BURNOUT SYNDROME IN THE MEDICAL PROFESSION: ORGANIZATIONAL AND INDIVIDUAL FACTORS
BURNOUT SYNDROME IN THE MEDICAL PROFESSION
Abstract
The burnout syndrome represents a set of symptoms arising in a situation of prolonged stress at the workplace, in professionally demanding situations. It is characterized by emotional exhaustion, depersonalization and a sense of reduced personal accomplishment. In the 11th revision of the International Classification of Diseases, the World Health Organization defined burnout at work as an occupational phenomenon that affects health. The Maslach Burnout Inventory (MBI) is one of the tools used to measure the level of burnout. It has often been criticized for conceptual, methodological and practical reasons; however, it is still considered the gold standard for assessing job burnout and is used in 88% of all empirical studies. Factors that contribute to the development of burnout syndrome can be divided into organizational and individual factors. The complexity of work organization, as the crucial external factor, is reflected in the shaping of interpersonal relations, the establishment of hierarchies among employees, timely personnel planning and the need for professional training, which indirectly affects the degree of burnout of doctors at work. If one adds to that the need of doctors to engage in academic work, the failures in the medical system organization of the work are reflected in excessive working hours, devaluation of teaching work, inappropriate academic ranking, accumulation of engagements outside of teaching, pressure to publish papers and dissatisfaction with the criteria of scientific success. Personality traits, as the first and most important individual/internal factor, can speed up or slow down the occurrence of burnout syndrome at work due to the nature of their influence. They play a big role in making this syndrome noticeable in extroverted people and vice versa, causing it to remain unrecognized and hidden in introverted people. Thus, they make it difficult for this syndrome to be registered and delay the provision of timely assistance. The occurrence of burnout syndrome, which develops as a response to chronic professional stress, coupled with greater opportunities for professional development, better earnings and working conditions, as well as higher quality standards, are the key triggers of the migration of healthcare workers, both in Europe and in our country.
References
1. Maslach C, Jackson SE. The measurement of experienced burnout. J Organ Behav. 1981; 2(2): 99–113.
2. WHO [World Health Organization]. Burn-out an “Occupational Phenomenon”: International Classification of Diseases. Available online: https://www.who.int/mental_health/evidence/burn-out/en/
3. Aumayr-Pintar, C.; Cerf, C.; Parent-Thirion, A. Burnout in the Workplace: A Review of Data and Policy Responses in the EU. 2018. Available online: https://www.eurofound.europa.eu/publications/report/2018/burnout-in-theworkplace-a-review-ofdata
4. Lastovkova, A.; Carder, M.; Rasmussen, H.M.; Sjobergg, L.; de Groene, G.J.; Sauni, R.; Vevoda, J.; Vevodova, S.; Lasfargues, G.; Svartegren, M.; et al. Burnout Syndrome as an Occupational Disease in the European Union: An Exploratory Study. Ind. Health 2018; 56, 160–165.
5. Schaufeli, W.B.; Desart, S.; De Witte, H. Burnout Assessment Tool (BAT)—Development, Validity, and Reliability. Int. J. Environ. Res. Public Health 2020; 17, 9495.
6. Boudreau RA, Boudreau WF, Mauthe-Kaddoura AJ. From 57 for 57: A bibliography of burnout citations 17th Conference of the European Association of Work and Organizational Psychology (EAWOP); Oslo, Norway2015.
7. Maslach C, Jackson S, Leiter M. The Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, CA: Consulting Psychologists Press 1996.
8. Maslach C. Understanding burnout: work and family issues. In: Halpern DF, Murphy SE, eds. From work-family balance to work-family interaction: changing the metaphor. Mahway, NJ: Lawrence Erlbaum. 2005; 99–214.
9. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001; 52: 397–422.
10. Montero-Marin J, Araya R, Blazquez BO, Skapinakis P, Vizcaino VM, Garcia-Campayo J. Understanding burnout according to individual differences: ongoing explanatory power evaluation of two models for measuring burnout types. BMC Public Health. 2012; 12.
