Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Editorial

Physician burnout: Who will protect us from ourselves?

Michael Fralick and Ken Flegel
CMAJ July 08, 2014 186 (10) 731; DOI: https://doi.org/10.1503/cmaj.140588
Michael Fralick
Michael Fralick is an internal medicine resident at the University of Toronto. Ken Flegel is Senior Associate Editor, .
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ken Flegel
Michael Fralick is an internal medicine resident at the University of Toronto. Ken Flegel is Senior Associate Editor, .
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

See related analysis on page 761 and at www.cmaj.ca/lookup/doi/10.1503/cmaj.131053, and infographic, www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.140588/-/DC2

When the workday ends at Volkswagen, so does an employee’s access to company email. Atos, an information technology company with more than 80 000 employees, is going one step further. It is eliminating company email. The Bank of Montreal, following the lead of Goldman Sachs Group Inc., is insisting that its junior bankers take weekends off. Businesses have realized the unintended consequence of their employees always being reachable: burnout. The resultant absenteeism, decreased productivity and high employee turnover rates have forced companies to take notice.

Burnout, which was first described in 1974 by American psychologist Herbert Freudenberger, is not a recognized disorder in The Diagnostic and Statistical Manual of Mental Disorders. However, the World Health Organization International Classification of Diseases (ICD-10) defines burnout as a “state of vital exhaustion.” The Maslach Burnout Inventory,1 which is considered the gold standard in research studies for estimating burnout prevalence among physicians, captures three dimensions of burnout: emotional exhaustion from overwhelming work demands, depersonalization (e.g., impersonal response toward patients or coworkers) and a perceived lack of personal accomplishment. Symptoms of burnout can be physical (e.g., insomnia, fatigue, headaches, gastrointestinal upset) and psychological (e.g., irritability, cynicism, decreased concentration).

Like many common ailments, the path to burnout is set years before symptoms manifest. Many of us entered medical school as perfectionists who were not afraid of self-sacrifice. We were aware that our success in medical school would be defined by academic performance and long hours in hospital. Then we entered residency. Estimated prevalence of burnout among residents, regardless of the year of training, is as high as 50%.2 One might expect that long hours are the major cause of resident burnout. In a related article in CMAJ, Pattani and colleagues3 highlight that the maximum allowable shift length in Canada, with some exceptions, is 26 hours. In the United States, Europe and New Zealand, the maximum is about 16 hours. However, the evidence that reducing work hours improves quality of life is lacking, and some studies show that reducing work hours leads to a worse quality of life.4,5 Improving quality of life and preventing burnout will not be achieved by residents simply working fewer hours.

The demands of residency last a few years; however, careers as physicians last a lifetime. Two-thirds of Canadian physicians feel that their workload is too demanding.6 Although feeling burned out is common, it is not normal, and it is likely to affect medical practice. We seem to have little opportunity to unplug from emails, texts, phone calls and pages. Once the clinical day is over, administrative commitments, teaching responsibilities and research projects await our attention. Is it any wonder that some businesses have decided to simply turn their email systems off at the end of the workday?

Burnout is neither benign nor temporary: it can lead to anxiety, depression, substance abuse, addiction, and in rare cases, suicide.7 The consequences of physician burnout extend beyond the physician. More than half of Canadian physicians feel their family and personal lives have suffered because of the demands of their profession.6

Physician burnout can also negatively affect patient care.7 In one survey, more than 50% of physicians reported that they felt that tiredness, exhaustion or sleep deprivation had a negative effect on the care they delivered.7 Physicians have a professional obligation to be in good health to practise good medicine. Making correct diagnoses and appropriate therapeutic decisions, which are fundamental to the role of every physician, requires effective functioning of the mind.

Evidence-based approaches to managing burnout are lacking; however, time away from work and behaviour-modification techniques are generally used. Encouraging results from small observational and randomized trials show that mindfulness and meditation may play a protective role in the prevention and management of burnout.2

Because we know the causes of burnout, we should focus on prevention. Common-sense recommendations may prove helpful: engage in self-care (e.g., exercise, healthy eating, meditation), take regular vacations, take breaks from email, learn how and when to say no, set limits for yourself rather than letting someone else set them for you, and learn to recognize the symptoms of burnout and to ask for help.2,6 The Canadian Medical Association’s website contains a number of useful resources (www.cma.ca/living/provincialphysicianhealthprograms). Continuing medical education courses are also available for those interested in learning about meditation and mindfulness techniques.

Perhaps it’s time to learn a lesson from the business world. Physicians need to develop tangible strategies that encourage work–life balance and prevent burnout. If we don’t, we will suffer. So will our patients.

Footnotes

  • References, www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.140588/-/DC1

  • Competing interests: None declared for Michael Fralick. For Ken Flegel’s competing interests, see www.cmaj.ca/site/misc/cmaj_staff.xhtml

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 186 (10)
CMAJ
Vol. 186, Issue 10
8 Jul 2014
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Physician burnout: Who will protect us from ourselves?
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Physician burnout: Who will protect us from ourselves?
Michael Fralick, Ken Flegel
CMAJ Jul 2014, 186 (10) 731; DOI: 10.1503/cmaj.140588

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Physician burnout: Who will protect us from ourselves?
Michael Fralick, Ken Flegel
CMAJ Jul 2014, 186 (10) 731; DOI: 10.1503/cmaj.140588
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Resident duty hours in Canada: past, present and future
  • PubMed
  • Google Scholar

Cited By...

  • Resident physician burnout: insights from a Canadian multispecialty survey
  • Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review
  • Planning for retirement from medicine: a mixed-methods study
  • Google Scholar

More in this TOC Section

  • A focus on access to health care in Canada
  • L’avenir de la médecine est ici et vous en êtes la trame narrative
  • The future of medicine is here and you are its story
Show more Éditorial

Similar Articles

Collections

  • Topics
    • Medical careers
    • Physician health

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire