Part 1: The Case of the Emergency Department Physician Who Burned Out: Risk Factors, Impact, and Early Interventions

Désirée Lie, MD, MSEd

Disclosures

November 16, 2009

The Case: Dr. X Develops Burnout

Dr. X is a 44-year-old, married, residency-trained emergency physician who has been working in the same emergency department (ED) in a town of 200,000 people for the past 12 years. He is married and has a 15-year-old son, who is in high school. At the beginning of his career, he worked 12-hour shifts for 3 weeks followed by a 1-week break, but 5 years ago, he increased his work hours and shortened the breaks to increase his income. He is still dissatisfied with his pay, although he maintains an expensive sports car, and he and his wife have a heavy mortgage on their home and 2 other properties.

The ED patient census has increased dramatically in the recent past, secondary to significant loss of jobs for the town's inhabitants from an economic recession and subsequent loss of health insurance. As a result, the hospital has put pressure on physicians to improve revenues through funded patient visits and billable procedures.

Dr. X is frequently exhausted after a shift. Nevertheless, he finds it difficult to fall asleep and wakes up frequently, thus perpetuating the exhaustion. He has no time for attending continuing medical education (CME) activities and has no interest in teaching or leadership positions within the hospital. He is cynical about his patients and his professional accomplishments, and he rarely feels satisfied at the end of a day's or night's work.

His wife is a full-time nurse in the intensive care unit, working different shifts from his, so they rarely have time for one another. Dr. X takes no more than 1 week of vacation a year with his wife and son -- the last vacation being over 1 year ago. He has little recreational interests, and he has not been to the gym for 5 years because of recurrent low back pain. He still considers himself healthy and does not have a primary care physician or see any other physician regularly.

He has a history of cigarette smoking and marijuana use, and an excess of alcohol intake during medical school. During residency, he suffered brief bouts of depression after breakups with girlfriends, with which he coped by going on drinking binges. Presently he enjoys several beers after his shifts, but avoids socializing and has lost most of his social contacts. He does not consider his ED colleagues as friends.

Self-assessment questions:

  • What is the definition of "burnout" in physicians?

  • What are the signs of and risk factors for physician burnout?

  • What are the differences in prevalence of burnout among physicians by specialty?

  • What is the potential impact of physician burnout on patients, the physicians themselves, and the healthcare organization?

  • What are the effective interventions to reduce burnout among physicians?

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