This post is dedicated to Dr. Christina Maslach, Professor Emerita at The University of California—Berkeley, for her brilliant career studying burnout. Over her fifty-plus years of work, Dr. Maslach originated the concept of burnout in her studies of women in caregiving professions, developed and validated the first accurate burnout measurement instruments, and extended her work to occupational burnout by co-developing The Areas of Worklife Model with Dr. Michael P. Leiter (see below). Dr. Maslach continues her work to this day, conducting and advocating for academically rigorous research and evidence-based practice in the area of burnout. In 2019, The World Health Organization integrated her concepts into its definition of burnout as “a legitimate occupational experience [not a medical diagnosis] that organizations need to address, characterized by three dimensions”: 1) exhaustion, 2) increased mental distance from the work / negativity / cynicism, and 3) reduced professional efficacy.…”
These three dimensions are important both in terms of definition and measurement. Dr. Maslach’s 1982 book: Burnout: The Cost of Caring, describing distress in the helping relationship established the classic triad of emotional exhaustion, depersonalization, and decreased sense of personal accomplishment. High emotional exhaustion is the feeling of being emotionally depleted and distraught to the extent that there is nothing left to give. This can lead to high depersonalization—a strong sense of disconnect, cynicism, and even resentment of patients. Finally, a lower sense of personal achievement may set in. These dimensions have their analogues in occupational burnout and its measures. The lower sense of personal achievement may occur less commonly in men, who also may experience depersonalization prior to exhaustion.
In 2021, Drs. Maslach and Leiter published: How to Measure Burnout Accurately and Ethically in Harvard Business Review. Their recent work on occupational burnout suggests that five distinct, different profiles commonly exist:
15% of people fit the true burnout profile—in other words, they test strongly negative on all three dimensions,
30% are engaged, testing strongly positive on all three dimensions, and
55% profile either as overextended (exhausted dimension only), disengaged (cynical dimension only), or ineffective (professional efficacy dimension only).
Maslach and Leiter outline several concerns about burnout measurement today such as describing the three dimensions as “symptoms” and then defining burnout as any one symptom (or even a “yes” answer to a single question):
“What leads to all these misuses? A major reason for these scoring modifications (and resulting inaccuracies) is that many think of burnout as some sort of medical disease or disability, and they want a single score that can diagnose whether individual employees have this disability or not, yet we never designed the MBI as a tool to diagnose an individual health problem. Indeed, from the beginning, burnout was not considered some type of personal illness or disease — a viewpoint that the WHO reiterated in its May 2019 statement.”
Instead, different profiles need to be addressed differently. Physicians fitting the overextended profile (exhaustion dimension only) require solutions specifically addressing workload; physicians with the true burnout profile may have workload problems but are also facing problems in multiple other Areas of Worklife; the six areas are: 1) workload, 2) control, 3) reward, 4) community, 5) fairness, 6) values. Their definitions are listed at the bottom of this article.
We have developed a program for physicians who are being hit hard by burnout using models created by executive coach, Dr. Marshall Goldsmith (see The Earned Life: Lose Regret, Choose Fulfillment 2022). Program details are available here.
Additional learning about physician burnout: a large body of work specifically related to physician wellness and physician burnout has been led by Dr. Tait Shananfelt, currently the founding Chief Wellness Officer at Stanford Medicine, as well as Associate Dean at the Stanford School of Medicine. Dr. Shanafelt is another strong advocate for addressing burnout mechanistically, i.e., at the level of the organization and its leadership, recognizing that burnout is not due to an individual resiliency deficiency. The Stanford Model of Professional Fulfillment is a comprehensive conceptual approach to physician wellness and burnout. One key finding is the need for alignment between the organization’s most senior leadership and departmental and unit leadership.
Areas of Worklife Model (Leiter and Maslach)
Workload: The amount of work to be done in a given time. A manageable workload provides the opportunity to do what you enjoy, to pursue career objectives, and to develop professionally. A crisis in workload is not just stretching to meet a new challenge, but going beyond human limits
Control: The opportunity to make choices and decisions, to solve problems, and to fulfill job responsibilities. A good match has correspondence between control and accountability. A mismatch occurs when you lack sufficient control to fulfill your responsibilities.
Reward: Financial and social recognition for contributions on the job. A meaningful reward system acknowledges your contributions to work and provides clear indications of what the organization values. People experience a lack of recognition as devaluing their work and themselves.
Community: The quality of an organization’s social environment. People thrive in communities characterized by support, collaboration, and positive feelings. Mismatches occur when you don’t have a positive connection with others at work.
Fairness: The extent to which the organization has consistent and equitable rules for everyone, and that resources are allocated according to generally understood and consistent procedures. Fairness communicates respect for the organization’s members. A lack of fairness indicates confusion in an organization’s values and in its relationships with people.
Values: Values are what is important to you and to the organization. When personal and organizational values are congruent, successes are shared. Mismatches occur when differences exist between your values and the organization’s values, or if the organization does not practice its stated values.
As always, let me know if we can help!
Dr. Shayne Taback is a pediatric subspecialist, PGME CIP Director, and Executive Coach for physicians across the continuum from new graduate to C-Suite Chief Medical Officer. To learn more about him and our other coaches, please click here. Or to contact Shayne, please email firstname.lastname@example.org or click here. To receive curated blog posts, please sign up to our newsletter below.