Key messagesWhat are the new findings?What is their significance?Introduction

Burnout seems to be a prevalent and serious problem among physicians.1 A US report ‘A crisis in Health care: a call to action on physician burnout’ concluded among others that ‘If left unaddressed, the worsening crisis threatens to undermine the provision of care, as well as eroding the mental health of physicians’.2 A study found that Danish midwives and homecare workers had high levels on both work-related and client-related burnout.3

A recent review has shown a prevalence of burnout ranging from 3% to 66% in healthcare professionals working in palliative care; however, no major differences in prevalence were found between nurses and physicians.1

Burnout can be characterised as a long-term stress reaction marked by emotional exhaustion and depletion of one’s emotional and physical resources. Affected physicians may feel drained and ‘used-up’, sensing a lack of personal accomplishment. It may involve negative, cynical, hostile attitudes and detached feelings towards patients and their relatives, known as depersonalisation.4 The latter may be worsened as most Western countries have implemented organisational changes in healthcare, that may increase ‘efficiency’ but may undermine the alignment between caregivers’ values and the reconfigured healthcare system.5 In clinical medicine, three pillars supporting professionals’ motivation and psychological well-being have been proposed: autonomy, competence and relatedness.6 All three may be threatened by the restructuring of the healthcare system.7 Within specialised palliative care (SPC) in Denmark, there is a tradition for group supervision with either monodisciplinary or interdisciplinary discussions of work-related issues. Often external supervisors are involved; however, the individual department is responsible for the framework of supervision.

The Danish Society of Palliative Medicine (DSPaM) is a society for physicians with an engagement in palliative medicine. In Denmark, palliative medicine is not yet an established medical specialty and the members of DSPaM have accordingly other medical specialties as background and have typically entered the field of palliative medicine rather late in their medical career. DSPaM decided to carry out a questionnaire survey of burnout among its members. Due to the nature of the work and the unformalised and unstructured education, the hypothesis was to find a high burden of burnout symptoms in the members of DSPaM.

Therefore, the aim of the present study was to investigate the prevalence of burnout symptoms among members of DSPaM.

MethodsStudy design

The study was performed as a cross-sectional questionnaire survey. Data were collected using an electronic questionnaire developed specifically for the purpose. All 160 registered members of DSPaM were invited to participate. The invitation to participate in the survey was sent out by mail on 1 October 2019, a reminder was sent on 25 October and data collection ended on 1 November 2019.

Assessment

The first part of the questionnaire posed questions concerning the physicians’ current employment, background, age and years of clinical experience. The second part was the Copenhagen Burnout Inventory (CBI). CBI is a tool for assessment of nature and intensity of burnout symptoms. The CBI was developed and validated as a part of Danish longitudinal study PUMA (Danish acronym for Project on Burnout, Motivation and Job Satisfaction).3 8 CBI has been validated and translated into a number of languages including English, Japanese, Mandarin, Cantonese, Swedish, Finnish, French, Slovenian and Spanish.8–11

The CBI characterises burnout as a state of prolonged physical and psychological exhaustion. Thus, the questionnaire includes 19 questions focusing on three areas of burnout: (1) personal burnout, (2) work-related burnout and (3) client-related burnout.3 Each category comprises 6–7 questions, and the sum of the score addresses the intensity of burnout symptoms. Ranging from symptoms of burnout that require no attention to symptoms that require response and ultimately require professional help immediately.

The sum score of each of the three domains differs with regard to intensity level for which type of intervention should be considered.8

Analysis

All analyses were performed using SPSS statistical software (V.25). Results were reported as descriptive statistics.

Results

Seventy-six physicians of the 160 members of DSPaM, who were invited to take part in the survey, filled in the questionnaire resulting in an overall response rate of 47.5%. Data on age were grouped in intervals of 5 years. The median age interval was 51–55 years (range 31–75). The median period since medical graduation was 24 years (range: 7–59 years) and the median employment period in SPC was 4 years (range: 0–32 years).

Seventy-eight per cent of respondents were mainly employed in SPC such as hospices or hospital-based palliative care units. Twenty per cent respondents were not employed in SPC and 2% responded ‘no relevance’. Fifty one per cent reported to receive regular supervision as part of their employment.

Workload in SPC

Median hours of planned work per week were 37 (range: 0–45 years). Median hours of patient contact per week were 24.5 (range: 0–40.5 hours).

CBI scores in personal, work-related and client-related burnout

Table 1 describes the presence of burnout symptoms for every category of burnout according to CBI. The last column reports the median score in each category. Additional comments to the questionnaire enlightened that the physicians experiencing burnout symptoms claimed poor leadership and reduced resources to be the major burden rather than client-related contact.

Table 1

Personal, work-related and client-related burnout

Given that the survey was sent to all members of DSPaM, the analysis included members working outside SPC. If only the 59, who worked mainly in SPC were included in the analysis, the findings were largely unchanged: the median personal burnout was 8.0 (8.0 median for all 76 participants), work-related burnout 7.0 (7.0 median for all participants) and client-related burnout 4.0 (3.5 median for all participants).

Discussion

The present study demonstrated a relatively low burden of burnout symptoms among physicians in DSPaM. However, about 50% showed symptoms of personal burnout that may deserve attention. The major burden of burnout symptoms was related to personal-related and work-related burnout. Comments to the questionnaire described poor leadership and reduced resources to be a larger burden rather than client-related contact.

A recent systematic review found a lower burnout rate among healthcare professionals providing palliative care in specialised settings compared with those providing palliative care in general settings.1 There can be many reasons for this difference. A mutual understanding within health professionals in SPC of the emotional strain working in palliative medicine could be an explanation.12 Supervision and the ability to provide understanding of the burdens and the benefits within the specific clinical situations could be another together with organisational insight resulting in good planning offering more favourable working conditions.13

About 78% of the responses in our survey came from physicians working in SPC. This could indicate that the organisation and working conditions in SPC generally support that healthcare professionals can work with patients who experience pronounced suffering. However, frontline healthcare providers like those working in SPC may often identify inefficiencies related to organisational structures and workflows, and poor policies and procedures for the delivery of optimal patient care due to the rigid silo structure of healthcare systems in most high-income countries.14

Some weaknesses of the present survey were the low response rate and the cross-sectional design, which precludes to draw conclusions about causality. However, the data presented here can hopefully be used in comparisons between different specialties or to show a development over time within SPC. Such comparative studies may be carried out in the future to provide ideas about causality regarding the development of burnout symptoms in physicians and what changes in the healthcare system and/or add-on interventions which might be helpful to diminish burnout symptoms among physicians and other healthcare workers.

Conclusion

This survey demonstrated a relatively low rate of burnout symptoms among physicians, who were members of the DSPaM. In particular, the client-related burnout score was low, while higher scores were observed in personal and work-related burnout. Despite the overall relatively low burden of burnout, it is notable that about half of the physicians reported a level of personal burnout that should be noted. Finally, we anticipate that this survey can constitute a baseline for monitoring the future development in prevalence of burnout.

Ethics statementsPatient consent for publication

Not required.

References↵↵↵↵↵↵↵↵↵↵↵

pp. Fiorilli C , De Stasio S , Benevene P . Copenhagen Burnout Inventory (CBI): A validation study in an Italian teacher group.,” TPM-Testing, Psychometrics, Methodology in Applied Psychology, vol. 22, no. 4. Cises, Srl, Benevene, Paula: Department of Human Sciences, Lumsa University of Roma, Piazza delle Vaschette 101, Roma, Italy, 00193, benevene@lumsa.it :537–51.

↵↵↵