Burnout: Prescription for a happier healthier you

Do you love your job? Do you feel energized, happy, and fulfilled, even when the work is demanding, and the conditions, at times, less than ideal? Are you devoted to, and impassioned by your work, and filled with ambition, ideals, and high objectives? If not, you may be at risk for, or experiencing, occupational burnout. As Dr. Michael Kaufmann, Medical Director of the OMA Physician Health Program and Physician Workplace Support Program, warns, “Burnout looms as one of the greatest challenges to the veterinary profession” (1). Although our work can offer an extremely rewarding professional life, it can also offer countless challenges, impacting health, happiness, and performance — and risking burnout. With the right “prescription,” however, the challenges can be managed, and you can stay happy and healthy, perform at your best — and love your job!

What is burnout?

According to psychologist Christina Maslach (2), a prominent pioneering researcher on the topic, occupational burnout is “a psychological syndrome of emotional exhaustion, depersonalization, and sense of low personal accomplishment” (2). It has been described as “a state of physical, emotional or mental exhaustion combined with doubts about one’s competence and the value of one’s work” (3) and “the process by which a person, in response to prolonged stress and physical, mental and emotional strain, detaches from work” (4). In sum, burnout is seen as a three-dimensional syndrome, with the salient features of exhaustion, cynicism and inefficacy, and is considered both “a state” and “a process.”

What causes burnout?

Burnout is the result of long-term, unresolvable work-related stress (5). Stress is recognized as a common occupational health concern in the veterinary profession (6). In fact, studies in the profession have identified the rate of work-related stress to be high (7) or moderately high (8), making the risk for burnout real.

Worldwide, a growing body of research has accumulated on stress in the veterinary workplace. The results have been unsurprisingly consistent (9), given the global nature of clinical veterinary practice. According to the literature (6,8,9–14) the list of veterinary workplace stressors seems nearly endless and includes:

• long work hours; excessive workload;

• emergency on-call;

• working time problems (e.g., not enough time per patient or rest breaks per day)

• work-home interference

• under-staffing

• inadequate professional support

• unclear job descriptions

• a mismatch between the person’s and the organization’s expectations

• a difference in values or practice philosophy

• hospital policies and procedures that lead to difficulties

• the pressure to over-service or over-prescribe

• unexpected outcomes of clinical cases

• difficult relationships with managers, colleagues, and clients

• high and unreasonable client expectations

• recovery of amounts of money not paid by clients

• lack of control over treatments due to clients’ cost constraints

• lack of recognition from the public

• lack of resources to do the job properly

• immoral or unethical practices

• ethical problems and performance of euthanasia

• low remuneration

• financial pressures and low profit margins

• not having enough holidays

• administrative duties

• high levels of job complexity and concern about maintaining skills and expertise

• insecurity of work and

• career path concerns.

Workplace factors aside, person-level factors, such as personality and coping styles, may also contribute to the risk of burnout. Those with perfectionist tendencies, who have unrealistic standards and expectations of themselves, their job and others (15), and/or who feel overly responsible for the welfare of others (16) may be at greater risk. Likewise, the risk may be higher for those who lack the necessary skills to fulfill their work responsibilities, coupled with insecurity, the inability to relax, and Type A personalities (15).

How does burnout arise?

Burnout arises insidiously. It is easy to miss the warning signs. As a process, burnout has been described as a set of stages (4) that blur together so that one rarely realizes what is happening:

Physical, mental, and emotional exhaustion: You start to feel differently about the job you loved and had boundless enthusiasm and energy for. You thought it would meet all your expectations, but you’re starting to sense that something is wrong. You can’t seem to put a finger on it, but you feel increasingly drained — physically, mentally, and emotionally.

Shame and doubt: Over time, you begin to feel disappointed and disillusioned. The job isn’t working out the way you expected, and the more you try to fix things, working even harder, the more exhausted and frustrated you become. You start to question your abilities and competence, and feel your confidence waning. You may even start to question your achievements, and even discount them.

Cynicism and callousness: With a growing sense of inadequacy and insecurity, you start to blame those around you for your difficulties, and detach yourself, taking on a “look out for #1” kind of attitude. As your negativity increases you may start to openly criticize the practice, or management, or coworkers. To cope with the worry, powerlessness, and disillusionment, you may resort to escapism (i.e., drinking, eating, shopping).

