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to the immense underrecognition of burnout in physicians.
The ability to quantify burnout using a validated instrument
(MBI-HSS) has enhanced our capacity to detect burnout and
to understand the factors associated with it. Studies that have
used the MBI-HSS have shown lower levels of burnout in
otolaryngologists when compared with other surgical special-
ties.
1,13
Studies have also shown that burnout in otolaryngolo-
gists varies based on level of training. In a 2007 study, Golub
et al
5
found high levels of burnout in 10% of residents sur-
veyed, whereas Hill and Smith
6
found that 31% of residents
experienced high levels of burnout. This is in comparison to
a survey of academic faculty demonstrating high levels of
burnout in 4% and a separate study of department chairs that
had high levels in only 3%.
7,8
Our investigation further bears
this out, with burnout syndrome demonstrated in only 3.5%
of practicing otolaryngologists surveyed.
This difference is thought to be the result of the higher
work hour demands placed on residents, who, despite the
recent reduction in work hours mandated by the Accreditation
Council for Graduate Medical Education, are still working
more hours per week than their attending counterparts. Indeed,
in many studies, the number of hours worked per week has
consistently been shown to be one of the strongest predic-
tors of physician burnout.
1,7,22,23
This was also the case in
the present study, which demonstrated a significant corre-
lation between the number of hours worked per week and
one’s level of EE. Given the demanding nature of the med-
ical field, this is not surprising; yet if a reduction in the
level of burnout is to be expected with one’s career
advancement, perhaps efforts to curb burnout are best tar-
geted toward residents in training. These interventions may
alleviate burnout stemming from overwork, but they would
not obviate the search for modifiable risk factors to curb
the incidence of burnout deriving from other sources.
Our understanding of the risk factors that contribute to
burnout is still emerging. In a recent survey of academic
faculty in otolaryngology, Golub et al
7
found that dissatis-
faction with the balance between personal and professional
life was one of the strongest predictors of burnout. A similar
survey of academic chairs in otolaryngology found that
burnout was correlated with low spousal support, the loss of
key faculty, and disputes with the medical school dean.
8
These findings shed light on one of the key elements of
burnout: the sense of losing control of one’s professional
life. In fact, a strong sense of control of one’s environment
has been shown to be of paramount importance to attenuat-
ing symptoms of burnout.
4,24,25
In the current study, younger age and fewer years in
practice were significant predictors of burnout. This is in
keeping with previously published data in otolaryngologists
and other surgical specialties.
7,26
This may be explained by
the perceived lack of control of one’s professional environ-
ment at the early stages of one’s career when new and often
unfamiliar stressors are brought to bear. Physicians who
have been in practice longer have most likely adapted
coping mechanisms that are protective against burnout.
Experience also allows for maturity and increased confi-
dence, both of which provide an improved sense of control
over professional matters. It is also somewhat more difficult
to determine the optimal professional/personal balance ear-
lier in one’s career, thus increasing the strain of each.
Interestingly, practice setting did not correlate with burnout,
thus highlighting the importance of personal coping skills as
a more important determinant of response to stress than
work environment. We also found no significant correlation
between religious beliefs and EE or DP.
The quality of interpersonal relationships and personal sup-
port systems has been highlighted as having a significant
impact on the development of professional burnout.
15,18,23
The
presence of work-home conflicts has also been shown to be a
major contributing factor to surgeon burnout.
25
Our present
analysis demonstrates an inverse relationship between the
number of years married and both EE and DP. One explana-
tion is that the experience and maturity acquired through years
of marriage improve one’s adaptability to its demands and
insulates against the development of EE and DP. Certainly, the
personal stresses of a new marriage can be challenging, and
when compounded with the constant emotional and psycholo-
gical demands of patient care, this may significantly increase
one’s risk of burnout. Our study also found that having more
children in the home was significantly correlated with both EE
and DP. Given the constant demands of childrearing, this is
not surprising. Yet the complex interplay of these demands
with one’s professional aspirations may also contribute to
Table 4.
Significant Predictors of Burnout
Covariate
Predictor Regression Coefficient (
b
) Standard Error 95% Confidence Interval (of
b
)
R
2
P
Value
Age
EE
2
3.28
0.77
2
4.80 to –1.76
0.15
\
.0001
DP
2
1.05
0.36
2
1.75 to –0.34
0.08 .0041
No. of years married
EE
2
0.24
0.069
2
0.38 to –0.11
0.11 .0007
DP
2
0.09
0.032
2
0.16 to –0.03
0.08 .0045
Presence of children in the home
EE
1.93
0.86
0.22 to 3.64
0.05 .0275
DP
0.88
0.38
0.12 to 1.64
0.05 .0235
Hours worked/wk
EE
0.15
0.047
0.06 to 2.24
0.10 .0016
No. years on the job
EE
2
0.27
0.11
2
0.49 to –0.07
0.06 .0108
Abbreviations: EE, emotional exhaustion; DP, depersonalization.
Fletcher et al
27