Burnout Defined

This post continues ACCC’s ongoing conversation on how mitigate burnout and foster well-being and resilience among all staff involved in the delivery of cancer care.

Besides the common understanding of burnout as a workplace phenomenon, the criteria for being “burned out” can vary widely. What one person calls burnout another may view as run-of-the-mill workplace stress.

While there have been many attempts to define burnout over the years, a mutually agreed upon definition remains elusive. Merriam-Webster defines burnout as “exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration.” The Mayo Clinic has called it “a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity.” Some academic and mainstream reports and surveys on the topic assume a common understanding of the word rather than defining it explicitly.

At the end of May, the World Health Organization (WHO) took its turn by announcing it had revised its previous definition of burnout as a "state of vital exhaustion" to a more explicit, nuanced definition. This new definition will appear in the International Classification of Diseases (ICD-11), which will go into effect 2022. WHO refers to burnout as a “syndrome” caused by “chronic workplace stress that has not been successfully managed.” WHO assigns three characteristics to burnout:

• feelings of energy depletion or exhaustion
• increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job
• reduced professional efficacy

WHO’s revised definition explicitly states that burnout is a workplace phenomenon and “should not be applied to describe experiences in other areas of life.” Because this definition articulates and enumerates burnout’s symptoms, it may give this workplace phenomenon more legitimacy, perhaps opening doors for people to get the professional help they need. 

This may be of particular importance to clinicians and allied healthcare professionals, who repeatedly report experiencing more burnout than others. When ACCC surveyed its membership earlier this year, approximately 33 percent of respondents said they are “definitely burning out,” while nearly 16 percent said their symptoms of burnout “won’t go away.”

Other surveys have also uncovered high burnout rates in the healthcare community. In a recently released survey of 5,000 physicians by the American Medical Association, nearly 44 percent said they had at least one symptom of burnout in 2017. In comparison, 28 percent of all U.S. workers report burnout symptoms.

Concern over growing rates of burnout among U.S. clinicians has captured national attention in recent years, and in 2017 resulted in the launch of the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience. This network of more than 60 organizations, including ACCC, is committed to reversing trends in clinician burnout. 

As a multidisciplinary organization, ACCC recognizes that caring for patients can take a physical and emotional toll on all members of the multidisciplinary oncology care team, from the front desk staff who greets patients to the physician who treats them. In a 2013 survey cited in the Annals of Family Medicine, of 508 employees working for 243 healthcare employers, 60 percent reported burnout, and 34 percent said they planned to look for a different job.

Time will tell whether the new ICD-11 definition of burnout will affect its perception and diagnosis among healthcare professionals. But having an explicit, detailed definition can definitely enhance the ongoing conversation about how we can better care for our caregivers.