Burnout has been well documented within the physician profession, but burnout also affects other health care professionals, including pharmacy residents. Burnout is not a defined clinical diagnosis, but a culmination of physical and mental symptoms in the form of exhaustion, emotional isolation from work or personal activities, and decreased work performance.1 Studies around burnout have shown that when residency program rigors and demands outweigh the coping abilities of a pharmacy resident, the resident’s perception is associated with high perceived stress and negative affect levels.2 Because of the stressors of the pharmacy profession, burnout symptoms can result in lack of motivation and impaired cognitive function in “burnt-out” pharmacy residents to perform at a high level, which can jeopardize patient safety.
It is important to be cognizant of burnout symptoms and their consequences within the pharmacy resident population. I have a friend who personally experienced symptoms of burnout that led to a mild adverse event for one of his patients during his PGY1 residency program. The culmination of adjusting to recent changes made to his workplace, recovering from a sinus infection, and multitasking between three patient encounters contributed to his missing a drug allergy during the verification step of a patient’s prescription.
Identifying burnout symptoms is important to determine proper management strategies for individuals to avoid or mitigate burnout. In 2016, the National Academy of Medicine initiated a collaborative effort with more than 30 organizations to build a plan to combat pharmacist burnout during residency and in clinical practice.2
Symptoms
Common symptoms of burnout include depression, dysphoria, and physical exhaustion.2 Potential causes stem internally from feeling overworked and pressured or neglecting to tend to self-care needs. Other causes can be compounded by external factors such as work- or personal-related influences (e.g., coping with changes in the workplace, moving into a new house, developing a physical illness, experiencing sleep deprivation).1
Risk Factors
The strategic plan for avoiding or mitigating burnout can define risk factors within various categories on the basis of external or internal influences. External influences mainly affect well-being, or satisfaction with life, positive functioning, and absence of negative emotions. External influences are environmental factors that can produce “burnout” triggers, which the resident cannot control. Internal influences mainly affect coping and resiliency skills. The pharmacy resident has control over the internal influences and can take action to mediate “burnout” triggers.
Change in external or internal influences can (greatly or poorly) affect a pharmacy resident’s well-being, productivity, and quality of patient care provided. Because potential causes and influencers of well-being can be identified, action can be taken to mitigate or prevent pharmacy resident burnout. If you have identified individuals who have burnout, you can help them mitigate their burnout by acting on the specific external and internal influences affecting their well-being.
Mitigation Strategies
Pharmacy resident well-being can be enhanced by creating a work environment that is healthy for all members of the program. This includes creating a sense of community at the workplace, promoting flexibility and work-life balance in the culture of the resident’s program, and communicating clear expectations to allow transparency between members of the program. These examples promote well-being and allow pharmacy residents to take the time to use their coping and resiliency skills to recover from stressful events that may be compounded by internal influences.
Not all pharmacy residents deal with burnout symptoms in the same way. Therefore, pharmacy residents may need to be taught how to build (or sharpen) coping and resiliency skills when external influences, such as a death in the family or unclear expectations in the residency program, occur in the resident’s life. It is important to help the resident address any stressors that may present during residency in order to resolve the issue.
Some advice to give residents when promoting well-being is to learn techniques to improve their self-wellness. Some key techniques residents should be taught include being aware of personal triggers that increase stress (e.g., sleeping less than normal, reduced diet intake, reduced time spent away from work-related tasks). Ultimately, only they can decide how to deal with these stressors.3
Residents need to learn to take time away from work to incorporate healthy decompression hobbies into their lives (e.g., exercise, journaling, listening to music, meditation). Residents should find someone they trust to discuss the status of their well-being. This allows residents to open up, reflect on their thoughts and experiences, and gauge their balance of resiliency and productivity within the challenges of their residency program.3-5
Burnout prevalence has become increasingly high in the health care profession within the past decade and is only expected to climb in the near future. Burnout in pharmacy residents and other health care workers results in decreased quality of patient care and ultimately patient harm. All members of pharmacy workplaces should recognize, identify, and limit external factors by implementing policies that promote well-being in the workplace. By implementing self-wellness policies and learning coping and resiliency skills, pharmacy residents will be positioned for success to mitigate and prevent burnout in the pharmacy workplace. Have you experienced burnout? What have you done to prevent future burnout? Please send your comments to [email protected] and start a discussion!
About the author: Chase Board is a PGY2 ambulatory care pharmacy resident at the Virginia Commonwealth University School of Pharmacy. Chase enjoys helping patients with diabetes, learning, traveling to new cities, and watching football.
References
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG), 2006-. Depression: What Is Burnout? Updated January 12, 2017. Available at https://www.ncbi.nlm.nih.gov/books/NBK279286/. Accessed August 2, 2019.
- Le HM, Young SD. Evaluation of stress experienced by pharmacy residents. Am J Health Syst Pharm 2017;74:599-604.
- Silvester JA. Journey to a resilient & thriving pharmacy workforce. Presented at: VPhA Annual Conference; September 2018. Available at https://virginiapharmacists.org/wp-content/uploads/2018/09/VPhA-Annual-Convention-Sept2018-SilvesterFinal.pdf. Accessed August 8, 2019.
- Zinurova E, DeHart R. Perceived stress, stressors, and coping mechanisms among PGY1 pharmacy residents. Am J Pharm Educ 2018;82:Article 6574.
- Morspan CM, Olenik A. Empowering pharmacists to address burnout and resiliency. J Am Pharm Assoc 2018;58:473-5. Available at https://www.japha.org/article/S1544-3191(18)30382-0/fulltext. Accessed August 10, 2019.