11. Shen, B.; McCaughtry, N.; Martin, J.; Garn, A.; Kulik, N.; Fahlman, M. The relationship between teacher burnout and student motivation. Br. J. Educ. Psychol. 2015, 85, 519–532.
12. Maslach C, Jackson SE, Leiter MP, Schaufeli WB, Schwab RL. Maslach Burnout Inventory. Mind Garden. https://www.mindgarden.com/117-maslach-burnout-inventory. Updated 2019.
13. Lindeman B, Petrusa E, McKinley S et al. Association of burnout with emotional intelligence and personality in surgical residents: can we predict who is most at risk? J Surg Educ 2017; 74: e22–e30
14. Parte L, Herrador-Alcaide T. Teaching Disruption by COVID-19: Burnout, Isolation, and Sense of Belonging in Accounting Tutors in E-Learning and B-Learning. Int J Environ Res Public Health. 2021 Sep 30;18(19):10339.
15. Jakovljevic B, Stojanovic K, Nikolic Turnic T, Jakovljevic VL. Burnout of Physicians, Pharmacists and Nurses in the Course of the COVID-19 Pandemic: A Serbian Cross-Sectional Questionnaire Study. Int J Environ Res Public Health. 2021 Aug 18; 18 (16): 8728.
16. Casalino LP, Li J, Peterson LE, Rittenhouse DR, Zhang M, O'Donnell EM, Phillips RL Jr. Relationship Between Physician Burnout And The Quality And Cost Of Care For Medicare Beneficiaries Is Complex. Health Aff (Millwood). 2022 Apr; 41(4): 549-556.
17. Gome JJ, Paltridge D, Inder WJ. Review of intern preparedness and education experiences in General Medicine. Intern Med J. 2008; 38: 249–53.
18. Daugherty SR, DeWitt C, Baldwin J, Rowley BD. Learning, satisfaction, and mistreatment during medical internship: a national survey of working conditions. JAMA. 1998; 279:1194–9.
19. Bola S, Trollip E, Parkinson F. The state of South African internships: a national survey against HPCSA guidelines. S Afr Med J. 2015; 105: 535.
20. Martinez W, Lehmann LS, Thomas EJ, Etchegaray JM, Shelburne JT, Hickson GB, et al. Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents. BMJ Qual Saf. 2017; 26: 869–80.
21. Rodrigues H, Cobucci R, Oliveira A, Cabral JV, Medeiros L, Gurgel K, et al. Burnout syndrome among medical residents: a systematic review and meta-analysis. PLoS ONE. 2018; 13: e0206840.
22. Facey AD, Tallentire V, Selzer RM, Rotstein L. Understanding and reducing work-related psychological distress in interns: a systematic review. Intern Med J. 2015; 45: 995–1004.
23. Raúl A. Borracci, Graciana Ciambrone, Eduardo B. Arribalzaga, Tolerance for Uncertainty, Personality Traits and Specialty Choice Among Medical Students, Journal of Surgical Education,Volume 78, Issue 6, 2021; Pages 1885-1895,
24. Sanfilippo F, Noto A, Foresta G, Santonocito C, Palumbo GJ, Arcadipane A, et al. Incidence and factors associated with burnout in anesthesiology : A systematic review. BioMed Research International. 2017; 8648925.
25. Whippen DA, Canellos GP. Burnout syndrome in the practice of oncology: results of a random survey of 1,000 oncologists. J Clin Oncol. 1991; 9(10): 1916-1920.
26. Girgis A, Hansen V, Goldstein D. Are Australian oncology health professionals burning out? A view from the trenches. Eur J Cancer. 2009; 45(45): 393-399.
27. Aljaroudi, M. Burnout levels for faculty members when coping academic accreditation requirements in the College of Education at King Saud University. JEPS 2015; 16: 11–52.
28. Holmes, E.S.; Santos, S.R.; Almeida, A.A.F.; Candeia, R.M.S.; Chaves, L.C.M.R.; Oliveira, A.E.C.; Fonseca, L.C.T.; Costa, M.B.S.; Batista, J.B.V.; Ribeiro, G.S.; et al. Prevalence of burnout syndrome and factors associated with university teachers. Int. Arch. Med. 2017; 10: 1–8.
