What's new in emergencies, trauma and shock – Burnout in emergency physicians

Murtuza Ghiya1, William Wilson2
1 Department of Emergency Medicine, K J Somaiya Medical College Hospital, Mumbai, Founder of Codeblu Holistic Wellness Solutions, India
2 A&E, NHS Hampshire Hospital Foundation Trust, Winchester, England

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Date of Submission30-May-2022Date of Acceptance31-May-2022Date of Web Publication27-Jun-2022 How to cite this article:
Ghiya M, Wilson W. What's new in emergencies, trauma and shock – Burnout in emergency physicians. J Emerg Trauma Shock 2022;15:75-6

Burnout is rampant in the health-care sector. While there is consensus about this already, it is nonetheless challenging to have an exact estimation of the incidence of burnout in physicians. The article, “Compassion Fatigue and Satisfaction among Turkish Emergency Medicine Residents Using the Professional Quality of Life Scale,” is an excellent example of demonstration of the challenges faced by our specialty. The study highlights that emergency physicians have an alarming rate of burnout and suffer from immense compassion fatigue and with time that will have a significant negative impact on all stakeholders: patients, doctors, and the specialty. We found the usual suspects such as poor work–life balance, workplace violence, poor administrative support, and bullying among others being the root cause of the problem.

A recent comprehensive systematic review of 182 studies published between 1991 and 2018 that involved 109,628 individuals in 45 countries observed a substantial variability in prevalence estimates of burnout among physicians, ranging from 0% to 80.5%.[1] The vast differences in the numbers were explained due to assessment methods, burnout definitions, and study quality. Keeping this as a backdrop, it is essential to acknowledge that burnout exists across geographies with each health system having its own intricate etiologies and associations. There is plenty of evidence now with cross-sectional prevalence studies across the globe churning statistics year after year. Most survey instruments are usually developed for use in the country of the creator and hence the concepts measured by them may get lost in translation and may not have applicability especially as health systems across the world remain so heterogeneous in their organization and functioning.

One does wonder what has kept the remaining cohort of emergency physicians unperturbed and motoring ahead. It would be interesting to get an insight into their approach and what they have done to build resilience and promote wellness. This would help plan interventions both at a personal and at an organizational level and then aim to evaluate its effect on productivity, patient care, and patient satisfaction. Different variables may influence well being and hence studies focused on different subpopulations are required.[2] As stated by Mueller et al. stressors exist “in the eye of the beholder”, which further reiterates individual susceptibility and vulnerability as additional predisposing factors for burnout.”[3],[4] One such individual factor is core self-evaluation (CSE).[3] Judge et al. hypothesized four core traits: (a) self-esteem or self-approval; (b) generalized self-efficacy; (c) neuroticism, which represents emotional instability; and (d) locus of control, which refers to the assumption of being able to control the environment.[5] They went onto explain how CSE is a higher-order factor that encompasses these traits and influences people's behavior and response to situations. Geuens et al. demonstrated the intricate relationship between CSE, situational factor, and coping mechanism as antecedents of burnout in hospital nurses.[3]

The time has come for a paradigm shift; to move away from problem defining to problem-solving! The need of the hour is to have a translation process of all the burnout data and evidence and progress in the form of policies and wellness solutions. Comprehensive professional training such as cognitive behavioral therapy, stress-reducing activities such as mindfulness and group activities, and strict implementation of work-hour limitations recommended by medical boards for residents are a few methods.[6] Qualitative data to understand what works and what does not will help in planning interventions ahead and search pragmatic solutions. With the boom of healthtech and the digital space, it may even be worthwhile for health-care professionals to consider wellness as an entrepreneurial venture.

It is time we realized that only healthy doctors can practice good and safe medicine for our patients. Burnout and wellness should not remain as buzzwords and the available data and research should lead to strong lobbying for firm wellness policy level changes at the departmental, institutional, and national levels. It is now time for action!

References

1.Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, et al. Prevalence of burnout among physicians: A systematic review. JAMA 2018;320:1131-50.

2.De Hert S. Burnout in healthcare workers: Prevalence, impact and preventative strategies. Local Reg Anesth 2020;13:171-83.

3.Geuens N, Verheyen H, Vlerick P, Van Bogaert P, Franck E. Exploring the influence of core-self evaluations, situational factors, and coping on nurse burnout: A cross-sectional survey study. PLoS One 2020;15:e0230883.