Failure, helplessness, and crisis: You feel overwhelmed, unable to cope, and like a total failure. You may adopt a “damned if I do, damned if I don’t” kind of attitude, with a sense of helplessness and despair. You have reached a crisis point.

Could you be burning out?

If you sense, by the description above, that you may be burning out, know that you’re unlikely to be alone. The CVMA conducted a national survey on the wellness of veterinarians, with a specific focus on burnout, to obtain data on the status of veterinarians in Canada (17). According to this study, 51% of veterinarians believed that they had suffered from burnout, and of these, 68% felt they were at risk of relapse. Of those who believed they had never experienced burnout, 75% believed they could be at risk. To know if you may be burning out, ask yourself the following questions:

1. Do you dread going to work?

2. Do you drag yourself in and have trouble getting started once you arrive?

3. Do you see work as a chore?

4. Do you feel constantly overwhelmed?

5. Are you no longer laughing or having fun at work?

6. Are your work relationships changing?

7. Are you less flexible, less of a team player?

8. Have you become cynical or critical at work?

9. Have you become irritable or impatient with co-workers or clients?

10. Are you feeling lethargic and empty in your work?

11. Do you lack the energy to be consistently productive?

12. Are you having trouble focusing and concentrating on your work?

13. Are you less able to complete tasks, follow guidelines, and meet deadlines?

14. Are you unconcerned about the quality of your work?

15. Do you lack satisfaction from your achievements?

16. Do you feel disillusioned about your job?

17. Do you chronically worry about your job?

18. Are you using food, drugs, or alcohol to feel better or to simply not feel?

19. Have your sleep habits or appetite changed?

20. Are you troubled by unexplained headaches, backaches, or other physical complaints? (18–20).

The higher the number of affirmatives, the higher the chance that you may, indeed, be burning out. While this may be the case, it’s advisable to consult a doctor or mental health professional, as some of these symptoms can also indicate certain health conditions, such as hypothyroidism and clinical depression (18).

What are the consequences?

Ignored or left unaddressed, occupational burnout can have significant personal, professional, and organizational consequences. At the personal level, burnout can lead to a plethora of physical and mental health concerns including cardiovascular disease, high cholesterol, Type 2 diabetes, stroke, obesity, increased vulnerability to illnesses, chronic fatigue, insomnia, depression, anxiety, alcohol or substance abuse, and suicidal ideation (18,21). These concerns not only affect one’s personal life, but spill over into one’s professional life.

At the professional level, performance suffers, and careers become jeopardized. The declines in efficiency, productivity, and professional competence, so typical of burnout, along with the concerning risk of medical errors, seriously impact career direction and development (22,23). Burnout can lead to sick days, disability leave, quitting, dismissal, and even career loss (24).

At the organizational level, burnout contributes to increased staff turnover, absenteeism, presenteeism, reduced productivity, reduced morale, incivility, conflict, toxicity, dysfunctional teamwork, job dissatisfaction, and workplace unhappiness, all of which prevent hospitals from achieving their goals and directives (12,20,22,23). Incapacitating individuals to organizations, the consequences of burnout are far-reaching.

As Gardner and Hini (12) highlight, “There is a need for a wide range of strategies to manage work-related stress among veterinarians.” (p. 119) In fact, a “prescription” may be in order, to help us better manage the stresses of veterinary practice that impact health, happiness, and performance — and risk burnout and its many consequences. The risk is related to who you are, what your job is, and where you work, so the prescription to sustain a happy, healthy you needs to address all three.

Prescription for a happier, healthier you!

