NOV 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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your jam-packed schedule looks like this on most days, there's a chance you're headed for burnout. Although we all can have bad days at work, burnout is actually "an erosion of positive enthusiasm," said John-Henry Pfifferling, PhD, director, Center for Professional WellBeing, Durham, N.C. The center helps healthcare professionals manage burnout. A physician feeling burnout is emotionally exhausted and unable to give more to patients. In turn, the physician feels cynical and even depressed, Dr. Pfifferling said. That depression can come from grieving over the loss of one's original expectations of a medical career—and what today's realities are. Plus, "there's a lack of sense of personal accomplishment, and that's associated with a desire to leave the job if not leave medicine altogether," said Mark Linzer, MD, director, Division of General Internal Medicine, Hennepin County Medical Center, Minneapolis, who studies physician burnout. It's unclear if physician burnout is actually more common nowadays, but there is more recognition of the phenomenon. "It may be more common now because we understand the process, and more people are willing to admit that they feel it," Dr. Pfifferling said. A study published last year in the Archives of Internal Medicine found that 45.8% of physicians from various specialties reported at least one symptom of burnout.1 Using a probability-based sample from the general U.S. population, the study investigators found that physicians were more likely to have symptoms of burnout and be dissatisfied with their work-life balance. The study also found that physicians in specialties on the front lines (like family medicine, general internal medicine, and emergency medicine) were at the greatest risk for burnout. Burnout among ophthalmologists That said, ophthalmologists have their own risk factors for burnout. A 2008 study from the Canadian Journal of Ophthalmology found that more than 35% of ophthalmologists studied in Quebec felt high levels of burnout and psychological distress.2 Their main stressors were a growth in demand for services, an ophthalmologist shortage, amount of work to be done, budget pressures, and repeated training of new work teams. To combat the stress effects, the ophthalmologists said they tried to work faster. Burnout in ophthalmology is of critical concern because of the aging population, which is increasing the demand for eye specialists, the investigators reported. Another study that focused on burnout among academic chairs in ophthalmology found that 9% of chairs surveyed were considered to have burnout, and 65% of those surveyed overall had scores consistent with low personal achievement, the highest risk factor for burnout.3 "Because the cost of burnout can be high, both in terms of a chair's psychological well-being and the actual cost associated with replacing a chair, it is important that strategies are put in place to reduce burnout in our academic leaders," the investigators concluded. Additionally, ophthalmologists often are perfectionists—making them more vulnerable to burnout, said Dr. Pfifferling. "They have expectations of themselves to be analytical, detail-oriented, and selfcritical—and that all has consequences," Dr. Pfifferling said. The pressure of perfectionism is felt even more deeply by subspecialists, who often feel they are the beacons of care in their niche area. Dr. Pfifferling has observed that perfectionism can make many oph- thalmologists excellent surgeons but that they may not take the time to seek adequate social support from friends and family to fight against stress. Other burnout factors Other factors affecting burnout can be felt by any physician. A study published in September in the Journal of American Medical Informatics Association found that, perhaps to no one's surprise, EMRs are contributing to physician stress— which could lead to more burnout.4 The study reported that physicians in offices with a moderate amount of EMR use reported greater stress and lower job satisfaction, said lead investigator Stewart Babbott, MD, professor of medicine, and director, Division of General and Geriatric Medicine, University of Kansas Medical Center, Kansas City. Physicians at clinics that use EMRs a large amount were more likely to feel time pressure during patient visits and more dissatisfaction and intent to leave the profession. "Work is very different now," said Dr. Linzer, a co-investigator on the EMR study. "There's a lot of time spent at a computer, and the rewarding part of the job with patients has been compromised." In fact, he said some physicians may only be spending as little as 12% of their time with patients. Finally, there's the stress of managing a demanding work life with a home life, said Esen K. Akpek, MD, associate professor of ophthalmology and rheumatology, and director, Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University, Baltimore. "If you have a grant due next week and 17 surgeries to get through today and two kids at home, then when patients complains that they can't perform warm compresses and lid continued on page 22 December 2013 • Ophthalmology Business 21

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