Burnout is physical or emotional exhaustion associated with a feeling of reduced accomplishment and loss of personal identity. Burnout has long been a worry in the healthcare profession. Many factors contribute the development of burnout such as high job demands in conjunction with a lack of control; disconnect between individual values and those of the organization; insufficient rewards such that one feels taken for granted, undervalued, and/or undercompensated; work overload; unfairness; and a breakdown of community. Most notably, the current rising incidence of burnout has been correlated to the recent changes in medical processes, such as the institution of the electronic medical record.
Orthopaedic surgeons experience some of the highest rates of burnout as compared to other specialties1. In fact, half of the orthopaedists working at Duke report some symptoms of burnout, showing the relevance and incidence as a problem in our own department and specialty.
A growing body of research shows that physician burnout is linked to medical errors. Several recent meta-analyses show this to be the case across multiple specialities2. At the 2018 Scoliosis Research Society annual meeting the pre-course was entitled “Physician Well Being for the Benefit of the Patient: How Can We Be Better for Everyone Else?” These developments highlight the importance of addressing physician burnout to not only provide an enjoyable workplace, but all to ensure safe, high quality patient care.
While institutional factors play a role in physician burnout, there is much we can do to prevent burnout independent of the institution. Behavioral changes such as exercising, taking care of ourselves, eating well, and sleeping better are associated with less burn out. Interestingly, they are also associated with better clinical outcomes for the patients we treat. Connection in our everyday existence also decreases burnout. Connection can be with others at work or with a spouse or significant other. Indeed, there is a negative correlation in orthopaedic surgeons between burnout and marital harmony3.
An important factor related to burnout is mindfulness. This is the ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us. Mindfulness training was shown to substantially decrease burnout rates. Many medical schools and centers, including Duke, have mindfulness training programs for clinicians. The basic principles are to find a quiet and comfortable place; put aside all thoughts of the past and the future and stay in the present; focus on the sensation of air moving in and out of your body as you breathe; as thoughts come up in your mind, don't ignore or suppress them but simply note them; sit for a minute or two, becoming aware of where you are4.
Another critical factor is resilience. In a publication in the Journal of Bone and joint Surgery, it was suggested that resilience can be maintained by: embracing good work; becoming an ambassador of collaboration and collegiality; find and protect the meaning in what you do; accept that a life in orthopaedics is a family affair; and bear through the awkwardness of positive change. The authors of that study suggest that every day one should: notice what is going ‘‘right’’ about your day; savor interactions and moments that you enjoy; use your sense of humor; exercise; avoid the high-stress diet of junk food, caffeine, simple sugars; try calming activities (such as mindfulness); fill your environment with mood-boosters (e.g. lighting, sounds, and scents you like); and importantly don’t forget to believe in something bigger than yourself3. A simple approach is to end each day thinking about three good things, and this has been shown improve one’s overall mood.
By taking better care of ourselves, exercising, eating well, avoiding sleep deprivation, and the using of mindfulness, we will suffer less burnout, and provide better care for our patients5. While this may be a cultural shift in orthopaedics, it is taking hold in other specialties, such as in Otolaryngology, where these practices are incorporated into many of their residency programs6.
We are entering a phase in which there will be even more changes in the way we practice, as value-based care is coming to fruition. Like the institution of the electronic medical record, this will add additional stress to our lives, and risk a rise in feelings of burnout.
The tradition of orthopaedic teamwork at Duke and the relationships forged that extend to the Piedmont alumni group can be used to help mitigate burnout symptoms. In addition, a new management system that Duke is implementing will allow more integration and decision making at the local level. This will help with developing a feeling of community, and that physicians are enabled to effect change. By institutionally developing improved decision-making processes, and by the incorporating some of the personal practices outlined above, we can avoid some of the pitfalls around burnout that occurred around the stresses of the rollout of the electronic medical record. Given what we have learned and how well we can work together, we are well positioned to be a leader in well-being among orthopaedic surgeons.
- Sargent MC, Sotile W, Sotile MO, Rubash H, Barrack RL. Quality of life during orthopaedic training and academic practice. Part 1: orthopaedic surgery residents and faculty. J Bone Joint Surg Am. 2009 Oct;91(10):2395-405.
- Dewa CS, Loong D, Bonato S, Trojanowski L. The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic review. BMJ Open. 2017 Jun 21;7(6):e015141. doi: 10.1136/bmjopen-2016-015141.
- M. Catherine Sargent; Wayne Sotile; Mary O. Sotile; Harry Rubash; Peter S. Vezeridis; Larry Harmon; Robert L. Barrack. Managing stress in the orthopaedic family: Avoiding burnout, achieving resilience. Journal of Bone & Joint Surgery Am. 2011; 93:e40 1-13
- Goodman MJ1, Schorling JB. A mindfulness course decreases burnout and improves well-being among healthcare providers. Int J Psychiatry Med. 2012;43(2):119-28.
- Beach MC, Roter D, Korthuis PT et al. A multicenter study of physician mindfulness and health care quality. Ann Fam Med . 2013;11(5):421–428.
- O’Brien DC, Carr MM. Current wellness practices among Otolaryngology residencies. Otolaryngol Head Neck Surg . 2018;159(2):258–265