Prevalence of Burnout Among Intensivists is High
Abstract & Commentary
By David J. Pierson, MD, Editor, Professor, Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, is Editor for Critical Care Alert.
Synopsis: In this study of physicians working in French adult ICUs, evidence of burnout was present in nearly half. Burnout was more likely in female physicians, in those who were not married, and among those who reported strained relationships with colleagues and staff nurses.
Source: Embriaco N, et al. Am J Respir Crit Care Med. 2007 (published on line ahead of print January 18: doi:10.1164/rccm.200608-1184OC)
Professional burnout is a psychological syndrome in response to chronic interpersonal stressors on the job. In order to determine the prevalence of burnout among physicians working in ICUs, and to investigate associated factors, the investigators carried out a nationwide one-day survey study in the adult ICUs of 189 French public hospitals. Interns, residents, fellows, and attending physicians currently working in the ICU were surveyed. In addition to demographic information about the responding physicians, data were sought about the size and staffing of the ICU and the severity of illness of its patients. To quantitate the features of burnout, the authors used the Maslach Burnout Inventory (MBI) scale, a 22-item questionnaire used in other studies and previously shown to be reproducible and valid. The MBI uses a 7-point Likert scale (which does not include the word "burnout") to determine the frequency with which respondents experience certain feelings related to their work during the week preceding the day of the survey. Three domains of burnout are investigated: the emotional exhaustion subscale (9 items), which assesses feelings of being emotionally overextended and exhausted by one's work; the depersonalization subscale (5 items) measuring an unfeeling and impersonal response toward those under one's care; and the personal accomplishment subscale (8 items), which assesses feelings of competence and successful achievement in one's work with people.
The study took place on March 25, 2004. Directors of 189 of the 318 potentially eligible French ICUs (59%) agreed to participate in the study, and 978 physicians (82%) completed and returned the survey instrument. Of the respondents, 54% worked in teaching hospitals, and 72% were men; 24% were interns or residents, 14% fellows, and 62% attending physicians. Using the MBI scale, a high level of burnout was identified in 46.5% of the respondents, and of the others, 23.3% had a low level of burnout and 30.2% a moderate level of burnout. Of the intensivists, 37 % recorded 10 or higher in the depersonalization domain, a score considered to be high, indicating burnout. A high level of emotional exhaustion was present in 19%, and a low level of personal accomplishment in 39%. Of the respondents, 39.6% indicated that they wanted to leave their jobs, and this intention was higher in those whose level of burnout was also high. By the Centers of Epidemiologic Studies Depression Scale, evidence of depression was found in 24% of the respondents, 81% of whom also scored high on burnout.
Intensivists reporting high levels of burnout were more likely to be women, to be single, and to be younger with less ICU experience. Severity of illness and mortality among the patients whey cared for had no relationship to the likelihood of burnout. However, high workload and interpersonal conflicts, such as with colleagues or nurses, were associated with burnout; having better working relationships with nurses and chief nurses correlated with a lower frequency of burnout. The authors suggest that, while burnout is common, affecting nearly half of the intensivists in their study, improving working conditions and relationships with colleagues might have a favorable effect on its incidence and severity.
Commentary
Professional burnout is a psychological syndrome in response to chronic interpersonal stressors on the job, in which affected individuals lose concern and emotional feeling for the people with whom they work, coming to treat them in a detached or even dehumanized manner. Burnout is distinct from depression in that it is confined to the work environment, while the former affects all aspects of a person's life. In this study of physicians working in ICUs in public hospitals in France, almost half of them met accepted criteria for burnout according to one or more of the 3 domains studied.
In the only published study of burnout among intensivists in North America, Guntupalli and Fromm1 surveyed a random sample of 248 internist members of the Society of Critical Care Medicine, using the same instrument (the MBI scale) employed by Embriaco et al in the current paper. The findings were similar in that evidence of burnout was very common. In this earlier study, one-third of the respondents scored abnormally high on the emotional exhaustion scale, nearly two-thirds had abnormally low scores on the personal achievement scale, and 20% rated high on the depersonalization scale. In their survey, which included only attending physicians (no trainees), Guntupalli and Fromm found that high levels of emotional exhaustion were associated with anticipating leaving critical care before retirement.
Although methods and results have varied somewhat, as discussed by the authors of the present article, studies to date indicate that burnout is present in somewhere between one quarter and two-thirds of physicians working in the ICU. The associations between burnout and high workload, and with the quality of working relationships with colleagues and nurses documented in the study by Embriaco and colleagues, suggest possible avenues for prevention and remediation. Whether reorganization and efforts to improve collegial working relationships can reduce the prevalence and severity of burnout remains to be seen, but would certainly seem worthwhile based on the findings of this study.
Reference
- Guntupalli KK, et al. Intensive Care Med. 1996;22:625-630.
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