Expert Commentary

Strategies for maintaining resilience to the burnout threat

Professional burnout is a constant threat because the attributes that make physicians successful also put us at risk. Some simple, lifestyle-changing tools, however, can reverse the risk.

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In this Article

  • Symptoms by stage of burnout
  • Tips to reduce stress and burnout
  • Who is most at risk for burnout?



It sometimes seems that the pace of life, and its stresses, have spiraled out of control: There just never seems to be enough time to deal with all the directions in which we are pulled. This easily can lead to the exhaustion of physical or emotional strength or motivation, otherwise known as “burnout.” Burnout is physical or mental collapse caused by overwork or stress and we are all at risk of suffering it. Conflicting demands on our time, loss of control (real or imagined), and a diminishing sense of worth grind at us from every direction.

In general, having some control over schedule and hours worked is associated with reductions in burnout and improved job satisfaction.1 But this is not always the case. Well-intentioned efforts to reduce workload, such as the electronic medical records or physician order entry systems, have actually made the problem worse.2 The seeming level of control that comes with being the chair of an obstetrics and gynecology department does not necessarily reduce burnout rates,3 and neither does the perceived resilience of mental health professionals, who still report burnout rates that approach 25%.4

This article continues the focus on recalibrating work/life balance that began last month with “ObGyn burnout: ACOG takes aim,” by Lucia DiVenere, MA, and the peer-to-peer audiocast with Ms. DiVenere and myself titled “Is burnout on the rise and what are the signs ObGyns should be on the lookout for?” Here, I identify the causes and symptoms of burnout and provide specific tools to help you develop resilience.

Who is most at risk for burnout?

Estimates range from 40% to 75% of ObGyns currently suffer from professional burnout, making the lifetime risk a virtual certainty.1−3 The idea of professional burnout is not new, but wider recognition of the alarming rates of burnout is very current.4,5 A recent survey of gynecologic oncologists6 found that of those studied 30% scored high for emotional exhaustion, 10% high for depersonalization, and 11% low for personal accomplishment. Overall, 32% of physicians had scores indicating burnout. More worrisome was that 33% screened positive for depression, 13% had a history of suicidal ideation, 15% screened positive for alcohol abuse, and 34% reported impaired quality of life. Almost 40% would not encourage their children to enter medicine and more than 10% said that they would not enter medicine again if they had to do it over.

Residents and those at mid-career are particularly vulnerable,7 with resident burnout rates reported to be as high as 75%.8 Of surveyed residents in a 2012 study, 13% satisfied all 3 subscale scores for high burnout and greater than 50% had high levels of depersonalization and emotional exhaustion. Those with high levels of emotional exhaustion were less satisfied with their careers, regretted choosing obstetrics and gynecology, and had higher rates of depression—all findings consistent with older studies.

  1. Peckham C. Medscape Lifestyle Report 2016: Bias and Burnout. Medscape website. Published January 13, 2016. Accessed July 7, 2016.
  2. Shanafelt TD, Boone, S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377–1385.
  3. Martini S, Arfken CL, Churchill A, Balon R. Burnout comparison among residents in different medical specialties. Acad Psychiatry. 2004;28(3):240–242.
  4. Lee YY, Medford AR, Halim AS. Burnout in physicians. J R Coll Physicians Edinb. 2015;45(2):104–107.
  5. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–1613.
  6. Rath KS, Huffman LB, Phillips GS, Carpenter KM, Fowler JM. Burnout and associated factors among members of the Society of Gynecologic Oncology. Am J Obstet Gynecol. 2015;213(6):824.e1–e9.
  7. Dyrbye LN, Varkey P, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician satisfaction and burnout at different career stages. Mayo Clin Proc. 2013;88(12):1358–1367.
  8. Govardhan LM, Pinelli V, Schnatz PF. Burnout, depression and job satisfaction in obstetrics and gynecology residents. Conn Med. 2012;76(7):389–395.
  9. Becker JL, Milad MP, Klock SC. Burnout, depression, and career satisfaction: cross-sectional study of obstetrics and gynecology residents. Am J Obstet Gynecol. 2006;195(5):1444–1449.
  10. Castelo-Branco C, Figueras F, Eixarch E, et al. Stress symptoms and burnout in obstetric and gynaecology residents. BJOG. 2007;114(1):94–98

Why burnout occurs

Simply identifying ourselves as professionals and the same attributes that make us successful as physicians (type-A behavior, obsessive-compulsive commitment to our profession) put us at risk for professional burnout (see “Who is most at risk for burnout?”). Those predilections combine with the forces from the world in which we live and practice to increase this threat (TABLE 1). Conditions in which there are weak retention rates, high turnover, heavy workloads, and low staffing levels or staffing shortages increase the risk of burnout and, when burnout is present, are associated with a degraded quality of care.5

Does stress cause burnout?

Stress is often seen as the reason for burnout. Research shows that there is no single source of burnout,6 however, and a number of factors combine to cause this physical or mental collapse. Stress can be a positive or negative factor in our performance. Too little stress and we feel underutilized; too much stress and we collapse from the strain.

There is a middle ground where stress and expectations keep us focused and at peak productivity (FIGURE 1). The key is the balance between control and demand: When we have a greater level of control, we can handle high demands (FIGURE 2). It is when we lack that control that high demands result in what has been called “toxic stress,” and we collapse under the strain.

Stress is not always bad. Optimally, it can drive us to even greater performance.

The level of control over our efforts can spell the difference between toxic stress and high productivity.


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