Many Faces of Burnout

By Sena Gok, Junayd Hussain

Burnout, defined as an occupational syndrome by the World Health Organization in 2017, is a growing epidemic among all workforces, particularly in the healthcare field. Since it was first conceptualized in the 1970s, its impact on healthcare providers continues to be studied and advocated for, as a healthcare condition with significant consequences.1,2

The growing issue of burnout has plagued and tested the efficiency of healthcare systems globally, particularly since the beginning of the COVID-19 pandemic. With growing uncertainty of the individual and systemic issues leading to burnout among healthcare providers from all walks of life, we decided to review this issue alongside experts and providers in episode #101 of Raw Talk Podcast: The Many Faces of Burnout in Healthcare. 3,4

Burnout is characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. It can lead to losing passion for the role, feeling overwhelmed, and detachment from work – all of which negatively impacting patients, their families, and other healthcare team members.5 Dr. Amit Arya, a palliative care lead and Board Member of the Canadian Society of Palliative Care Physicians, says, “Burnout is the outcome of extensive stress on the job. In the last few years, research has shown that 38% of palliative care physicians have burnout due to the emotionally heavy work we do”. The current state of the healthcare system in Ontario, with recurring staff shortages paralleled by underfunding and underresourcing of long-term care homes, has led to rationing of palliative care – often seen as a privilege rather than a human right, notes Dr. Arya.

Experts suggest that burnout among healthcare workers stems from systemic issues such as absenteeism, job insecurity, understaffing and the expectation for healthcare workers to perform outside their area of expertise. This can lead to feelings of being undervalued and segregated within the healthcare community, as well as conflicts and dissatisfaction with their roles. Emily Rowland, a registered nurse and a Ph.D. candidate at the Pediatric Rehabilitation Program at the University of Toronto, highlights the sources of burnout among healthcare providers, including advocating for better safety and equipment, trying to get people to take the virus seriously, and facing mistrust from the public and political system. For example, Bill 124, also known as the “Protecting a Sustainable Public Sector for Future Generations Act”, enacted in Ontario in 2019, has placed caps on public sector compensation, including that of nurses. This has spurred considerable opposition from the nursing body, who argue that the caps will negatively affect their ability to negotiate fair wages and working conditions.6

The impacts of burnout are widespread among healthcare providers and trainees, significantly altering the culture of healthcare.7 According to Dr. Yezarni Wynn, a psychiatry resident at the University of Toronto, it has been difficult for residents with long hours and little time for self-care and relaxation. With the 80 hour-work weeks and fewer weekends, providers have sleep deprivation and develop further physical and mental health issues.8 In his words “Burnout is not just about feeling overworked, but also about the disproportionate expectations placed on healthcare professionals. For underrepresented minorities in medicine, burnout is an even more complex issue, as they may face additional stressors and factors that contribute to their burnout. These may include feeling underrepresented, imposter syndrome, a lack of safety in advocating for themselves, tokenism, and a lack of support and role models.” Recruiting a diverse population of healthcare professionals is one matter, but ensuring the consistent safety and support of a diverse healthcare workforce presents a distinct challenge within the healthcare system. Issues of discrimination and injustice, also providing support and resources for minority trainees, are key components of addressing this challenge and ensuring the well-being of all healthcare professionals.

COVID-19’s Role in Burnout

The term “healthcare hero” was created at the beginning of the COVID-19 pandemic to show appreciation towards our frontline workers within the healthcare system. Nevertheless, this term needs to be revised due to oversimplifying the struggles these individuals encounter daily. Furthermore, it falsely suggests that healthcare workers are invulnerable while failing to recognize that many face personal challenges and repercussions from the pandemic just like the rest.

According to healthcare providers, the “hero” label has not translated to any beneficial policies or sustainable support, as seen with the lack of paid sick days for many healthcare providers. It also glamorizes the field of medicine and healthcare, not acknowledging the challenges and difficulties that come with the profession.9

What Supports are Needed to Prevent Burnout?

