Numerous studies have shown that an average of 1 in 3 practicing physicians are suffering from symptomatic burnout on any given office day ... worldwide, regardless of specialty. In a 2012 survey of US physicians, 60% said they would quit today if they “had the means.”
Burnout is a chronic epidemic in physicians and recent research is showing that women and men experience burnout differently. In this article you will learn the 3 cardinal symptoms of burnout and how to recognize them in both men and women.
The 3 classic signs and symptoms of burnout are measured by a standardized evaluation, the Maslach Burnout Inventory (MBI). They are:
1. Emotional Exhaustion
The doctor is tapped out after the office day, hospital round, or being on call and is unable to recover with time off. Burnout is differentiated from “ordinary stress” by the inability to recover fully in the time away from work. Over time the physician’s energy level begins to follow a downward spiral. As they near the bottom, most physicians will begin to say or think, “I’m not sure how much longer I can go on like this.”
This shows up as sarcasm, cynicism, or a negative, callous, excessively detached response to patients and job duties. Burned out doctors will begin to blame and complain about their patients and their problems. In settings where burnout levels are high, these attitudes and behaviors will be seen as normal or even a healthy process of venting.
3. "Reduced Accomplishment"
Here the doctor starts to question whether they are offering quality care and whether what they do makes a difference or really matters at all. A common thought or statement at this time is, “What’s the use”?
As more women join they physician workforce, researchers are beginning to notice differences in the way burnout presents in men and women. If you think for a moment about the three scales of the MBI, you will probably be able to imagine the differences. Here is what groundbreaking research published in 2011 is showing.
NOTE: This study is based on practicing physicians. There is good reason to believe the following burnout symptom patterns are true in ANY stressful profession such as nursing, behavioral medicine, law enforcement, military personnel, and even parenting.
The Female Pattern = 1, 2, 3
Women seem to follow the classic 3-part pattern of the MBI above--in the original order.
Burnout in women doctors starts with Emotional Exhaustion. Women traditionally support others in numerous areas of their lives ... at home and at work. There is only so much energy and compassion to go around. Exhaustion of reserves and entering the downward spiral are the usual first signs.
Cynicism, sarcasm, and blaming patients are step 2 of burnout for women. These behaviors, as a group, are actually a defense mechanism. It is a subconscious attempt to shield oneself from the source of the energy drain. It feels somewhat better for an instant in time and yet does nothing to stop the actual drain or relieve the feeling of exhaustion. Cynicism is especially difficult for women to keep up for very long before stage 3 kicks in.
“Reduced accomplishment” and doubting the quality of their practice and the difference their work makes in their patients lives.
The Male Pattern = 2, 1, ?
Men more commonly start with depersonalization and cynicism which serves as a coping mechanism for overwhelming stress. "My patients are such a bunch of $%@+!%.” This is, again, a dysfunctional response to the inherent stress of being a doctor and is only a temporary relief. After all, these are the people we spent decades learning to serve.
Emotional exhaustion follows. The downward spiral worsens until they are tapped out. It is important to note that our medical education taught us to function for long periods of time “on empty.” This state of emotional exhaustion often is a chronic condition can be mistakenly interpreted as “a normal part of being a physician” by those suffering from burnout.
Compared with the female Burnout pattern, men’s stage 3 is remarkable for its absence.
Male physicians are far less likely to feel that the quality of their work has diminished. A common statement is, “… sure I’m stressed, but I’m not burned out because I am still doing good work.”
This can lead to a cynical, exhausted male physician who keeps going despite burnout because he feels he is still a "good doctor.” This lack of a stage 3 allows them to continue to practice in denial of their distress despite the exhaustion and cynicism their coworkers, patients, and family witness on a daily basis.
One final gender difference
Another major difference between women and men is willingness to ask for help and support. Isolation is a constant challenge for physicians. Stress and burnout only deepen the sensation of being alone at the top and the belief that no one else could possibly help.
For many doctors, acknowledging burnout and telling someone else you can’t keep going like this feels like an admission of inadequacy, failure, not being tough enough, or a sign that you actually are crazy (just as you have suspected for a while now). Despite these tendencies, women are much more likely to tell someone they are exhausted, ask for help, and receive it.
Men are much more likely to remain in denial and isolated, descending into a classic disruptive doctor pattern or suffering a burnout complication such as divorce, drug and alcohol addiction, and suicide.
The bottom line
When you notice these signs in yourself, take a breath and a break.
Recognize them for what they are—burnout. This is a cue to step back, take better care of your own personal needs, and create some boundaries for a more balanced life. You, your staff, your patients, and your family will be glad you did.
When you notice these signs and symptoms in a colleague, reach out.
Tell them what you are seeing and ask how they are doing. Be a little pushy. Keep checking in. The normal initial response to your outreach—from both women and men—will be denial. As long as you see signs of burnout, please keep reaching out. Be there as a friend when they finally ask for your support. Your caring and persistence could save their career, their marriage ... even their life.
Dike Drummond, M.D., is a family physician, executive coach and creator of the Burnout Prevention MATRIX Report containing over 117 ways doctors and organizations can work together to lower stress and prevent physician burnout. He provides stress management, burnout prevention and physician wellness and engagement coaching and consulting through his website, The Happy MD.