Burnout: Talk Isn't Enough. It's Time We Do Something
Burnout—we read about it, feel it, see it, and hear it. It’s been reported on heavily in the media and our medical literature, but what are we as EMS and emergency physicians doing to deal with it?
While we are trained to care for others under any circumstance, when it comes to our own well-being, the training is lacking. I can vividly recall my first major traumatic event as an EMT: I pulled up on scene and saw a baby carriage under the wheel of a truck. We worked hard to treat the patient, but as a crew, we never spoke about the impact it had on us. In the emergency department I treated a 30-year-old man who ended up dying, but I was never taught how to tell family members that their loved one had just died. No one told me what to do when all his family members were looking to me for support and still hoping for a different outcome.
We’re tasked to care for others, and we’re there when others need us most. But we also need to be there for ourselves. We’re told that by being in this business we’ll burn out—because of the long hours, little sleep, low pay, or just the nature of our work. To fix it, we’re told to meditate, be mindful, and exercise, but let’s be honest, that’s all much easier said than done.
What Is Burnout?
Defining burnout is an important starting point. In 1974 Herbert Freudenberger a German psychologist, described burnout as “becoming exhausted by…excessive demands on energy, strength, and resources.” Burnout consists of symptoms such as exhaustion, fatigue, gastrointestinal disorders, and headaches, as well as frustration, anger, cynicism, and depression, much of which we can relate to today.1 From the time Freudenberg began to discuss burnout through 2011, there was an approximate eightfold increase of publications related to burnout.1 Of the 1,225 articles published during that period, a vast majority reported on causes and related factors. While about a third of these discussed the prevalence of burnout, only 13% discussed reducing or preventing it. As the rates of suicide and depression among EMS workers increase,2 we need to shift the discussion toward effective means of preventing and reducing burnout and simultaneously enhancing our well-being.
While EMS and emergency department providers may have a higher rate of burnout compared to the general population,2,3 psychiatric problems are by no means unique to our industry. Over the last two generations, the rates of depression across our population have increased rapidly, with only a nominal increase in happiness.4
These reasons are why I decided to take part in a two-day course on burnout, depression, and resilience along with my healthcare peers at Duke University. There I learned burnout can be looked at as “the impaired ability to experience positive emotion.”5 I learned about evidence-based resilience tools focused on building gratitude, increasing awareness of the positive, and identifying character strengths. These tools, through randomized, controlled studies across various healthcare workers, have been proven to decrease depressive symptoms and increase happiness (as measured by positive emotion, engagement, and finding meaning in life) immediately and up to half a year postintervention.6 It stands to reason if we can increase our positive emotions, we can begin to decrease our burnout.
How to Help
Where does that leave us? Starting in July EMS and other emergency medical and associated professionals can participate in WISER (Web-based Implementation for the Science of Enhancing Resilience), an evidence-based web intervention aimed at promoting resilience and decreasing burnout in healthcare providers. Our participation has the potential to improve our own well-being while contributing to the much-needed research aimed at providing specific, easy, and manageable interventions to reduce burnout and promote resilience among EMS and ED providers. These free, easily implementable, and sustainable approaches seem to be promising in helping improve our well-being, relationships, work satisfaction, and patient interactions.
With your help we can begin to address some of the issues that plague our providers. To enroll and participate please visit the WISER site.
1. Heinemann LV, Heinemann T. Burnout Research: Emergence and Scientific Investigation of a Contested Diagnosis. SAGE Open, 2017 Jan; 7(1).
2. Martin CE, Tran JK, Buser SJ. Correlates of suicidality in firefighter/EMS personnel. J Affect Disord, 2017 Jan 15; 208: 177–83.
3. Lu DW, Dresden S, McCloskey C, Branzetti J, Gisondi MA. Impact of burnout on self-reported patient care among emergency physicians. West J Emerg Med, 2015 Dec; 16(7): 996–1,001.
4. Seligman MEP. Flourish. Simon & Schuster, 2012.
5. J. Bryan Sexton, PhD, Director, Duke Patient Safety Center.
6. Seligman ME, Steen TA, Park N, Peterson C. Positive psychology progress: empirical validation of interventions. Am Psychol, 2005 Jul–Aug; 60(5): 410–21.
Joshua Schwarzbaum, MD, is an emergency and EMS physician. He completed his residency at Jacobi and Montefiore Medical centers in Bronx, N.Y., and his fellowship at RWJBarnabas Health in Newark, N.J. He currently works as an attending physician and associate EMS director at Saint Barnabas Hospital in Bronx. His interests include underserved populations, the patient interaction, teaching, well-being, and the outdoors.