In medicine, there exists a culture of perseverance and the expectation that trainees should be able to “power through” difficult times. The culture of insisting on perseverance without disregarding burnout is deeply ingrained in the medical education system, which makes it challenging to disrupt. However, it is crucial to acknowledge the negative impact on trainees’ mental health and the effectiveness of future physicians. Thus, questioning the insistence on perseverance and considering the need to address the risk of burnout is necessary.10

Instead, much-needed attention must be paid to providing support and resources for trainees to manage the stresses of medical training. Dr. Simone Bernstein, another psychiatry resident at Washington University, suggests that institutions should create opportunities for residents to take part in initiatives that promote wellness. This could be implementing an opt-out method, where institutions make accessible and confidential counselling services mandatory for residents during work hours, providing a way for everyone to understand and appreciate the importance of mental health in the healthcare profession. Additionally, supervisors and senior trainees should be mindful of the messages they send to junior trainees and make an effort to break the cycle of perpetuating this culture of perseverance.

The concept of “radical acceptance” is widely encouraged in healthcare as it involves acknowledging difficult circumstances and managing them. However, it should not be used to justify poor working conditions or blame individuals. Rather, a compassionate approach that addresses systemic issues contributing to burnout is necessary. This involves providing support and resources for trainees and fostering a culture of empathy within healthcare organizations. Shifting societal beliefs about success and performance in the field, and embracing a more holistic approach to resilience, may prove more effective in addressing burnout among healthcare workers than traditional resilience training. Prioritizing their wellbeing is crucial for healthcare workers to deliver optimal care for their patients. It’s time for healthcare organizations to acknowledge that it is a systemic issue, take action and recognize the importance of supporting the well-being of its workforce.

Acknowledgements

We would like to acknowledge the efforts and ideas of the rest of the episode #101 team: Atefeh Mohammadi and Helen Yang were Show Hosts on the episode. Larkin Davenport Huyer held the position of Content Creator, Alex Jacob acted as the Audio Engineer, and Noor Al-Kaabi served as our Co-Executive Producer. To learn more about the impact of burnout among healthcare providers since the beginning of the COVID-19 pandemic, we invite you to listen to episode #101 of Raw Talk Podcast, titled “Many Faces of Burnout in Healthcare” (3). Also, check out our references for more information on the bolded topics and some interesting resources the team has compiled in the episode’s show notes on the Raw Talk Podcast website.

References

1. Burn-out an “occupational phenomenon”: International Classification of Diseases [Internet]. [cited 2022 Sep 27]. Available from: https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

2. Hillert A, Albrecht A, Voderholzer U. The Burnout Phenomenon: A Résumé After More Than 15,000 Scientific Publications. Front Psychiatry. 2020 Dec 9;11:519237.

3. #101 The Many Faces of Burnout in Healthcare [Internet]. [cited 2023 Jan 30]. Available from: http://www.rawtalkpodcast.com/ episode/101

4. Murthy VH. Confronting Health Worker Burnout and Well-Being. N Engl J Med. 2022 Aug 18;387(7):577–9.

5. De Hert S. Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies. Local Reg Anesth. 2020 Oct 28;13:171–83.

6. About Bill 124 and Actions – Ontario Nurses’ Association [Internet]. [cited 2023 Jan 30]. Available from: https://www.ona.org/ about-bill-124/

7. Rodrigues H, Cobucci R, Oliveira A, Cabral JV, Medeiros L, Gurgel K, et al. Burnout syndrome among medical residents: A systematic review and meta-analysis. PloS One. 2018;13(11):e0206840.

8. Liu Y, Zhang Q, Jiang F, Zhong H, Huang L, Zhang Y, et al. Association between sleep disturbance and mental health of healthcare workers: A systematic review and meta-analysis. Front Psychiatry [Internet]. 2022 [cited 2023 Jan 30];13. Available from: https://www. frontiersin.org/articles/10.3389/fpsyt.2022.919176

9. Cox CL. “Healthcare Heroes”: problems with media focus on heroism from healthcare workers during the COVID-19 pandemic. J Med Ethics. 2020 Aug;46(8):510–3.

10. Veal CT. We Burn Out, We Break, We Die: Medical Schools Must Change Their Culture to Preserve Medical Student Mental Health. Acad Med J Assoc Am Med Coll. 2021 May 1;96(5):629–31.