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INTRODUCTION

Anywhere from a quarter to half of physicians worldwide are estimated to experience job burnout. General internal medicine and family medicine—the specialties for most adult hospitalists—claim some of the highest rates of physician burnout in the United States. Within the adult generalist fields, several studies suggest clinic-based primary care physicians report burnout more frequently than their inpatient peers, but hospitalists remain among the physicians most susceptible to job burnout.

The unique work-life challenges of hospital medicine practice include demands on hospitalists to serve several contemporary physician roles as boundary spanners, communicators, nonleader team members, quality enhancers, and caregivers. Even as hospitalists have become permanent fixtures in most hospitals, role conflicts remain common with the competing demands of patients, other clinicians, administrators, and employers. Shiftwork with day/night schedule changes and sleep deprivation causes physiologic stress. Productivity and efficiency demands are pervasive in modern health care organizations and a driver of high workload. Pay uncertainties with health care reform and capitated care, and the pressures to standardize care which lead to loss of autonomy and intense scrutiny of performance contribute to conditions under which job burnout is expected to remain a concern for the discipline.

WHAT IS BURNOUT?

Burnout is a psychological syndrome leading to a worker’s erosion of engagement with their job due to long-term exposure to emotionally demanding work. It is a condition observed predominantly among those in the helping professions, like health and social services where direct, frequent, and intense interactions with people are common and where the outcomes of work are not fully dependent on worker actions. Burnout is commonly conceptualized as having three constitutive dimensions. The first, emotional exhaustion is a literal depletion of worker energy due to work demands. It may manifest in hospitalists as “compassion fatigue” or the tendency to distance themselves—cognitively and emotionally—from their work as they realize they cannot continue to give of themselves to patients and coworkers. In essence, it is a coping response to work overload. The second is depersonalization, marked by a detached emotional callousness or cynicism that manifests as indifference or dysfunctional attitudes and behaviors toward patients. It is often a protective response to emotional exhaustion. The final component of burnout, diminished personal accomplishment, is the erosion of a worker’s sense of personal effectiveness, which brings on a feeling of powerlessness and the tendency to negatively evaluate oneself. This may manifest as a hospitalist not completing assigned tasks or as worsening professional self-esteem. Emotional exhaustion is usually considered necessary for burnout to be diagnosed, the other components may occur in parallel, sequentially, or not at all.

Burnout is distinct from related concepts like stress, depression, and dissatisfaction. The definitions of each have been established empirically and while they overlap significantly, burnout is specific to the context of the workplace as an ongoing emotional response to chronic demands and interpersonal stressors. Job dissatisfaction is a predictor of ...

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