Clinical Orthopaedics and Related Research®
Clin Orthop Relat Res (2016) 474:1864–1866 / DOI 10.1007/s11999-016-4899-8
A Publication of The Association of Bone and Joint Surgeons®
Published online: 26 May 2016
Ó The Association of Bone and Joint Surgeons1 2016
CORR Insights CORR Insights1: Among Musculoskeletal Surgeons, Job Dissatisfaction Is Associated With Burnout Thomas K. Wuest MD, MMM
Where Are We Now?
T
he authors of the current study provide insight into the prevalence of, and the influential factors contributing to, physician burnout in a population of academic orthopaedic and trauma surgeons. Members of the Science of Variation
This CORR Insights1 is a commentary on the article ‘‘Among Musculoskeletal Surgeons, Job Dissatisfaction Is Associated With Burnout’’ by van Wulfften Palthe and colleagues available at: DOI: 10.1007/ s11999-016-4848-6. The author certifies that he, or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR1 or The Association of Bone and Joint Surgeons1. This CORR Insights1 comment refers to the article available at DOI: 10.1007/s11999-0164848-6.
123
Group, a musculoskeletal research collaborative, were surveyed using validated instruments [7, 11] regarding job satisfaction and burnout. While they found that the vast majority of this cohort was quite satisfied with their current practice and profession, they did identify a correlation between the symptoms of burnout and decreased job satisfaction. They also reported that having children was the only factor among those surveyed that correlated to less burnout—excellent news for those fathers and mothers in the profession! Physician burnout is often defined as emotional exhaustion and depletion, which could potentially lead to a loss of personal accomplishment. A sense of detachment, helplessness, and loss of personal worth often are cited as the hallmark symptoms of this condition. Physician burnout is deservedly receiving increasing attention from the medical profession [4, 9, 10]. Daniels and colleagues addressed this topic in
a recent review [1] and found an increased level of burnout in orthopaedic surgeons as compared to the general population and other medical professionals. Individuals who matriculate into medical school and succeed in competitive residency programs and practice settings often develop dangerous combinations of behaviors, which taken together, can contribute to professional burnout. The need to succeed, unrealistic self-reliance and independence, minimization of emotional reactions, perfectionist attitude, difficulty setting boundaries, unwillingness to relinquish control, fear of vulnerability, lack of positive feedback, and a training milieu that often discourages delegation of work or the acceptance of assistance from colleagues, staff, and coworkers are but a few of the potential facilitators of burnout within the medical profession.
T. K. Wuest MD, MMM (&) Slocum Center for Orthopedics and Sports Medicine, 55 Coburg Rd., Eugene, OR 97401, USA e-mail: [email protected]
Where Do We Need To Go? As these signs and symptoms of burnout become more frequently
CORR Insights1 1865
Volume 474, Number 8, August 2016
CORR Insights
recognized and appreciated within our profession, it should be the task of physician leaders, medical school and residency directors, and personal and professional colleagues to address and treat them. Many questions remain unanswered: (1) Do the reduced residency work hours and current training programs adequately prepare physicians for the ‘‘real-life’’ practice of medicine and surgery? After all, no one ‘‘rotates off the service’’ in actual practice. (2) Does this predestine the young practitioner to a situation that rapidly becomes overwhelming and an early contributor to potential burnout? (3) Can the above signs and symptoms of burnout be identified early enough in training and practice to effectively mitigate them? (4) Can the burdens of contemporary medicine, including increased coding requirements, documentation mandates, information overload, and enforced electronichealth-record implementation, be adjusted or corrected to minimize the symptoms of burnout and job dissatisfaction? (5) Can the environment of shame often associated with an adverse outcome or event be transformed to one of support and encouragement? (6) Where are our blind spots in discussing this condition? In a difficult and personal testament to the comments above, I will be leaving my surgical orthopaedic
trauma practice within the month. After 23 years of a thriving surgical practice, establishing a regional orthopaedic trauma referral service, and nearly 15 years of practice leadership, I am finding that I no longer have the innate desire, physical stamina, and dedication to patients that led me to my profession. Arguably, at the ‘‘top of my game’’ with regard to decision-making, patient engagement, and surgical/technical skills as a mid50-year-old practitioner, the multiple factors cited in the above discussion have led to this decision.
