The Physician Soul: Burnout, Secondary Stress, and Compassion Among Physicians
Benjamin Doolittle, M.D., MDiv, Associate Professor, Yale University School of Medicine
The prevalence of burnout among attending physicians ranges between 30-67%. Workload, insurance issues, and the electronic medical record have been cited as the most common stressors. Burnout is a heterogeneous syndrome defined as emotional exhaustion, detachment, and lack of accomplishment. Recently, attention has been given to the importance of secondary traumatic stress and compassion satisfaction. Secondary traumatic stress is defined as the symptoms of anxiety and emotional duress when providers experience vicarious trauma when caring for patients. Compassion satisfaction is defined as the positive feelings and meaningful sense of purpose derived from caring for patients. These three variables – burnout, secondary stress, and compassion satisfaction – have been shown to correlate with poor quality care and lack of professionalism. While burnout has been well studied among physicians, secondary stress and compassion satisfaction have had scant mention in the literature and few robust surveys exploring modulating variables.
We explored these three aspects of work stress and several potential modulating influences using validated instruments. We administered a survey to attending physicians who are members of two chapters of the American College of Physicians. 337 responded. Prevalence of burnout was 51%. 23% self-identified as being depressed. 61% considered themselves spiritual. 38% considered themselves religious.
Several variables correlated with burnout, secondary stress, and compassion satisfaction. Greater resilience, the quality of perseverance and passion for long-term goals , was associated with lower burnout (r=-0.29, p<.001), lower secondary stress (r=-0.23, p<.0001), and greater compassion (r=+0.41, p<.001). greater institutional support was correlated with lower burnout (-0.35, p<.0001), lower secondary stress (r=-0.14, p<.02), and greater compassion (r=+0.28, p<.001). greater friendship also correlated with lower burnout (r=-0.25, p<.0001) and greater compassion (r=+0.28). exercising 3 times per week for 20 minutes was also correlated with lower burnout (p<.05), secondary stress (p<.05), and greater compassion satisfaction (p<.05).
In multivariate analysis, resilience, friendship, institutional support, and spiritual coping strategies accounted for 55% of the variance for burnout (p<.0001), 43% for compassion satisfaction (p<.0001), and 32% for secondary stress (p<.0001). implications on the importance of these variables will be discussed.
The prevalence of burnout among attending physicians ranges between 30-67%. Workload, insurance issues, and the electronic medical record have been cited as the most common stressors. Burnout is a heterogeneous syndrome defined as emotional exhaustion, detachment, and lack of accomplishment. Recently, attention has been given to the importance of secondary traumatic stress and compassion satisfaction. Secondary traumatic stress is defined as the symptoms of anxiety and emotional duress when providers experience vicarious trauma when caring for patients. Compassion satisfaction is defined as the positive feelings and meaningful sense of purpose derived from caring for patients. These three variables – burnout, secondary stress, and compassion satisfaction – have been shown to correlate with poor quality care and lack of professionalism. While burnout has been well studied among physicians, secondary stress and compassion satisfaction have had scant mention in the literature and few robust surveys exploring modulating variables.
We explored these three aspects of work stress and several potential modulating influences using validated instruments. We administered a survey to attending physicians who are members of two chapters of the American College of Physicians. 337 responded. Prevalence of burnout was 51%. 23% self-identified as being depressed. 61% considered themselves spiritual. 38% considered themselves religious.
Several variables correlated with burnout, secondary stress, and compassion satisfaction. Greater resilience, the quality of perseverance and passion for long-term goals , was associated with lower burnout (r=-0.29, p<.001), lower secondary stress (r=-0.23, p<.0001), and greater compassion (r=+0.41, p<.001). greater institutional support was correlated with lower burnout (-0.35, p<.0001), lower secondary stress (r=-0.14, p<.02), and greater compassion (r=+0.28, p<.001). greater friendship also correlated with lower burnout (r=-0.25, p<.0001) and greater compassion (r=+0.28). exercising 3 times per week for 20 minutes was also correlated with lower burnout (p<.05), secondary stress (p<.05), and greater compassion satisfaction (p<.05).
In multivariate analysis, resilience, friendship, institutional support, and spiritual coping strategies accounted for 55% of the variance for burnout (p<.0001), 43% for compassion satisfaction (p<.0001), and 32% for secondary stress (p<.0001). implications on the importance of these variables will be discussed.