#Dermlife and the Burned-out Resident

Although dermatology residents have been shown as among the least burned-out residents across specialties, the burnout syndrome still afflicts almost 1 in 3 dermatology residents. Awareness of the notable burnout prevalence may facilitate identification. Intrinsic and extrinsic factor modification may mitigate the risk of burnout.

Dermatologist Dr. Jeffrey Benabio quipped, “The phrase ‘dermatologist burnout’ may seem as oxymoronic as jumbo shrimp, yet both are real.”1 Indeed, dermatologists often self-report as among the happiest specialists both at work and home, according to the annual Medscape Physician Lifestyle and Happiness Report.2 Similarly, others in the medical field may perceive dermatologists as low-stress providers—well-groomed, well-rested rays of sunshine, getting out of work every day at 5:00 pm to catch happy hour and live the #dermlife. However, the reality is that the syndrome of burnout does not spare our specialty. In fact, the low-stress perception of dermatologists may instead make recognizing burnout within others and ourselves challenging. Awareness of the notable prevalence of burnout within dermatology may facilitate identification and modification of associated predictors.

Burnout in Dermatology Residents

Burnout is a syndrome of emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment that affects residents of all specialties3; however, there is a paucity of literature on burnout as it relates to dermatology. Although long work hours and schedule volatility have captured the focus of resident burnout conversations, a less discussed set of factors may contribute to dermatology resident burnout, such as increasing patient load, intensifying regulations, and an unrelenting pace of clinic. A recent survey study by Shoimer et al3 found that 61% of 116 participating Canadian dermatology residents cited examinations (including the board certifying examination) as their top stressor, followed by work (27%). Other stressors included family, relationships, finances, pressure from staff, research, and moving. More than 50% of dermatology residents surveyed experienced high levels of emotional exhaustion and depersonalization, while 40% demonstrated a low sense of personal accomplishment, all of which are determinants of the burnout syndrome.3
Comparison to Residents in Other Specialties

Although dermatology residents experience lower burnout rates than colleagues in other specialties, the absolute prevalence warrants attention. A recent study published in the Journal of the American Medical Association of 3588 second-year medical residents in the United States found that rates of burnout symptoms across clinical specialties ranged from 29.6% to 63.8%. The highest rates of burnout were found in urology (63.8%), neurology (61.6%), and ophthalmology (55.8%), but the lowest reported rate of burnout was demonstrated in dermatology (29.6%).4 Although dermatology ranked the lowest, that is still nearly a whopping 1 in 3 dermatology residents with burnout symptoms. The absolute prevalence should not be obscured by the ranking among other specialties.
Preventing Burnout

Several burnout prevention and coping strategies across specialties have been suggested.

Mindfulness and Self-awareness

A study by Chaukos et al5 found that mindfulness and self-awareness are resilience factors associated with resident burnout. Counseling is one strategy demonstrated to increase self-awareness. Mindfulness may be practiced through meditation or yoga. Regular meditation has been shown to improve mood and emotional stress.6 Similarly, yoga has been shown to yield physical, emotional, and psychological benefits to resdients.7

Work Factors

A supportive clinical faculty and receiving constructive monthly performance feedback have been negatively correlated with dermatology resident burnout.3 Other workplace interventions demonstrating utility in decreasing resident burnout include increasing staff awareness about burnout, increasing support for health professionals treating challenging populations, and ensuring a reasonable workload.6

Sleep

It has been demonstrated that sleeping less than 7 hours per night also is associated with resident burnout,7 yet it has been reported that 72% of dermatology residents fall into this category.3 Poor sleep quality has been shown to be a predictor of lower academic performance. It has been proposed that to minimize sleep deprivation and poor sleep quality, institutions should focus on programs that promote regular exercise, sleep hygiene, mindfulness, and time-out activities such as meditation.7

Social Support

Focusing on peers may foster the inner strength to endure suffering.1 Venting, laughing, and discussing care with colleagues has been demonstrated to decrease anxiety.6 Work-related social networks may be strengthened through attendance at conferences, lectures, and professional organizations.7 Additionally, social supports and spending quality time with family have been demonstrated as negative predictors of dermatology resident burnout.3

Physical Exercise

Exercise has been demonstrated to improve mood, anxiety, and depression, thereby decreasing resident burnout.6

Final Thoughts

Burnout among dermatology residents warrants awareness, as it does in other medical specialties. Awareness may facilitate identification and prevention, the latter of which is perhaps best summarized by the words of psychologist Dr. Christina Maslach: “If all of the knowledge and advice about how to beat burnout could be summed up in 1 word, that word would be balance—balance between giving and getting, balance between stress and calm, balance between work and home.”8

References

  1. Benabio J. Burnout. Dermatology News. November 14, 2017. https://www.mdedge.com/edermatologynews/article/152098/business-medicine/burnout. Accessed August 14, 2019.
  2. Martin KL. Medscape Physician Lifestyle & Happiness Report 2019. Medscape website. https://www.medscape.com/slideshow/2019-lifestyle-happiness-6011057. Published January 9, 2019. Accessed August 14, 2019.
  3. Shoimer I, Patten S, Mydlarski P. Burnout in dermatology residents: a Canadian perspective. Br J Dermatol. 2018;178:270-271.
  4. Dyrbye LN, Burke SE, Hardeman RR, et al. Association of clinical specialty with symptoms of burnout and career choice regret among us resident physicians. JAMA. 2018;320:1114-1130.
  5. Chaukos D, Chaed-Friedman E, Mehta D, et al. Risk and resilience factors associated with resident burnout. Acad Psychiatry. 2017;41:189-194.
  6. Ishak WW, Lederer S, Mandili C, et al. Burnout during residency training: a literature review. J Grad Med Educ. 2009;2:236-242.
  7. Tolentino J, Guo W, Ricca R, et al. What’s new in academic medicine: can we effectively address the burnout epidemic in healthcare? Int J Acad Med. 2017;3.
  8. Maslach C. Burnout: a multidimensional perspective. In: Schaufeli W, Maslach C, Marek T, eds. Professional Burnout: Recent Developments in Theory and Research. Washington, DC: Taylor and Francis; 1993:19-32.