Burn out among Anesthesiologists; Enough studies time for action!

Myron Yaster MD, Norah Janosy MD, Rebecca Margolis, DO

Anoushka M Afonso, Joshua B Cadwell, Steven J Staffa, David Zurakowski, Amy E Vinson. Burnout Rate and Risk Factors among Anesthesiologists in the United States.  Anesthesiology. 2021 May 1;134(5):683-696. PMID: 33667293

Editorial

Steve Alan Hyman. Burnout: The "Other" Pandemic.  Anesthesiology 2021 May 1;134(5):673-675 PMID: 33667300

We don’t think it’s possible for a day to go by without hearing or reading something about physician burnout.  “Burnout syndrome is a condition characterized by the dimensions of emotional exhaustion, depersonalization, and low sense of personal accomplishment. Burnout is a clinically meaningful condition that is intricately linked with decreased quality of life, physician health, patient satisfaction, quality of care, and unprofessional behavior; and increased medical errors” (Anoushka et al.  PMID: 33667293). Indeed, this issue is so important that health care organizations have referred to it as a ‘public health crisis’. Further, the Society for Pediatric Anesthesia has formed a new special interest group (SIG) devoted to physician well-being.  If any of you are interested in joining please contact us norah.janosy@childrenscolorado.org or rmargolis@chla.usc.edu

Amy Vinson of the Boston Children’s Hospital is a leader in physician well-being and working with the ASA published this addition to the burnout literature. Using a survey of ASA members, prior to the COVID 19 global pandemic, and with a 14% response rate, the authors found a very high prevalence (almost 60%!) of burnout amongst anesthesiologists. Workplace factors more than personal factors are the primary causes— in fact a perceived lack of support at work had an odds ratio of 10 for burnout syndrome!  Additionally, working greater than or equal to 40 h/week, staffing shortages, and lack of a workplace confidant were all associated with burnout.  Importantly, being a member of the LBGTQIA was an independent risk factor for burnout (OR 2.2).  

As the editorial points (Hyman PMID: 33667300) out “how many more articles do we need that identify burnout?” We already know that this syndrome is pervasive to pandemic proportions. It interferes with healthcare workers’ lives. It interferes with quality of patient care. It interferes with effective workplace activity. Now is the time for a call to action and the time to initiate a new direction for burnout research. The discourse on healthcare provider well-being needs to be reframed: stop shaming physicians into feeling that they are not “resilient enough”. Instead, our healthcare system is the cause of physicians moral injury and necessitates systemic change.  Institutions often turn a “blind eye” to dysfunctional workplace characteristics that may promote burnout and have negative employee consequences.  Modifying individuals is much simpler than modifying the workplace. It would behoove institutions to spend less time holding wellness and resilience seminars and spend more time correcting the institutional causes of burnout. To address individual issues without addressing workplace issues does not provide a comprehensive solution to the problem. This promises to be a laborious task, but a necessary one.

A YouTube video that I (MY) watched awhile ago sums up my feelings about burnout or really moral injury the best.  If you can, take a couple of minutes to watch it and tell us what you think. 

Myron Yaster MD, Norah Janosy MD, Rebecca Margolis, DO