Avoiding Burnout in Practice

Milton Little, MD, FAAOS | Aaron Brandt, MD

October 19, 2022


Two months into my second year of practice, I just finished my board collection period and trying to acclimate to a new environment and city…all I can tell you is that I am no expert in how to “avoid” burnout. As much as I want to give you the answers to beating burnout, like the syndrome itself, one size does not fit all. Christina Maslach, Professor of Psychology (Emerita) at UC Berkeley, who helped define and measure burnout, defined burnout as a syndrome involving emotional exhaustion, depersonalization, and low job satisfaction. Essentially, there is a mismatch between the job and the individuals that can have a profound effect on physical and emotional well-being.  

What do you think of when you hear the word burnout? Are you someone who reads an article like this and immediately googles the symptoms…”Oh, that’s definitely me”? Are you someone who is “fine” and absolutely nothing is wrong? Or are you someone who thinks, “Here we go again! People just need to be more resilient.” Whichever category you find yourself in, if you haven’t experienced burnout, there is a good chance you will. Shanafelt et al. surveyed physicians in 2014 and found over half of all surveyed experienced burnout. As med students, we battle to make the grade, feeling like any low mark or blemish will alter our entire future. As residents, we are tested mentally and physically to prepare for our careers. Again, pushing to be the best to get the best fellowships, jobs, awards, etc. Then we hit the pinnacle, right? We enter practice and finally settle into our careers…but wait! I want to be a department chair someday. I need to publish as much as possible to make the institution and myself look good. I have to build a great practice, and now I’m responsible for each patient outcome, setback, and complication. Hyperventilating a little? Not me. As surgeons and high achievers, we are at some of the highest risk for this issue. We are pushed to say yes to every opportunity for half of our careers, just to be told later we need to learn how to say no.  

Burnout is out there, and yes, we have to be better about trying to avoid it, not just react when it hits us. In this short post, I am not going to try to give all the answers to this question. Research in many fields has yet to provide clear explanations, including the life’s work of Dr. Maslach, and I sure don’t have them. What I offer today is a little discussion of the syndrome that is burnout and strategies that can hopefully help us shift from reactive to proactive.

Burnout is a Problem!

Burnout is not a new topic, and there has been a lot of work in the area in many fields to define what it is and what it is not. While mental health disorders are inherent to the individual, no person is without risk of suffering from the condition that is burnout. So step one is to acknowledge that we are all at risk for burnout. We must learn about what contributes to burnout and understand what it is not. Maslach et al. listed 6 of the factors that contribute to burnout:

– Unsustainable workload

– Perceived lack of control

– Insufficient rewards for effort

– Lack of a supportive community

– Lack of fairness

– Mismatched values and skills

We must be familiar with these domains as individuals and as leaders in the field. While we often focus on burnout strategies individually, we are not working alone. Where things are challenging for you, there are others affected. If we don’t define the issues, we can’t address them.  

What is Your “Why”?

No matter what stage you are at in this process, it’s time to check in with yourself. Your purpose is just that, yours. The environment will change, and the people around you will change. And your goals and values may change. So you must ask yourself if you are living the way you want. Each time in my life, I have started to feel burnt out; the job or stress was not the critical factor. Sometimes things are not ideal in our lives, but how we function in those environments and situations is in our control. The most significant factor was losing perspective on my identity and what mattered to me. If you don’t keep those values front and center, your decisions will be driven by factors more likely to pull you further away.    

No Answers Without Questions

Lack of control in a situation is often a significant source of burnout. One way to gain control immediately is to take inventory of your situation. “I don’t have time for that,” you say…well you’ve made it to this point in the post, so do it now.  

  • Define the different areas you are or want to be putting time and energy into. Make a list. Build a grid or table. Draw pictures or whatever you want. If you are like me, you have to say yes and assume it’s not too much. You got this, right? Well, hold onto that list, and the next time you are asked to take on another task, take a look. That visual may be enough to help you say, “I’m sorry, I just can’t right now.”
  • Identify what is in your control and what is not? Sometimes we are giving energy to something we don’t have to. Probably more often, we are struggling against something we can’t control. If you don’t know where something lands, let’s go back to “why.” One of the most underutilized words we all learn as children and either forget or are deterred from using. Asking “why” allows us to move from people who let things happen to them and become people who are involved in the process. Why is the system like this? Why don’t we have more help? We can better help solve the problem when we understand the setting more.

Prepare

Building healthy and sustainable habits while things are good is an excellent step to avoid burnout. It’s not easy to look at things critically when feeling good. Who wants to be a pessimist and think about the hard times, right? Well, I like to look at it as being realistic. There will be ebbs and flows to life, and we must anticipate that. Decide what parts of your life you must have and think about the what-ifs. Sometimes this exercise is one of recall from times you were stretched thin and unable to maintain some of those things you love (reading, running, baking, etc.). Learn from it. Try to build consistency and protected space for those must-haves. Most of us have heard that the best offense is a good defense. Definitely the area I struggle with most and arguably the most important. Protect yourself.  

Build a Culture

Part of fighting burnout is recognizing we are in it together.  Burnout is a syndrome that we can combat, but unlike many issues, it requires interdependence. One of many things we learned from the pandemic is that burnout rates increased, and the isolation amplified these issues. We have to look out for each other, and part of preparation is building a culture of support and safety. We can make regular touch-point meetings to stay connected to our teams, peers, staff, etc. Identify mentors and maintain relationships with those you can contact when needed. So many aspects of this career are out of our control, but interpersonal relationships are not one of those areas. Plenty of research supports that even under challenging circumstances, we will feel more satisfied and fulfilled if we are more connected to the people around us. More importantly, we will better identify when some of these symptoms manifest in each other. 

Say Something!

If you struggle with burnout or think you are at risk, SAY IT OUT LOUD! Look in the mirror and say it. Tell your partner, friend, family member, dog…whomever. No, you are not failing and not admitting you can’t handle things. You are also not alone. You are becoming self-aware and noticing the imbalance, and recognizing the toll it is taking. In the end, our job is to care for other people. If we are not healthy and functioning at a high level, it’s our patients we are now placing at risk.  

Additional Resources:

  • Ames SE, Cowan JB, Kenter K, Emery S, Halsey D. Burnout in Orthopaedic Surgeons: A Challenge for Leaders, Learners, and Colleagues: AOA Critical Issues. J Bone Joint Surg Am. 2017;99(14):e78. doi:10.2106/JBJS.16.01215
  • Daniels AH, DePasse JM, Kamal RN. . Orthopaedic Surgeon Burnout. Journal of the American Academy of Orthopaedic Surgeons. 2016; 24 (4): 213-219. doi: 10.5435/JAAOS-D-15-00148.
  • Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory. Evaluating Stress: A Book of Resources. 1997:191e218.
  • Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory. Palo Alto, CA: Consulting Psychologists Press; 1996.
  • Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, West CP. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015 Dec;90(12):1600-13.

DISCLOSURES: Dr. Little Globus Medical, Consultant: Depuy Synthes, Consultant: Restor3D, Committee Member: AO Fellowship Committee; OTA Membership Committee; OTA Diversity Committee; OTA Wellness Committee. Dr. Brandt This individual reported nothing to disclose.

Read the AAOS Code of Conduct for Discussion Group Terms, Conditions and Disclaimers HERE.

Copyright© 2022 by the American Academy of Orthopaedic Surgeons

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