How Do We Get There? The age-old adage of ‘‘the first step is to admit you have a problem,’’ certainly is applicable in the realm of physician burnout. Many of the ‘‘attributes’’ listed above with regard to physician training and success in medical school and practice need to be recognized as pathologic, rather than traits to be emulated. Recent work in mindfulness [5], stress management, individual coaching and counseling have demonstrated some effectiveness [2, 3, 6, 8]. Medical training needs to be redirected from one of fierce individualism and rivalry toward teaching effectively about teamwork and collaboration. Much as the medical malpractice
realm has migrated from a stance of avoidance and silence to one of a focused apology and increased openness when dealing with an adverse event, the training of our present and future physicians needs to evolve. The recognition of burnout, the emphasis and reliance upon peer support networks, and physician group leadership focused upon correcting potentially volatile work environments should become the new normal. It will be a difficult transition, but with the current status of the medical profession’s workplace satisfaction and burnout, there remains no other choice. Concepts such as intrinsic versus extrinsic value for compensation, the nurturing of core values, the quality and sincerity of workplace relationships, collegial collaboration and community, can no longer be relegated to others or dismissed as not applicable to a physician or surgeon. If we fail to act now, we risk the continued loss of the most valuable resource in the delivery of medical and surgical care—us.
References 1. Daniels AH, DePasse JM, Kamal RN. Orthopaedic surgeon burnout: Diagnosis, treatment, and prevention. J Am Acad Orthop Surg. 2016;24:213–219. 2. Goodman MJ, Schorling JB. A mindfulness course decreases
123
Clinical Orthopaedics and Related Research1
1866 Wuest
CORR Insights
burnout and improves well being among healthcare providers. Int J Psychiatry Med. 2012;43:119–128. 3. Isaksson Ro KE, Tyssen R, Hoffart A, Sexton H, Aasland OG, Gude T. A three-year cohort study of the relationships between coping, job stress and burnout after a counseling intervention for help-seeking physicians. BMC Public Health. 2010;10:213. 4. Kelly JD. Your best life: Coping with emotional pain in a demanding work environment. Clin Orthop Relat Res. 2016;474:315–318. 5. Kelly JD 4th. Your best life: mindfulness–the end of suffering. Clin
123
Orthop Relat Res. 2015;473:426– 429. 6. Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, Quill TE. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302;1284–1293. 7. Lloyd S, Streiner D, Hahn E, Shannon S. Development of the emergency physician job satisfaction measurement instrument. Am J Emerg Med. 1994;12:1–10. 8. Martins AE, Davenport MC, Del Valle MP, Di Lalla S, Domı´nguez P,
Ormando L, Ingratta A, Gambarini H, Ferrero F. Impact of a brief intervention on the burnout levels of pediatric residents. J Pediatr (Rio J). 2011;87:493–498. 9. Maslach C, Jackson SE, Leiter M. Maslach Burnout Inventory Manual, 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996. 10. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397–422. 11. Shirom A, Melamed S. A comparison of the construct validity of two burnout measures in two groups of professionals. Int J Stress Manag. 2006;13:176–200.
Clin Orthop Relat Res (2016) 474:1864–1866 / DOI 10.1007/s11999-016-4899-8
A Publication of The Association of Bone and Joint Surgeons®
Published online: 26 May 2016
Ó The Association of Bone and Joint Surgeons1 2016
CORR Insights CORR Insights1: Among Musculoskeletal Surgeons, Job Dissatisfaction Is Associated With Burnout Thomas K. Wuest MD, MMM
Where Are We Now?
T
he authors of the current study provide insight into the prevalence of, and the influential factors contributing to, physician burnout in a population of academic orthopaedic and trauma surgeons. Members of the Science of Variation
This CORR Insights1 is a commentary on the article ‘‘Among Musculoskeletal Surgeons, Job Dissatisfaction Is Associated With Burnout’’ by van Wulfften Palthe and colleagues available at: DOI: 10.1007/ s11999-016-4848-6. The author certifies that he, or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR1 or The Association of Bone and Joint Surgeons1. This CORR Insights1 comment refers to the article available at DOI: 10.1007/s11999-0164848-6.
123
Group, a musculoskeletal research collaborative, were surveyed using validated instruments [7, 11] regarding job satisfaction and burnout. While they found that the vast majority of this cohort was quite satisfied with their current practice and profession, they did identify a correlation between the symptoms of burnout and decreased job satisfaction. They also reported that having children was the only factor among those surveyed that correlated to less burnout—excellent news for those fathers and mothers in the profession! Physician burnout is often defined as emotional exhaustion and depletion, which could potentially lead to a loss of personal accomplishment. A sense of detachment, helplessness, and loss of personal worth often are cited as the hallmark symptoms of this condition. Physician burnout is deservedly receiving increasing attention from the medical profession [4, 9, 10]. Daniels and colleagues addressed this topic in
a recent review [1] and found an increased level of burnout in orthopaedic surgeons as compared to the general population and other medical professionals. Individuals who matriculate into medical school and succeed in competitive residency programs and practice settings often develop dangerous combinations of behaviors, which taken together, can contribute to professional burnout. The need to succeed, unrealistic self-reliance and independence, minimization of emotional reactions, perfectionist attitude, difficulty setting boundaries, unwillingness to relinquish control, fear of vulnerability, lack of positive feedback, and a training milieu that often discourages delegation of work or the acceptance of assistance from colleagues, staff, and coworkers are but a few of the potential facilitators of burnout within the medical profession.
