OSLI Retina

September 2020

Issue link: http://osliretina.healio.com/i/1287260

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480 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina Practical Retina Incorporating current trials and technology into clinical practice Burnout in Ophthalmology by Neha Siddiqui, MS; and Michael Tsipursky, MD For this Practical Retina column, I requested Michael Tsipursky, MD, and Neha Siddiqui, MS, to share their expertise and experiences regarding burnout in oph- thalmology. During the last decade we have seen an ac- celerating trend of burnout through- out medicine. Why is this? To have this discussion, we first need to understand the causes of burn- out, which are ex- tensive and increasing year over year. Factors such as isolation, increases in mundane tasks, increasing patient volumes, lack of intellectual stimula- tion, decreasing autonomy, reimburse- ment hassles, and most recently wear- ing personal protective equipment to see patients are just some examples. We need to develop a framework to create coping mechanisms as well as build solutions at the individual and institutional level to combat this concerning trend. Another important aspect of burn- out is that we need to notice signs in our colleagues and trainees. Of- ten the signs are missed. Be aware of colleagues acting out of character or who seem very irritable. Rather than penalizing colleagues, please take a moment to inquire and listen to them. This is our duty and you may very well save their lives. Dr. Tsipursky and Ms. Siddiqui generously share their extensive knowledge regarding burnout in oph- thalmology. They will dissect, ana- lyze, and summarize the salient issues surrounding this sensitive and vitally important topic. I am certain that the insights regarding burnout presented in this piece will prove to be very valuable for our community. Burnout is a psychological state encompassing a combination of emotional exhaustion, depersonalization, and low feeling of personal accomplishment. 1 It is especially prevalent in medicine, where work-related stressors tend to be more extreme, responsibilities are numerous, and one is surrounded by and constantly compared to successful peers. Here, we provide an overview of burnout in ophthalmology and its causes, summarize a framework behind understanding burnout, outline methods to bring awareness to burn- out in fellow colleagues, and appraise both personal and policy-oriented suggestions to combat burnout. Now considered a billable condition in the International Classification of Diseases, 10th edition (ICD-10) with code Z73.0, burn- out is officially defined as a "state of vital exhaustion." It is widely prevalent in all medicine, with more than half of physicians reporting at least one symptom of burnout when assessed with the Maslach Burnout Inventory. 2 Ophthalmology as a field has some of the lower reported rates of burnout, but "low" is relative to other surgical specialties, and still much higher than the gen- eral population. 3 Ophthalmologists report burnout at a high rate of 37%. Women in ophthalmology report an even higher rate at 43%, and middle-career physicians report higher burnout than those in early or late stages. 4,5 Burnout is linked to mental health. A 2018 survey found that 46% of ophthalmologists felt burned out, depressed, or both. 4 A recent study from Mayo Clinic found that 41% of physicians screened positive for depression. 2 This mental state affects pro- ductivity and work environment, as nearly half with depression report expressing frustration in front of staff/peers, becoming easily exasperated with colleagues and patients, and being less engaged/friendly. 4 There is concern over this affecting out- comes, as well, with burnt-out clinicians rating patient safety as a lower priority. 6 Burnout not only affects psyche and productivity, but the literature also points to physical sequelae. A review by Salva- gioni et al. showed that burnout was a predictor of 12 physi- cal conditions including hypercholesterolemia, diabetes, cor- onary heart disease, severe injuries, and mortality below the age of 45 years. 7 There is even bigger concern is that burnout Neha Siddiqui Michael Tsipursky doi: 10.3928/23258160-20200831-01 Seenu M. Hariprasad Practical Retina Co-Editor

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