Registrar burnout at Wits far exceeds international norms

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More than that 80% registrars at the University of the Witwatersrand‘s School of Clinical Medicine suffer from burnout, a response to prolonged stress, with “extremely high” levels of depersonalisation, affecting professional response to patients, found a survey published in the SA Medical Journal.

In a 2014 US study, 60% of registrars were found to be suffering from burnout.

Researcher Cathelijn Zeijlemaker said in a Times Select report that she was particularly worried by the “extremely high” feelings of depersonalisation she uncovered among 170 registrars who completed an online questionnaire. This detachment from work, which resulted in unfeeling and impersonal responses to patients, “is associated with negative effects on professionalism”, she said.

The report says the publication of Zeijlemaker’s research, which she presented at the SA Association of Family Physicians conference in Midrand, coincides with a World Health Organisation Bulletin in which a Cape Town doctor describes how he quit as an emergency physician after feeling an overwhelming sense of futility. Many of the responses indicated registrars were suffering in both categories, but depersonalisation was the biggest problem area.

Richard Heron, co-chair of the International Occupational Medicine Society Collaborative, said patients would ultimately suffer as a result. “The compassionate, caring environment is harder to maintain and mistakes are more likely,” he is quoted in the report as saying. “Burnout is not just linked to the health of the doctor, it also affects the safety of the patient.”

Abstract
Background: Burnout is a response to prolonged stress and consists of three elements: emotional exhaustion (EE), depersonalisation (DP), and feelings of personal accomplishment (PA). The existence of burnout in doctors is often not acknowledged but has major consequences for personal and professional life. Only limited research has been done on the prevalence of burnout among registrars in South Africa (SA).
Objectives: To describe the prevalence of burnout in a cohort of SA registrars, and assess relationships between burnout and sociodemographic factors.

Methods: A cross-sectional descriptive internet survey was conducted. Respondents were registrars in departments of the School of Clinical Medicine at the University of the Witwatersrand, Johannesburg, SA. The Maslach Burnout Inventory (MBI) was used to measure burnout. Relationships were assessed by the independent-samples t-test and analysis of variance.
Results: A total of 585 emails were delivered to registrars, of whom 201 started the survey (response rate 34%); 170 questionnaires were analysed. The mean age of the respondents was 33 years, and the male/female ratio was 1:1.8. The mean (standard deviation) score for EE was 3.5 (1.2), for DP 2.7 (1.1) and for PA 4.1 (1.1). The overall level of burnout was 84%. None of the respondents scored low over all categories. No significant association between sociodemographics (age, sex, discipline, year in the programme and experience) and MBI dimensions was found.
Conclusions: The prevalence of burnout in this study was higher than that reported in the national and international literature. Levels of DP were extremely high and are worrying, as DP affects professionalism and engagement of doctors. In keeping with the literature, no associations were found between sociodemographic factors and burnout, suggesting that the cause of burnout should be sought in the work environment. Efforts to improve autonomy in the workplace, development opportunities and promoting peer collaboration are needed to prevent burnout.

Authors
C Zeijlemaker, S Moosa

Times Select report (subscription needed) SA Medical Journal abstract

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