29. Tijdink, J.K.; Vergouwen, A.C.; Smulders, Y.M. Emotional exhaustion and burnout among medical professors: a nationwide survey. BMC Med. Educ. 2014; 4: 183.
30. Mojsa-Kaja J, Golonka K, Marek T. Job burnout and engagement among teachers - Worklife areas and personality traits as predictors of relationships with work. Int J Occup Med Environ Health. 2015; 28(1): 102-19.
31. Leiter, M. P. Burnout as a developmental process: Consideration of models. In W. B. Schaufeli, C. Maslach, & T. Marek (Eds.), Professional burnout: Recent developments in theory and research. Washington, DC: Taylor & Francis (1993).
32. Hui Q, Yao C, Li M, You X. Upward social comparison sensitivity on teachers' emotional exhaustion: A moderated moderation model of self-esteem and gender. J Affect Disord. 2022 Feb 15; 299: 568-574.
33. Leiter, M. P. Burnout as a crisis in professional role structures: Measurement and conceptual issues. Anxiety, Stress & Coping.1992; 5(1), 79–93.
34. Burke, R.J. and Leiter, M.P. Contemporary organizational realities and professional efficacy: Downsizing, reorganization and transition. In: P. Dewe, M.P. Leiter and T. Cox (Eds.), Coping and health in organizations. London: Taylor & Francis. 2000; 237-258.
35. Galaiya Rath KS, Huffman LB, Phillips GS et al. Burnout and associated factors among members of the Society of Gynecologic Oncology. Am J Obstet Gynecol 2015; 213: 824-e1
36. Galaiya Malik AA, Bhatti S, Shafiq A et al. Burnout among surgical residents in a lower-middle income country–Are we any different? Ann Med Surg 2016; 9: 28–32
37. G McAbee JH, Ragel BT, McCartney S et al. Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey. J Neurosurg 2015; 123: 161–173.
38. Aldrees T, Hassouneh B, Alabdulkarim A et al. Burnout among plastic surgery residents: National survey in Saudi Arabia. Saudi Med J 2017; 38: 832.
39. Lien SS, Kosik RO, Fan AP, et al. 10-year trends in the production and attrition of Chinese medical graduates: an analysis of nationwide data.Lancet. 2016; 388: S11-S11.
40. Pinto da Costa, M., Giurgiuca, A., Andreou, E., Baessler, F., Banjac, V., Biskup, E., … De Picker, L. Women, partners, and mothers–migratory tendencies of psychiatric trainees across Europe. Frontiers in Public Health. 2019; 7: 143.
41. Pinto da Costa, M., Giurgiuca, A., Holmes, K., Biskup, E., Mogren, T., Tomori, S., … De Picker, L. To which countries do European psychiatric trainees want to move to and why? European Psychiatry. 2017; 45: 174–181.
42. Šantrić-Milićević, M.M.; Terzić-Supić, Z.J.; Matejić, B.R.; Vasić, V.; Ricketts, T.C., III. First-and fifth-year medical students’ intention for emigration and practice abroad: A case study of Serbia. Health Policy 2014, 118, 173–183.
43. Tang L, Pang Y, He Y, Chen Z, Leng J. Burnout among early-career oncology professionals and the risk factors. Psychooncology. 2018 Oct; 27(10): 2436-2441.
44. Shoman, Y., Marca, S., Bianchi, R., Godderis, L., Van der Molen, H., & Guseva Canu, I. Psychometric properties of burnout measures: A systematic review. Epidemiology and Psychiatric Sciences. 2021; 30, E8.
45. Galaiya R, Kinross J, Arulampalam T. Factors associated with burnout syndrome in surgeons: a systematic review. Ann R Coll Surg Engl. 2020 Jul; 102(6): 401-407.
46. Accreditation Council for Graduate Medical Education Resident/Fellow and Faculty Surveys. https://www.acgme.org/Data-Collection-Systems/ Resident-Fellow-and-Faculty-Surveys.
47. Zhao Y, Musitia P, Boga M, Gathara D, Nicodemo C, English M. Tools for measuring medical internship experience: a scoping review. Hum Resour Health. 2021 Jan 14; 19(1): 10.