What Causes Burnout: The Factors In Healthcare

I don’t need to convince people that burnout exists in healthcare anymore, it does. No doubt about it. A few years ago, I attended the national ASHP conference. I specifically went for two reasons: (1) to catch up with a friend (2) they had a good lineup on burnout (for the first time ever!). But even before that time of recognition, burnout was prevalent in pharmacy and healthcare. The data was just starting to catch up, and be buzzy aka a “hot topic” to talk about. Still, actions speak louder than words and I still think our employers have a long way to go.

The good news about focusing on burnout? The awareness takes away a lot of the stigma and also helps our employers see the importance of giving people the tools (a lot of this is a HUGE mindset shift) to do their jobs effectively.

There are a lot of things contributing to burnout in healthcare right now. We are under resourced, under staffed, and under appreciated by people and employers. Leadership research and articles everywhere state that to increase employee engagement and productivity (thus, contributing to the organization’s bottom line), employees need to feel appreciated in their workplace and that their voice is heard. Sometimes I wonder why corporations are so dense as to overlook this part. But, I digress. Let’s get into the details!

In the first large national study of burnout in 2011, more than half of U.S. physicians reported symptoms, a number more than twice that of any other profession studied. Other studies have shown similarly high rates among nurses and other healthcare workers.

What about pharmacists? Where do we stand? According to a study in the Journal of the American Pharmacists Association (JAPha), more than 50% of community pharmacists were considering quitting jobs. Occupational stress and satisfaction were positively correlated with the intention to search for a new position. Twenty percent of the respondents felt that stress from their employment adversely affected their mental health and well-being, physical health, quality of work, or relationships with family and friends.

People in our profession have been saying they’re burnt out for years, and the data is starting to catch up. Recent pharmacy surveys have more than half of respondents identifying themselves at risk for burnout.  Pharmacy-specific articles are starting to shed light on the problem as well as tackling evidence-based solutions.

Pharmacists are not the only ones feeling the pressure. Pharmacy residents and students experience burnout as well. A study published in American Journal of Health-System Pharmacy (AJHP) looked at 534 pharmacy residents and saw that residents who worked more than 60 hours per week had higher levels of depression, hostility, and dysphoria than residents who worked fewer than 60 hours. Sixty hours! When you look at how healthcare practices operate, that’s really not a lot. I don’t know many residents that work less than that and most clinical pharmacists that I have worked with easily put in that many hours.

Students also go nonstop without real breaks, and with the constant distractions and intense patient interactions, community and hospital pharmacists have stress levels that are through the roof. It’s no wonder that we, as a profession, are experiencing high levels of stress, dissatisfaction, and burnout. We talk a lot about getting things done and advancing our practice, but how many of us have the energy to do that at the end of the day?

What Contributes to Burnout?

Our current healthcare environment is low cost, high quality. We are expected to do a lot of things well without a lot of resources. And this is not unique to pharmacy. It encompasses all facets of healthcare.

Without getting into a debate of how it should be (I mean, yes we should be producing high-quality work as efficiently as we can, but we also need resources and processes in place to make us successful!) let’s explore how we can mitigate some of the contributing factors.

Overall, if we like the work that we do, how does burnout happen? The National Academy of Medicine (NAM) put together a model that shows the internal (individual) and external (work) factors associated with clinical well-being and resilience and links them from clinician well-being to healthcare outcomes. Here is a not so all inclusive list:

Internal factors:

where you are in your education, since students, residents, and new practitioners are way more susceptible to these negative feelings.

acuity and load of clinical responsibilities, administrative responsibilities or teaching responsibilities

proficiency with technology

family dynamics and financial stressors

level of engagement and connection to meaning and purpose in your work

coping and communication skills, resilience, empathy

degree to which you feel included and connected

organizational skills and ability to delegate

work-life integration

External factors:

alignment of societal expectations and the clinician’s role

culture of safety where you work

patient behavior and expectations

political and economic climates

accreditation and quality ratings

litigation risks

human resources policies

insurance company policies

reimbursement structure

power dynamics

workload

level of support for healthcare team members

*for the full list visit www.nam.edu

So, you get the point by now.

There’s a lot out there that can create feelings of unease and dissatisfaction in a pharmacist. The truth is that this list is only a fraction of the reasons why so many of us are overwhelmed. Finally, when all of these factors become too much, and we can’t let go, we experience burnout.

So, at this point, we get that there are A LOT of things that can contribute and when they become too much to handle burnout is the result. How does it manifest? And how do we differentiate chronic stress and emotional exhaustion from everyday stressors?

Ask yourself:

Does your family say that you come home angry?

Have you become cynical or critical at work?

Are you abusing alcohol or another substance so that you can cope?

Have you noticed increased medical errors?

Has your productivity decreased?

Have you become irritable or impatient with coworkers, customers, and patients?

**These are all signs that you may have reached your limit.

Burnout is also more prevalent with those that have intense interactions with people. For example, we have heavy conversations all day about matters surrounding death, disability and serious side effects. Many of these talks are emotionally charged when patients get hit with the fear of not having access or being able to afford medication

Self-care and job satisfaction also get neglected in the healthcare field. We do what we have to do to take care of our patients in terms of time and our mental capacity. Sure, maybe we’re grumbling about it on the inside or to our coworkers, but we usually don’t recognize the stress as significant enough to demand a change from ourselves or our employer.

The reality is that we may not have taken a break, eaten, or gone to the bathroom in the past 8 hours, but we still make sure the medications get where they need to go. In the long run, we need to make sure the care that we give to our patients is sustainable by ensuring that our lifestyle is realistic and that we are taking time to recharge.

I have had the privilege of working in some of the top hospitals and pharmacy-centered health systems in the country. What I have found in smaller institutions is that the leadership just does not get it. I say this with much love as I know that we all have our silos of expertise, but until we start recognizing the struggles of other disciplines, and until leadership packages their “why”, mission and organizational values to help both their employees and their patients, I think there will always be a struggle. That is one of the things I loved about Duke (and they practiced what they preached) - their mission was “caring for our patients, their loved ones, and each other”. I still remember it almost ten years later.