Addressing Fatigue in Emergency Physicians and Clinician Researchers

Introduction

Emergency physicians and staff members are the frontline and bulwark of the healthcare system, providing the full spectrum of acute care to patients in times of crisis. However, the demanding nature of their profession often puts them at risk of emotional exhaustion (e.g. moral injury/burnout), a phenomenon that is unfortunately common amongst emergency clinicians, with upwards of 60% of providers reporting moderate to high symptoms of burnout.⁴ However, burnout is not exclusive to clinical practitioners. Researchers and academics, particularly those engaged in clinician research, also face the challenges of burnout, emphasizing the need for an interdisciplinary and holistic approach to support those dedicated to acute care science. In this piece we explore the prevalence of burnout in both emergency physicians and clinician researchers, emphasizing the importance of a comprehensive support system to foster resilience and well-being.

Understanding Burnout

Burnout is a complex and multifaceted phenomenon characterized by emotional exhaustion, depersonalization and a reduced sense of personal accomplishment.^2,3 The fast-paced, high-stakes environment of emergency medicine has been associated with near and long term effects on providers including the development of burnout among physicians.¹ The constant pressure, long hours and exposure to traumatic events can take a toll on their mental and emotional well-being, with past work finding elevated risk for the development of psychological and even physiological changes such as blood pressure, poor sleep, and anxiety.⁵

Similarly, clinician researchers, who navigate the delicate balance between clinical practice and research endeavors, face unique challenges. The pressures to publish, secure grants and juggle clinical responsibilities can lead to high degrees stress and burnout. The parallel demands of clinical and research roles make it imperative to recognize burnout as a shared concern in both spheres of such clinician-investigators.

The Interconnectedness of Clinical Practice and Research

Clinician researchers play a pivotal role in advancing medical knowledge by bridging the gap between clinical practice and research. Their work directly influences patient care, making their contributions invaluable. However, the interconnectedness of these roles also means that burnout in one domain can spill over into the other.

Emergency physicians engaged in research may find themselves caught in a cycle of burnout, as the demands of clinical practice and research responsibilities feed into each other. It is crucial to recognize this intricate balance and develop strategies to support these individuals comprehensively. To address burnout effectively, a multifaceted approach is necessary. Some potential strategies to support emergency physicians and clinician researchers in their pursuit of acute care work include:

Promoting Academic Work-Life Balance

• Create a culture that values and prioritizes work-life balance with appropriate recognition and administrative support for research and clinical efforts.
• Explore supportive scheduling approaches that address challenges often seen by clinician-investigators regarding working hours and timing of research/operational meetings which may run at different cadences to the classic emergency clinician schedule.

Team-based Approaches

• Foster a collaborative and supportive team environment. Encourage open communication and teamwork to share the burden of responsibilities. Developing strong interpersonal connections within the workplace can create a sense of community and shared responsibility.

Professional Development and Training

• Provide ongoing professional development and training opportunities. This can help emergency physicians and clinician researchers stay engaged and motivated in their respective roles. Investing in their growth and skill development contributes to a sense of accomplishment and job satisfaction.

Research Support Infrastructure

• Establish a robust infrastructure to support clinician researchers. This includes administrative assistance, dedicated academic/research time and resources for data collection and analysis. Streamlining the research process can alleviate some of the stress associated with conducting research alongside clinical duties.

Leadership and Advocacy

• Encourage leadership at all levels to advocate for the well-being of emergency physicians and clinician researchers. Address systemic issues that contribute to burnout and create a culture that prioritizes the mental and emotional health of healthcare professionals.

Conclusion

Burnout is a pervasive challenge that affects emergency physicians and clinician researchers alike. Recognizing the interconnectedness of clinical practice and research is crucial in developing comprehensive strategies to support these dedicated individuals. By fostering a culture of well-being, promoting work-life balance and providing targeted resources, we can create a resilient healthcare workforce capable of delivering high-quality acute care while advancing acute care science. Establishing such a culture will help ensure a sustainable and fulfilling future for those on the front lines of healthcare innovation.

References

• CHANG, B. P., CARTER, E., NG, N., FLYNN, C. & TAN, T. 2018. Association of clinician burnout and perceived clinician-patient communication. The American journal of emergency medicine, 36, 156-158.
• MASLACH, C., JACKSON, S. E., LEITER, M. P., SCHAUFELI, W. B. & SCHWAB, R. L. 1986. Maslach burnout inventory, Consulting psychologists press Palo Alto, CA.
• MCMANUS, I. C., KEELING, A. & PAICE, E. 2004. Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Med, 2, 29.
• SHANAFELT, T. D., BOONE, S., TAN, L., DYRBYE, L. N., SOTILE, W., SATELE, D., WEST, C. P., SLOAN, J. & ORESKOVICH, M. R. 2012. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of internal medicine, 172, 1377-1385.
• SHECHTER, A., DIAZ, F., MOISE, N., ANSTEY, D. E., YE, S., AGARWAL, S., BIRK, J. L., BRODIE, D., CANNONE, D. E. & CHANG, B. 2020. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. General hospital psychiatry, 66, 1-8.