Your personal self

The prescription starts with you. The more resilient you are, the greater the chance you’ll thrive despite the challenges. How do you sustain resilience? Make a commitment to ongoing self-preservation and renewal (25). This means you make your “own” health a priority! Think of this as creating a “personal stewardship program.” Eat right, get enough sleep, and exercise so you’ll have the stamina to cope with the stresses. Have fun on a regular basis; enjoyable activities are freeing and rejuvenating. Turn to nature; the great outdoors can be a great stress reliever. Focus on your spiritual side; it enables perspective-taking and provides a sense of guidance. Engage in activities that bring relaxation; while deep-breathing exercises, yoga, and meditation work for some, knitting, painting, carpentry, or playing the piano works for others. Practice self-compassion; this is a potent form of self-care that transforms our relationship with ourselves (26). Seek social support; sharing with co-workers, friends, and family can help you cope with the stress and feelings of burnout (18,27,28). Another aspect of self-care is to mind your mindset. If you can’t change the stressors, change your perspective (18,25). When your thoughts turn negative, try to shift your attention to the positive. If you’ve become cynical, consider ways to improve your outlook. Spread optimism. Expect the best. Rediscover enjoyable aspects of your work. There are endless ways to adjust one’s perspective. Lastly, know when to ask for help. When the bad days outnumber the good ones, and the symptoms of burnout are obvious, it’s time to seek professional help (25).

Your professional self

The prescription continues with you. As Socrates (469–399 B.C.E.) wisely stated, “The unexamined life is not worth living.” So take time to reflect on your professional self. This could include journaling, spending time in nature, meditating, praying, or whatever will help you settle into moments of quiet contemplation and introspection (29). Identify what’s fueling your feelings of burnout so you can address the issues (18). Talk to colleagues and ask for help (30). Consider whether you (and your colleagues) may benefit from improving skills that help manage stress, such as mobilizing social support; problem-solving; decision-making; communication skills (including empathy, negotiation and mediation); conflict prevention and resolution; and grief management (12). Assess your interests, skills, and passions (18). How good is the fit between you, what you’re doing, and where you’re doing it? An honest assessment can help you decide whether you should consider other options in your practice or new career opportunities (31). As Fishell-Rowan (31) says, “Change may be daunting, but the cost of burnout’s long-term effects may far exceed the price of pursuing a new position or career.”

Your practice

The prescription ends with your practice. But in truth, this is where the prescription should begin! According to Maslach (32), “we need to pay greater attention to the social and organizational environment in which individuals work, and to be more creative about solutions at those levels, rather than just at the individual one.” We have the greatest potential to avert burnout when we identify and manage the stressors in the workplace. Although the sources of stress vary from practice to practice, there are several strategies to consider. To start, make sure the tasks, technologies, and work environments are appropriate (12,30,33). Identify how tasks might be done with greater ease by attending to priorities, workflow, equipment needs, ergonomics, and other safety concerns. Attend to workloads, working hours, and work processes (12,33–35). This includes reviewing scheduling, staffing, breaks taken, hours worked, overtime policy, on-call duties, vacation, job-sharing, and administrative support. Ensure that demands are reasonable and manageable. Offer flexible work schedules. Create opportunities for variety with tasks, skills, caseload and/or location. Support work-life balance in whatever ways you can. Empower people by embracing a participative management style, increasing their control over their work, and providing discretion and decision latitude consistent with roles and responsibilities (12,33–36). Provide supportive and considerate supervision and build cohesive teams (26). Address communication practices to identify areas of stress and misunderstanding and make concerted efforts to reduce negative communication (31,35). Develop procedures for handling difficult clients. Coach and guide, blending support with appropriate levels of challenge, and be sure to conduct performance appraisals (12,33–35). Provide clear job expectations, develop equitable reward systems, and provide a sense of job security, all of which contribute to a culture of equity (12,33–35). Promote ongoing professional development, especially in work-related skills where the lack thereof is contributing to stress (12); continuing education is integral to job endurance. Ensure that confidential and relevant support resources are available for those experiencing stress (12). And lastly, each person can ask the question, “How do we make our hospital a great place to work, and a ‘workplace of choice?’” Then go do it. Many of the stressors in the veterinary workplace are in our control.

In closing…

Every occupation has its burden of stress, but as the research indicates, the burden is sizable in our profession. Stress can additively impact health, happiness, and performance, and ultimately lead to burnout. As captured by Shanafelt et al (37), burnout manifests as “emotional exhaustion that affects a person’s passion for work; ability to relate to others; sense of accomplishment or purpose; judgment; productivity; emotions; and overall health.” Burnout does not have to be “the undesired endpoint of a career that began with the noblest of intentions” (16). It is a difficult phenomenon to pinpoint, but with awareness and proactivity, a welcomed future can not only be envisioned, but achieved.