Biological Considerations of Burnout, Part 1

Understanding the biology underlying burnout is important in order to fully appreciate the nature of the phenomenon and implement effective strategies to address it.

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Burnout is a commonly discussed condition that can affect individuals across any, and all, domains of life.  While it may have initially been recognized amongst high demand professions, it can impact us in other roles, including personal domains, such as parenting.  It is commonly believed that the prevalence of burnout is progressively increasing across all aspects of life.  There is frequent discussion regarding the causes of burnout and how best to prevent and manage it.

The issue of burnout is a crucial topic affecting healthcare professionals.  There have been numerous studies investigating the prevalence and impact of burnout, commonly amongst physicians.  There is strong reason to believe, however, that the issue similarly affects all professionals working within the healthcare field.  As discussed previously, this issue is of tremendous importance across all areas of life, both professionally and personally.  The focus of this article mini-series, however, will be within the healthcare domain.

Burnout is typically and variably described as manifesting through extreme levels of exhaustion; depersonalization; loss of fulfillment and/or joy in the affected role; the presence of irritability, frustration, negativity or cynicism, and anger; and a decreased sense of accomplishment.  While not formally a medical diagnosis, the most recent ICD classification provides a specific code for occupational burnout.  The World Health Organization considers burnout to be an occupational phenomenon.  It is also important to recognize that an individual who becomes burned out in one facet of life will likely have effects on their other roles.

The previous considerations are not specific to healthcare and while are often discussed only within the professional context, apply equally to personal roles, in particular parenting.  Within the healthcare professional context, the issue of burnout is thought to directly affect approximately 50% of physicians, although this is likely to be a conservative estimate.  It is also largely believed to be a major contributor to healthcare professionals leaving their traditional clinical roles and, even, the healthcare field itself.

For all of these reasons, it is of critical importance that steps be taken to address this issue.  In order to most effectively accomplish this, it is necessary to first understand the nature of the issue at hand.  Given the significance of the topic within the healthcare field, there has been frequent and common discussion regarding the causes of healthcare professional burnout.  While the source of this issue is multi-factorial, much of the conversation has focused on the healthcare system itself, the culture of the system, the high demands placed upon healthcare professionals, and the relative lack of resources provided.  The discussion typically includes blame being placed squarely on these factors and an emphasis on burnout not being the fault of the individual.  Beyond identification of these systemic issues, however, there is little recognition of causal pathways to becoming burned out.  As a result, the only solutions provided are related to changing the culture and nature of the healthcare system which would be a monumental task.  Furthermore, it is unclear exactly how to sustainably and realistically change the nature of the system in a fashion that would reduce the risk of burnout.

The purpose of this article mini-series is to provide additional important considerations regarding the causes of burnout and, in future articles, applying these insights into developing additional strategies to address this important topic.  From the outset it is important to emphasize that while these articles will not further emphasize the systemic and cultural factors within the healthcare system that are related to burnout, it is fully appreciated that these are significant.  More importantly, it is fully recognized that it is not an individual’s fault for becoming burned out.  With these two acknowledgements in place, it is appropriate to turn attention towards consideration of the biology of burnout.

As discussed above, the common discussion surrounding the causes and onset of burnout focus on the healthcare system itself.  Again, to reiterate, this is an important consideration.  There is, however, an equally important question to ponder.  If the healthcare system is the cause of burnout, why are there some healthcare professionals who are not affected and, in fact, by all accounts those who appear to thrive within the very system that is said to be the cause of burnout?

This important question, from my perspective, begs for a greater understanding of what causes burnout within the healthcare field and, by extension the larger population.  In his work, performance psychologist Michael Gervais, PhD has described burnout as being the result of an over emphasis on internal and external demands in relation to internal and external resources.  This equation intuitively makes sense and contributes to the understanding of the important question regarding why not all healthcare professionals become burned out.

From my perspective, however, this framework, while helpful, is incomplete.  There is little direct insight into the specific resources which are needed to combat burnout and it is also unclear how exactly the condition of burnout results from the imbalance of demands and resources for some but not others.  It is also possible to place some degree of fault, although this is not an inherent feature of the framework, on the individual for not having developed sufficient resources or managed demands adequately.

In my opinion, a more complete understanding of the phenomenon of burnout is provided through application of Polyvagal Theory.  As this theory describes the biological processes underlying the function of our nervous system it provides insight into the determinants of our experience.  For this reason, it is better able to describe the variable impact that the healthcare system and its culture may have across different individuals.  In addition, by virtue of the principles described by Polyvagal Theory, it becomes more readily apparent how stimuli in the healthcare environment interact with individual factors in the development of burnout.  Through implementation of a polyvagal informed paradigm, it becomes possible to not only better understand the factors impacting burnout, but develop strategies to reduce its risk and manage those who have developed burnout.

As with all Practices of the Healthcare Athlete, the biological understanding provided through the application of Polyvagal Theory is applied in the development of the polyvagal informed toolbox of mind-based and body-based skills and strategies.  The upcoming articles in this mini-series will explore in more detail the biological basis for development of burnout and, subsequently, skills and strategies to better manage this crucial issue.  

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Allison, M.  The Play Zone:  A Neurophysiological Approach to our Highest Performance.

Gervais, M; Carroll, P.  Compete to Create: An Approach to Living and Leading Authentically.  Audible Original; 2020.

Porges, SW.  Polyvagal Safety: Attachment, Communication, Self-Regulation.  New York: W.W. Norton & Company; 2021.

Porges SW, Porges S.  Our Polyvagal World: How Safety and Trauma Change Us.  New York: W.W. Norton & Company; 2023.

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