T. K. Wuest MD, MMM (&) Slocum Center for Orthopedics and Sports Medicine, 55 Coburg Rd., Eugene, OR 97401, USA e-mail: [email protected]
Where Do We Need To Go? As these signs and symptoms of burnout become more frequently
CORR Insights1 1865
Volume 474, Number 8, August 2016
CORR Insights
recognized and appreciated within our profession, it should be the task of physician leaders, medical school and residency directors, and personal and professional colleagues to address and treat them. Many questions remain unanswered: (1) Do the reduced residency work hours and current training programs adequately prepare physicians for the ‘‘real-life’’ practice of medicine and surgery? After all, no one ‘‘rotates off the service’’ in actual practice. (2) Does this predestine the young practitioner to a situation that rapidly becomes overwhelming and an early contributor to potential burnout? (3) Can the above signs and symptoms of burnout be identified early enough in training and practice to effectively mitigate them? (4) Can the burdens of contemporary medicine, including increased coding requirements, documentation mandates, information overload, and enforced electronichealth-record implementation, be adjusted or corrected to minimize the symptoms of burnout and job dissatisfaction? (5) Can the environment of shame often associated with an adverse outcome or event be transformed to one of support and encouragement? (6) Where are our blind spots in discussing this condition? In a difficult and personal testament to the comments above, I will be leaving my surgical orthopaedic
trauma practice within the month. After 23 years of a thriving surgical practice, establishing a regional orthopaedic trauma referral service, and nearly 15 years of practice leadership, I am finding that I no longer have the innate desire, physical stamina, and dedication to patients that led me to my profession. Arguably, at the ‘‘top of my game’’ with regard to decision-making, patient engagement, and surgical/technical skills as a mid50-year-old practitioner, the multiple factors cited in the above discussion have led to this decision.
How Do We Get There? The age-old adage of ‘‘the first step is to admit you have a problem,’’ certainly is applicable in the realm of physician burnout. Many of the ‘‘attributes’’ listed above with regard to physician training and success in medical school and practice need to be recognized as pathologic, rather than traits to be emulated. Recent work in mindfulness [5], stress management, individual coaching and counseling have demonstrated some effectiveness [2, 3, 6, 8]. Medical training needs to be redirected from one of fierce individualism and rivalry toward teaching effectively about teamwork and collaboration. Much as the medical malpractice
realm has migrated from a stance of avoidance and silence to one of a focused apology and increased openness when dealing with an adverse event, the training of our present and future physicians needs to evolve. The recognition of burnout, the emphasis and reliance upon peer support networks, and physician group leadership focused upon correcting potentially volatile work environments should become the new normal. It will be a difficult transition, but with the current status of the medical profession’s workplace satisfaction and burnout, there remains no other choice. Concepts such as intrinsic versus extrinsic value for compensation, the nurturing of core values, the quality and sincerity of workplace relationships, collegial collaboration and community, can no longer be relegated to others or dismissed as not applicable to a physician or surgeon. If we fail to act now, we risk the continued loss of the most valuable resource in the delivery of medical and surgical care—us.
References 1. Daniels AH, DePasse JM, Kamal RN. Orthopaedic surgeon burnout: Diagnosis, treatment, and prevention. J Am Acad Orthop Surg. 2016;24:213–219. 2. Goodman MJ, Schorling JB. A mindfulness course decreases
123
Clinical Orthopaedics and Related Research1
1866 Wuest
CORR Insights
burnout and improves well being among healthcare providers. Int J Psychiatry Med. 2012;43:119–128. 3. Isaksson Ro KE, Tyssen R, Hoffart A, Sexton H, Aasland OG, Gude T. A three-year cohort study of the relationships between coping, job stress and burnout after a counseling intervention for help-seeking physicians. BMC Public Health. 2010;10:213. 4. Kelly JD. Your best life: Coping with emotional pain in a demanding work environment. Clin Orthop Relat Res. 2016;474:315–318. 5. Kelly JD 4th. Your best life: mindfulness–the end of suffering. Clin
123
Orthop Relat Res. 2015;473:426– 429. 6. Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, Quill TE. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302;1284–1293. 7. Lloyd S, Streiner D, Hahn E, Shannon S. Development of the emergency physician job satisfaction measurement instrument. Am J Emerg Med. 1994;12:1–10. 8. Martins AE, Davenport MC, Del Valle MP, Di Lalla S, Domı´nguez P,
Ormando L, Ingratta A, Gambarini H, Ferrero F. Impact of a brief intervention on the burnout levels of pediatric residents. J Pediatr (Rio J). 2011;87:493–498. 9. Maslach C, Jackson SE, Leiter M. Maslach Burnout Inventory Manual, 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996. 10. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397–422. 11. Shirom A, Melamed S. A comparison of the construct validity of two burnout measures in two groups of professionals. Int J Stress Manag. 2006;13:176–200.
