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| EDITORIAL |
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| Year : 2018 | Volume
: 23
| Issue : 2 | Page : 76-77 |
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Physician burnout: Are we taking care of ourselves enough!
Sandeep Grover
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| Date of Web Publication | 14-Nov-2019 |
Correspondence Address:
Sandeep Grover
Department of Psychiatry, PGIMER, Chandigarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmhhb.jmhhb_45_19
How to cite this article:
Grover S. Physician burnout: Are we taking care of ourselves enough!. J Mental Health Hum Behav 2018;23:76-7 |
Physician burnout is a well-known entity in Western countries, especially in the United States. The concept evolved in 1960s and over the years has been well-recognized phenomenon among doctors and other medical professionals. Over the years, a reasonable amount of literature has accumulated to understand the concept, its symptoms, its stages, prevalence, assessment instruments, and management.[1] Available data also suggest that physician burnout can have many negative consequences for the patient and health outcomes, besides the adverse outcomes for the physicians.[1] Considering the importance of the same, it is often recommended that physicians must be routinely screened for physician burnout. It is also suggested that clinicians must learn to take care of themselves.
When one compares the available literature, physician burnout, has received little attention in India. Only a handful of studies have evaluated physician burnout from India.[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13] Most of these studies are limited to resident doctors or interns, with one study focusing on registered medical practitioners in India.[8] The prevalence of burnout in these studies varies from 5.15% to more than 90%, depending on the cutoffs used to define burnout.[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13] One study which included both residents and the faculty members of a public sector tertiary care hospital reported that the prevalence of burnout was higher in resident doctors when compared to the faculty members.[4] In terms of correlates, available data suggest a lack of significant difference across medical and surgical specialties.[2] Factors which have been shown to be associated with physician burnout include high work overload,[3] low recreational activities, verbal or physical abuse by patients/caregivers, lack of empathy from seniors.[4] Studies among medical students suggest that burnout among students is related to unsatisfactory hostels, inadequate library facilities, frequent examinations, excessive competitive attitude among students, political conflicts, jealousy, and peer rivalry.[5] The study, which included participants from the government and private sector, suggests that possibly private practice gives more control over job style and may be responsible for low levels of burnout.[6] Studies which have evaluated the association of burnout with work engagement suggest that those who experience higher burnout have higher work engagement.[7] In terms of gender, data suggest higher rates of burnout among females, and in terms of age,[8],[10] higher proportion of burnout was seen among older physicians. Further, the data suggest that clinicians experience more burnout than academicians.[8] In terms of psychological correlates, two studies suggest a positive correlation of burnout with perceived stress,[4],[11] and one study reported a negative correlation with trait emotional intelligence.[11]
From this available data, it can be said that, except for one study, which included, about 500 physicians[8] and another study which included 300 orthopedicians from various parts of the country, there is a lack of nationwide data on physician burnout.[12]
| Why it Is Important to Talk About Physician Burnout in the Indian Context? | |  |
India is a country with a huge population. If one looks at the number of available medical professionals in India, the doctor–patient ratio in this country is dismal. Due to this, doctors, especially those working in the public sector are faced with significant patient load. In the private sector, many physicians too are overloaded with patients, for some, by design, and for some, by compulsion due to the popularity. It is not uncommon to hear a single doctor catering to 100–200 outpatients a day. This outpatient load is further compounded by the inpatient load, attending to emergencies, looking after the administrative responsibilities, etc. Further, if the doctor is a trainee or a teacher/supervisor, they have the additional load of academics, teaching, and supervising the academics. All these are compounded by the fact that doctors in country like India are looked on as gods, who are expected to save everyone. Other extreme is that doctors are considered as vultures, who are interested in only earning money. This is further compounded by the medico-legal issues, different laws governing the medical profession, and violence against medical professionals. It is not uncommon to hear that doctors are being thrashed, due to no fault of theirs.
In terms of training, MBBS is considered to be one of the most stressful courses. Studies globally suggest that medical undergraduate students have a high level of stress. Cost of medical education in India is huge. With the expansion of the private medical colleges in India, the cost of an MBSS course ranges somewhere from 30 lakhs to 1 crore rupees, despite the eyewash of national entrance examination. This forces many of the students and their parents to take loan for the studies and add to the stress in the life of a doctor. The problem compounds further when someone is interested in pursuing postgraduation. The cost of the postgraduation course varies from specialty to specialty and it can go up to 3–4 crores, depending on the specialty and the college.
