Burnout is a common concern among all professions, especially among the individuals associated with healthcare. With the increasing demands in the health care services and the lack of trained staff in return puts immense pressure on the existing professionals leading to higher hours of work and pressure. ‘The British Medical Association’s report on the mental health of doctors in 2019 found that one in nine doctors stated that they were fearful of making errors due to systemic pressures. It is believed that the nature of psychiatry that is trained and equipped to deal with concerns like burnout can never face burnout because they know how to deal with it, but in reality, the nature of the work psychiatrist is involved it makes it’s a pre disposing factor for them to face burnout.
Burnout is defined as a state of complete exhaustion happening due to chronic stress which results in sickness leading to depletion of resources, emotional and mental fatigue.
- Burnout has 3 major characteristics:
- Complete exhaustion
- Decreased work productivity
- Sense of ineffectiveness
Maslach and Jackson were the first ones to identify the concept of burnout, they developed an assessment called Maslach burnout inventory which measures three aspects of burnout mainly emotional exhaustion, depersonalization, and a sense of personal accomplishment. This assessment helped understanding the individual’s level of burnout.
Various studies and articles have shown that healthcare professionals working in the field of psychiatry, as opposed to healthcare workers in any other field tend to experience more burnout because of the stress related to high emotional exhaustion at work, depression as well as other constraints. Various issues related to psychiatrists such as anxiety, hypocrisy, stigma, lack of evidence in psychiatry are all the issues and assumptions that predispose to increased risk of psychiatric problems and burnout among psychiatrists.
Psychiatrists face significant pressure due to the stigma surrounding mental illness, societal expectations for recovery, and the general lack of acceptance of mental disorders as chronic conditions like diabetes or hypertension. Unlike other medical specialties, psychiatrists often face criticism during investigations of serious incidents, such as patient suicides or homicides, while physicians dealing with chronic physical illnesses are not held to the same scrutiny when patients suffer severe complications.
There is an unrealistic expectation for risk assessments in psychiatry to be more precise than those for physical health, which leads to undue blame on psychiatrists. The focus tends to be on perceived lapses in care from psychiatric services rather than recognizing the individual variations in risk stemming from factors like treatment adherence and the availability of psychosocial support for those with chronic mental health issues. This is one of the main reasons why psychiatrists tend to face burnout more and with greater intensity.
Deahl and Turner also identified several key stressors for psychiatrists, including the threat of violence and fear associated with it, limited resources, overcrowded inpatient wards, and a growing culture of blame within mental health services as one of major reasons for psychiatrist burnout. It's important to recognize that not all psychiatrists who face prolonged stressors experience burnout. Holloway et al. (19) present an interactive model that explores how these external stressors relate to mediating factors and stress outcomes. They illustrate this by stating that a struggling doctor without effective coping mechanisms working in a poorly resourced service may encounter greater occupational stress than a more successful colleague in a well-supported and fulfilling environment. Additionally, significant personal or professional events, such as a patient homicide, can impact even the most resilient and well-equipped professionals.
Psychiatrists may be more vulnerable to burnout because of their personality traits, which can lead them to internalize stressful experiences. Their training also significantly contributes to stress and burnout: psychiatric trainees engage more deeply with patients' personal struggles compared to those in other fields, often grappling with feelings of self-doubt, fear, and fatigue. While psychiatrists are trained in long-term verbal interventions, they frequently find themselves delivering short-term, predominantly biological treatments.
Additionally, the global workload for psychiatrists is expected to rise due to factors such as population growth, a shift toward community-based care, increased administrative responsibilities, higher standards of practice, and greater expectations for personal study and downtime, all while fewer individuals are entering the field of psychiatry. Thus, psychiatrists are collectively predisposed to stress from both internal and external influences.
In conclusion, burnout among psychiatrists is a complex issue that stems from a combination of systemic pressures, societal expectations, and the unique emotional demands of their profession. Despite their training in mental health, psychiatrists are not immune to the strains of chronic stress, often escalated by stigma, scrutiny, and inadequate resources. The unique challenges they face like dealing with patient outcomes and the culture of blame within mental health services contribute significantly to their vulnerability. Moreover, the evolving landscape of healthcare, characterized by increasing demands and diminishing workforce numbers, further raises these challenges.
To address burnout effectively, it is crucial to implement systemic changes that prioritize the mental well-being of psychiatrists. This includes fostering supportive work environments, reducing administrative burdens, and promoting peer support and resilience training. By recognizing the human element in psychiatric practice and providing the necessary resources and support, we can better equip psychiatrists to face their demanding roles and enhance their overall job satisfaction. Ultimately, addressing the issue of burnout is not only vital for the well-being of psychiatrists but also essential for the quality of care they provide to their patients.