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Commentary

Pharmacist Burnout: Hype or Reality?


June 20, 2019

mungerHave you experienced emotional exhaustion, feelings of cynicism and detachment from your work associated with a sense of low personal accomplishment from your employment?  You are by definition suffering from occupational burnout.1-2 A 2014 manuscript approximated that >50% of physicians reported at least one symptom of burnout, twice the rate of the general U.S. population.3-4  The estimates of burnout in health care spending are between $125-190 billion.5  A 2019 study estimated the attributable cost of physician burnout in the U.S. to approximately $4.6 billion ($7600/employed physician/year) due to physician turnover and reduced clinical hours.6  Are pharmacists immune to occupational burnout?  The answer is no, but the answer to the question is hampered by a scarcity of data.

Most studies have focused on satisfaction among community and institutional pharmacists. Satisfaction is directly mediated by work-family conflict, job stress, and career satisfaction.7-11 Age, gender, marriage, family roles and commitment, and number of children; affect work-family satisfaction.9   Two studies, one in community pharmacy and the other in institutional practice found that > 50% of pharmacists were dissatisfied with their current occupation, to the point of considering quitting their jobs.10-11  This is in congruence with the physician burnout study noted previously.3-4 Although a limited data set, these studies support that burnout is a reality in the pharmacy profession. 

It is important to recognize that current professional environment components may lead to burnout.  Contributors include but are not exclusive to; excessive workload, loss of autonomy, excessive administrative burdens, a decline in deriving a sense of meaning from work, and difficulty integrating personal and professional life.3, 10-12 Another contributor is a lack of camaraderie, a universally application of a team approach to patient care.  Practice isolation, especially commonplace to community pharmacy, is all too common, despite advances in team-approach education.  Community pharmacy especially seems very slow to change traditional dispensing functions.  The result is a lack of control over the work setting, isolation, heavy workloads, inadequate rewards, and lack of a true workplace community, leading to burnout.13

To date, very few tested burnout interventions are available in the literature.3 Some community pharmacy organizations have implemented programs to address poor satisfaction.  These interventions include developing a professional culture focused on the employee/practitioner by providing more flexible schedules, ability to trade shifts, and positive-based performance appraisals.14   In addition, cultural councils with a diversity of employees solicit feedback from an employee perspective, and employee recognition programs have been started.  In most places however, the individual pharmacist must pursue self-awareness and meaning on their own, usually based on their own resources.3   Self-preservation occurs despite the World Health Organization including “burnout” in its International Classification of Diseases Handbook.15

There are potential solutions that should be considered.  In 1964, Blake and Mouton developed a leadership model based on two key components: concern for people and the concern for production, presented in a grid format with each axis ranging from 1 (low) to 9 (high).16 (Figure 1)  In a team style (9/9) there is high concern for people and high concern for productivity.  Team style relies heavily on making each individual employee become a constructive part of the organization.  Each employee has autonomy with accountability resulting in individual governance within the organization.  When employees are granted more autonomy with a high level of discretion, work job satisfaction increased. 17 

Burnout is a reality, becoming more commonplace among pharmacists.  The profession should maintain a constant dialogue about this increasing problem. Why, because we are losing high quality pharmacists.11 The old declaration “Do Your Job” does not work anymore and should be replaced by “Service to the Mission”

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Mark A. Munger, PharmD, FCCP, FACC, is a professor of pharmacotherapy and adjunct professor of internal medicine, at the University of Utah, where he also serves as the associate dean of Academic Affairs for the College of Pharmacy. 

References:

  1. Maslach C, Jackson SE. Leiter MP. The Maslack Burnout Inventory. 3rd ed. Palo Alto, CA: Consulting Psychologists Pr; 1996.
  2. Maslach C, Schaufeli WB, Leiter MP. Job Burnout. Annu Rev Psychol 2001;52:397-422.
  3. Shanafelt TD, Boone S, Tan L Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among U.S. physicians relative to the general U.S. population. Arch Intern Med 2012;172:1377-85.
  4. Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general U.S. working population between 2011 nd 2014. Mayo Clin Proc 2015;90:1600-13.
  5. Pharmacist Burnout is Scary: Here is What to Do About it. https://www.pharmacytimes.com/contributor/alex-barker-pharmd/2018/01/the-science-behind-pharmacist-burnout-is-scary-heres-what-to-do-about-it Accessed 05/28/2019.
  6. Han S, Shanafelt TD, Sinsky CA, Awad KM, Dyrbye LN, Fiscus LC, Trockel M, Goh J. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med doi:10.7326/M18-1422.
  7. Gubbins PO, Ragland D, Castleberry AN, Payakachat N. Family commitment and work characteristics among pharmacists. Pharmacy 2015; 3:386-98.
  8. Gaither CA, Kahaleh AA, Doucette WR, Mott DA, Pederson CA, Schommer JC. A modified model of pharmacists’ job stress: The role of organizational, extra-role, and individual factors on work-related outcomes. Res Soc Adm Pharm 2008;4:231-43.
  9. Michel JS, Kortrba LM, Mitchelson JK, Clark MA, Baltes BB. Antecedents of work-family conflict: A meta-analytic review. J Organiz Behav 2011;32:689-725.
  10. Dunham ME, Bush PW, Ball AM. Evidence of burnout in health-system pharmacists. Am J Health-Syst Pharm 2018;75(4):S93-S100.
  11. Munger MA, Gordon E, Hartman J, Vincent K, Feehan M. Community pharmacists’ occupational satisfaction and stress: A profession in jeopardy? J Am Pharm Assoc 2013;53(3):30-44.
  12. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med 2003;114(6):513-9.
  13. Pharmacists and Burnout. https://www.pharmacytimes.com/contributor/alex-barker-pharmd/2018/12/pharmacists-and-burnout-the-first-step-is-to-acknowledge-the-data-about-providers Accessed 05/28/2019
  14. Munger MA, Higbee M. “Pharmacist’s Occupation Satisfaction and Coping with Stress” American Pharmaceutical Association 2015 Annual Meeting, San Diego, California, March, 2015.
  15. World Health Organization and Burnout. https://www.cbsnews.com/news/world-health-organization-classifies-work-burnout-an-occupational-phenomenon-2019-05-28/ Accessed 05/28/2019
  16. Blake, R.; Mouton, J. (1964). The Managerial Grid: The Key to Leadership Excellence. Houston: Gulf Publishing Co.
  17. Effects of Autonomy on Job Satisfaction.  https://work.chron.com/effects-autonomy-job-satisfaction-14677.html Accessed 05/28/2019
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