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Invited Commentary
September 9, 2020

Broadening the Discussion on Physician Burnout

Author Affiliations
  • 1Wake Forest Baptist Health, Winston-Salem, North Carolina
JAMA Surg. 2020;155(11):1049. doi:10.1001/jamasurg.2020.3364

In their study in this issue of JAMA Surgery, Hewitt et al1 have compared definitions and thresholds of burnout in general surgery residents, providing important insights into strategies to measure physician burnout. The study offers multiple strengths: a large and representative sample (N = 6956), an excellent survey response rate (85.6%), the use of a validated gold standard measure of burnout, and exploration of prevalence based on inconsistencies in the literature. The authors have asserted that the Maslach Burnout Inventory is scored and interpreted inconsistently in the literature regarding the time frame and number of symptoms needed for a respondent to be classified as having burnout. In fact, much of the recent prevalence research has required an elevation (using defined cutoffs) in only 1 of 3 dimensions (emotional exhaustion, depersonalization, or a decreased sense of personal accomplishment) for an individual to be considered burnt out.2,3 Such an approach may not capture burnout as a complex and dynamic construct.

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    1 Comment for this article
    Broadening the Discussion, Developing Resiliency Toward Burnout
    Edward Volpintesta, MD | retired general practitioner
    The authors were right to broaden the scope of burnout in terms that go beyond the Maslach scale. Including depression, fatigue, quality of life and job satisfaction as they have done more accurately humanizes what many doctors experience and understand as ‘burnout’.
    For example their suggestions about simply asking colleagues “How are you doing? What are you doing to take care of yourself? What matters most to you?” as they suggested are effective ways to start discussions with colleagues who may otherwise feel embarrassed to self-report their dissatisfaction or depression or any other complaint that has made them wonder why
    they ever became physicians!
    The authors’ comments to create small-group programs to promote community and connectedness cannot be emphasized enough. Speaking to a colleague who is familiar with the stresses in our health care environment has immeasurable value. Often a simple conversation with an empathetic colleague can prevent anxiety or depression from developing into a more serious condition.
    In my community hospital in Danbury Connecticut, we have a peer support system called PACT (Provider/Assistant Care Team); composed of volunteer members of the staff who are available to any health care worker who may feel overwhelmed by the stresses of caring for patients. During the Covid pandemic it has been particularly helpful.
    All hospitals should have peer support systems to help their doctors, nurses and any other health care provider who may be over whelmed by the stresses of caring for patients. Ideally, health care providers should be encouraged to share their tribulations with their colleagues in small groups.
    All health care providers are vulnerable to burnout. It is time to talk about it openly and without shame.