Provider burnout: Implications for our perinatal patients

Abstract

Objective

To describe the syndrome of physician burnout within neonatology, its relation to neonatal quality of care, and outline potential solutions.

Findings

Burnout affects up to half of physicians, including up to one-third of neonatologists, at any given time. It is linked to suicidality, substance abuse, and intent to leave practice, and it is strongly associated with reduced quality of care in the published literature. Resilience and mindfulness interventions rooted in positive psychology may reduce burnout among individual providers. Because burnout is largely driven by organizational factors, system-level attention to leadership, teamwork, and practice efficiency can reduce burnout at the level of the organization.

Conclusions

Burnout is common among neonatologists and consistently relates to decreased quality of patient care in a variety of dimensions. Personal resilience training and system-wide organizational interventions are needed to reverse burnout and promote high-quality neonatal care.

Introduction

Neonatology is a profession with demanding work schedules, intense interpersonal interactions, frequent complex and high-stakes decisions in the face of uncertainty, and rapidly developing new technologies. Many neonatologists chose this career because they were inspired by the potential to make a meaningful and longstanding difference in the lives of the patients and their families, but the modern practice environment now makes professional satisfaction more challenging. Neonatologists, along with physicians as a whole, are burdened by decreasing autonomy, reduced time at the bedside, and increasing barriers to balancing work and personal responsibilities. It is not surprising that burnout in physicians is much higher than in the general working population and remains high despite increasing recognition of its effects.¹

Burnout is a work-related, reversible syndrome primarily consisting of emotional exhaustion and/or depersonalization. It is inversely related to well-being, professional fulfillment, and compassion satisfaction.2, 3, 4 The prevalence of neonatologist burnout is not well described, but is estimated to be 20–30%.4, 5, 6 Although some drivers of burnout may be independent of specialization, neonatologists may experience unique drivers of burnout. For example, neonatologist exposure to the suffering and death of infants – a painful and unsettling experience – may cause emotional labor and moral distress, leading to compassion fatigue and emotional exhaustion.^4,7 Furthermore, the complexities of working with families of critically ill babies can be taxing and ethically challenging.⁸

Burnout is identified through survey instruments, most commonly the Emotional Exhaustion and Depersonalization subscales of the Maslach Burnout Inventory (MBI).⁹ The Emotional Exhaustion subscale consists of 9 prompts (i.e. “I feel emotionally drained from my work.”), and the Depersonalization subscale consists of 5 prompts (i.e. “I've become more callous toward people since I took this job.”). Both are scored on a 7-point Likert scale from “Never” (0) to “Every day” (6). A score of ≥27 for Emotional Exhaustion or ≥10 for Depersonalization is typically considered indicative of burnout symptoms. However, there are a myriad of alternative burnout inventories and scoring methods represented in the literature, each with different lengths and markers of psychometric validity as outlined in Table 1.

Although there has been suspicion that variability in assessment methods reduces the ability to draw conclusions,²¹ the relationship between burnout and quality of care in the published literature – regardless of assessment tool – is well-established.²²