Reeve (2012) noted that the theory seeks to link a host of factors, including human motivation, personality, and optimal functioning. The theory focuses on two types of motivation, including the intrinsic and extrinsic motivations. The theory was developed in the 1970s and 1980s and primarily focused on motivation (Teixeira et al., 2012). Extrinsic motivation emanates from external sources, while the intrinsic motivation originates from within. External sources of motivation include incentives such as recognition, accolades, awards, and respect. On the other hand, intrinsic aspects include interests, core values, and a person's sense of morality. Physician burnout strains three fundamental psychological resources, including competence, autonomy, and relatedness (Babenko, 2018).
One of the pillars of the ST theory revolves around the power of autonomy and the ability to motivate oneself. The difficult situations in the care setting, such as long working hours and a shortage of staff can adversely impact extrinsic motivation. It is in this regard that a physician must have self-determination, which provides them with the much-required platform to develop intrinsic motivation that enables them to overcome the challenges. The theory supports this project as it offers the basis for all the solutions given to physician burnout. Reduction of stress will solely depend on how individuals leverage their mental resources to come up with internal stimulation or motivation to complete difficult tasks.
References
Babenko, O., (2018, March). Professional well-being of practicing physicians: The roles of autonomy, competence, and relatedness. In Healthcare (Vol. 6, No. 1, p. 12). Multidisciplinary Digital Publishing Institute.
Hoffman, R. I., & Bonney, A. D. (2018). Junior doctors, burnout and wellbeing Understanding the experience of burnout in general practice registrars and hospital equivalents.
Rodrigues, H., Cobucci, R., Oliveira, A., Cabral, J. V., Medeiros, L., Gurgel, K., ... & Gonçalves, A. K. (2018). Burnout syndrome among medical residents: A systematic review and meta-analysis. PloS one, 13(11), e0206840.
Drummond, D., (2015). Physician burnout: its origin, symptoms, and five main causes. Family practice management, 22(5), 42-47.
Collier, R. (2017). Physician burnout a major concern. CMAJ: Canadian Medical Association Journal, 189(39), E1236.
Dewa, C. S., Loong, D., Bonato, S., & Trojanowski, L. (2017). The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic review. BMJ open, 7(6), e015141.
Kumar, S., (2016). Burnout and doctors: prevalence, prevention, and intervention. In Healthcare (Vol. 4, No. 3, p. 37). Multidisciplinary Digital Publishing Institute.
Patel, R., Bachu, R., Adikey, A., Malik, M., & Shah, M. (2018). Factors related to physician burnout and its consequences: A review. Behavioral Sciences, 8(11), 98.
Singh, R., & Marlowe, D., (2019). Provider Burnout. In StatPearls [Internet]. Stat Pearls Publishing.
Wiederhold, B. K., Cipresso, P., Pizzioli, D., Wiederhold, M., & Riva, G. (2018). Intervention for physician burnout: A systematic review. Open Medicine, 13(1), 253-263.
Fred, H. L., & Scheid, M. S. (2018). Physician Burnout: Causes, Consequences, and (?) Cures. Texas Heart Institute Journal, 45(4), 198-202.
West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: contributors, consequences, and solutions. Journal of internal medicine, 283(6), 516-529.
Teixeira, P. J., Carraça, E. V., Markland, D., Silva, M. N., & Ryan, R. M. (2012). Exercise, physical activity, and self-determination theory: a systematic review. International journal of behavioral nutrition and physical activity, 9(1), 78.
Reeve, J., (2012). A self-determination theory perspective on student engagement. In Handbook of research on student engagement (pp. 149-172). Springer, Boston, MA.
Shanafelt, T. D., Dyrbye, L. N., & West, C. P. (2017). Addressing physician burnout: the way forward. Jama, 317(9), 901-902.
