When burn-out reaches a pandemic level in gastroenterology: a call for a more sustainable work–life balance

Duong, Nikki Bollipo Steven Repaka Aparna Shaji Sebastian Tennyson Christina Charabaty Aline

Correspondence to Dr Nikki Duong, VCU, Richmond, Virginia 23219, USA;[e-mail] Introduction The concept of burn-out, defined as a complex construct of emotional exhaustion, depersonalisation and a decline in personal achievement, was first introduced by Herbert Freudenberg nearly five decades ago.1 Burn-out affecting all levels of healthcare professions is increasingly reported in the literature.2–4 Up to one-half of gastroenterologists report burn-out, with increased rates among trainees, early career physicians and interventional endoscopists.5 A recent UK survey on practising gastroenterologists reported significant rates of emotional ill health and work-related stress which impacted work performance.6 The factors contributing to burn-out among gastroenterologists include excessive clinical work load with increasing demands related to the complexity of patient care, work productivity, electronic health records (EHR), documentation to measure endoscopy standards as well as the lack of autonomy, administrative support, workplace relationships, work and home conflicts.5 6 Furthermore, the drivers of clinician burn-out may also lead to ‘moral injury’ when the knowledge of the care needs of the patient often at odds with the ability to provide it due to constraints are beyond the clinicians’ control.7 Burn-out may have grave consequences to the health of physicians and is associated with depression, increased risk of substance abuse and a twofold increase in the risk of suicide.4 6 In a UK survey,6 one-fifth of the respondents required occupational health or medical interventions including use of antidepressants or anxiolytics. Furthermore, the healthcare system as a whole may be adversely affected due to the cost associated with physician turnover and reduced productivity. Since the first case of COVID-19 was reported in Wuhan, China in December 2019, there has been an exponential increase in publications related to both COVID-19 and burn-out. [...]engagement in professional societies and social groups has been shown to help overcome physician burn-out.12 Although opportunities to travel, socialise and attend meetings in-person are limited due to the pandemic, many medical societies currently are offering professional and educational support for virtual connections. A number of applications such as Headspace or CALM have been recommended to be useful for healthcare professionals to build moral resilience by focusing on self-care.18 Physical exercise is also a well-established factor to improve mood and alleviate stress and may help mitigate and prevent burn-out among gastroenterologists.19 Summary The demands on the gastroenterologist extend beyond his or her hours at work.