However, if someone wants to serve the community, after the completion of their under-graduation, postgraduation, or super specialty-what remuneration would be offered to her/him in the government sector in the country? It would be futile to have a discussion on this if one compares the remuneration a doctor gets in the Western World and India.
With the emergence of the corporate sector, physicians are often under pressure to perform and meet the targets.
Public sector hospitals are overloaded with patients. The faculty in the medical colleges and central institutes is required not only to cater to the patient load but also teach the trainee residents. The faculty is also expected to carry out world-class research, with one cadre of people working as clinicians, academicians, and researchers. All this work is expected from the physicians, without any extra incentives or rewards for the good work or extra work.
If one takes all these into account, it can be said that physician burnout should possibly be more common in the Indian context. Accordingly, there is a need to assess and address the same.
| What Should Be Done? | | |
Various professional organizations representing various medical specialists should focus on physician burnout and make the physicians aware of burnout. There is also a need to carry out a nationwide survey to understand the prevalence of burnout in the Indian context and look at the cultural factors, which predispose and protect the physicians from burnout. At the institutional levels, all the institutes must include physician burnout in the curriculum and should teach the medical students as to how to care for themselves and their colleagues. Furthermore, there is a need to develop screening programs to assess physician burnout at the time of entry into the course and periodically thereafter, to address the same promptly. It is also important to create a culture, which facilitates the physicians, especially, to come out with their problems, instead then they feel stigmatized and hide their problems. The training programs also must be structured in such a way that these are less stressful for the trainees, for example, hectic postings should be followed by lighter postings, the heavy postings to be of shorter duration and the trainees allowed to choose the timing of their heavier posting as per their convenience.
Professional organizations, like the Indian Psychiatric Society, can collaborate with other organizations to increase awareness about the physician burnout and help physicians in other specialties to address the same.
| References | | |
| 1. | Grover S, Adarsh H, Naskar C, Natarajan V. Physician burnout: A review. J Ment Health Hum Behav 2018;23:78-85.  |
| 2. | Ratnakaran B, Prabhakaran A, Karunakaran V. Prevalence of burnout and its correlates among residents in a tertiary medical center in Kerala, India: A cross-sectional study. J Postgrad Med 2016;62:157-61. [ PUBMED] [Full text] |
| 3. | Gandhi K, Sahni N, Padhy SK, Mathew PJ. Comparison of stress and burnout among anesthesia and surgical residents in a tertiary care teaching hospital in North India. J Postgrad Med 2018;64:145-9. [ PUBMED] [Full text] |
| 4. | Grover S, Sahoo S, Bhalla A, Avasthi A. Psychological problems and burnout among medical professionals of a tertiary care hospital of North India: A cross-sectional study. Indian J Psychiatry 2018;60:175-88. [ PUBMED] [Full text] |
| 5. | Nandi M, Hazra A, Sarkar S, Mondal R, Ghosal MK. Stress and its risk factors in medical students: An observational study from a medical college in India. Indian J Med Sci 2012;66:1-2. [Full text] |
| 6. | Bhugra D, Bhui KS, Gupta KR. Burnout and stress among doctors and dentists in North India. Int J Cult Health 2008;1:24-9. |
| 7. | Jugale PV, Mallaiah P, Krishnamurthy A, Sangha R. Burnout and work engagement among dental practitioners in Bangalore city: A cross-sectional study. J Clin Diagn Res 2016;10:ZC63-7. |
| 8. | Langade D, Modi PD, Sidhwa YF, Hishikar NA, Gharpure AS, Wankhade K, et al. Burnout syndrome among medical practitioners across India: A questionnaire-based survey. Cureus 2016;8:e771. |
| 9. | Niranjan V, Udey B, Razdan RG. Evaluation of burnout in medical interns: An institutional study. Int J Med Clin Res 2017;5:2173-5. |
| 10. | Kulkarni S, Dagli N, Duraiswamy P, Desai H, Vyas H, Baroudi K. Stress and professional burnout among newly graduated dentists. J Int Soc Prev Community Dent 2016;6:535-41. |
| 11. | Swami MK, Mathur DM, Pushp BK. Emotional intelligence, perceived stress and burnout among resident doctors: An assessment of the relationship. Natl Med J India 2013;26:210-3. |
| 12. | Shetty SH, Assem Y, Khedekar RG, Asha S, Arora M. Indian orthopaedic surgeons are less burned out than their Western colleagues. J Arthrosc Joint Surg 2017;4:1-7. |
| 13. | Shetty A, Shetty A, Hegde MN, Narasimhan D, Shetty S. Stress and burnout assessment among post graduate dental students. Nitte University Journal of Health Science 2015;5:31-6. |
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