What is Burnout?

Burnout has been defined, and redefined, ever since American psychologist Herbert Freudenberger coined the term in the 1970s. Newer related phrases point to “compassion fatigue,” “occupational phenomenon” “burnout syndrome,” and more. Some have even categorized the signs of burnout, placing them into as many as 12 possible stages.

But at the end of the day, “burnout” means the loss of meaning in one’s work, coupled with mental, emotional, or physical exhaustion as the result of long-term, unresolved stress. When people think of burnout in medicine, it is generally in the context of attending-level physicians. However, burnout is very common among psychiatry residents, with an estimated prevalence of 33.7%.1

As a psychiatry resident, the term “burnout” may seem impossible to thwart, in the sense that it arises as a result of facing mentally and emotionally taxing patients on a day-to-day basis – this is literally our job. But burnout is very real – the ICD-11 lists it as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed” – and this syndrome places psychiatry residents at a very high risk of developing the same conditions they treat. Burned-out mental health professionals experience unusual amounts of pressure as they may not be able to handle the very same advice that they give to their patients.

As a Resident, Am I at Risk of Burnout?

As noted, burnout can occur in stages or have a gradual onset, rather than being acute in nature. Although psychiatry residents (and our fellow doctoral interns in psychology) may experience the development of burnout differently, some common traits persist.

Early in the process, residents may begin to experience predicted stressors of the job. For example, learning how to approach a difficult or violent patient. Psychiatry residents face a unique challenge of dealing with unpredictable patients that may become physically aggressive at any time. This anticipated stress may actually lead to the onset of stress, whereby residents notice that their ability to handle clinical situations becomes more difficult.

Without coping skills, this stress can become chronic in nature, occurring more frequently with increased severity. If the process continues, burnout symptoms (more on these below) may become so embedded in the resident’s life that they become ingrained into their personality. Depending on the intensity of stress involved, suicidal thoughts, attempts, and completion may become a greater concern.2
Some risk factors that place psychiatry residents at higher risk of burnout are:

  • dealing with emotionally taxing patients on a daily basis
  • becoming fearful of violent patients (who may require physical or chemical restraints)
  • having multiple cluster B personality-type patients in a day, among others.

How Do I Recognize Burnout?

While clinician “burnout” is not easy to define, its symptoms are generally recognizable. Some symptoms are physical, such as:3

Other symptoms may be cognitive in nature, such as:

  • cynicism toward patients
  • detachment from patients, colleagues, family, and friends
  • feeling a lack of accomplishment
  • increased forgetfulness
  • feeling easily overwhelmed
  • disconnected thoughts

Behavioral changes are common as well and may be recognized by those around you. If a colleague suggests you may be burned out, don’t take it lightly.
Burnout is not only debilitating for providers but also it also impacts those who rely on us as residents. For example, evidence shows that physician burnout has a significant negative impact on patients. In a 2017 review in the British Medical Journal, it was found that burnout is associated with medical errors and poor patient care.4

How Do I Prevent Burnout from Happening to Me?

There are several ways psychiatry residents can prevent burnout. These may include proper sleep, exercise, therapy, limitation of alcohol/drugs, and socialization.

Make Sleep a Priority
In terms of sleep, proper routines, and getting 7 to 8 hours of sleep per night is helpful. The best sleep practices include going to sleep and waking up at the same time every day, including on the weekends. Screen time should be limited 1 to 2 hours prior to bed as the brightness of the screen tricks the brain into thinking it’s daytime. If screen time is needed, you may consider lowering the brightness of the screen or turning on a blue light filter. Lastly, excessive time should not be spent in the bedroom outside of sleep and intimate activities (in other words, don’t make it your home office or check work-related emails while in bed).

If these behavioral changes are ineffective, try sleep aids such as melatonin. Quick tip – it is important to take melatonin is several hours before sleep so that it can build up in the body and peak around bedtime.

Limit Stressors
In the office, there are a few specific strategies that may limit psychiatry-specific stressors. When dealing with difficult patients, acknowledge your own feelings, concerns, and fears. This practice can help build your understanding of countertransference and predict your overall frustration tolerance – you can use this personal knowledge to tweak your patient communications and approaches throughout your career. (More from Dr. Arial Botta on trying mindfulness).

Set Boundaries
Set your own boundaries and limitations. As we have learned, patients will try to break these rules – figure out how you will react and respond, and stick to your own methods. For example, some patients will try to split up the clinical team. You can pre-empt this by getting your team together regularly to ensure that similar goals are in place for each patient.

One piece of advice we have already experienced – when approaching a potentially violent patient, it is better to evaluate that patient as a team with an attending present so that less responsibility is placed on any one individual at any time.

I Already Feel Burned Out, What’s Next?

You may not be through your second or third year of residency and already feel burned out. In many cases, this is quite normal and you will go on to complete your residency if you: a) acknowledge your stressors and, b) ask for help.

Talk to your program directors and ask for accommodations, including fewer calls or potential limits on the number of patients seen in one day. Clarify how many paid-time-off days you are allotted and strategize ways to disperse them to meet your needs. If your time-off has been depleted and other strategies are not working, another conversation should occur to discuss the possible leave of absence. Most program directors are willing to work with residents within the confines of their contract – they too, have been in your shoes.

Despite the cliché, understand “you are not alone.” With a front-facing grasp on the realities of burnout, there are tactics and tools you can use to fight ongoing burnout and facilitate a healthier residency experience. By mastering these skills now, you will lay the groundwork for a successful long-term career as a psychiatrist or mental health professional.

Practice Essentials: How I Avoid Burnout

If I have a particularly difficult workday, I make sure to prioritize sleep, especially if I am scheduled to work the next morning. If I have a few days without adequate sleep, I definitely notice my stress levels begin to peak. If needed, I take OTC melatonin for a few nights which usually does the trick to get back on schedule. In addition, I prioritize my tasks and attempt to spread them out on a timeline if possible. –Christie Richardson, DO

I inform my attending on service about any fears of burnout and they are usually willing to work with me on a more manageable workload. I have found that most psychiatric attendings are approachable and flexible. –Danielle Weitzer, DO

References
Last Updated: Sep 9, 2021