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Dr. Zanni is a psychologist and healthsystems specialist based in Alexandria, Virginia.

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What comes to mind when one thinks of occupational hazards? Most think of jobs involving heavy physical demands or exposure to potentially life-threatening situations. Pharmacists, however, are at high risk for a more subtle, insidious occupational hazard: burnout. It is psychologically and physically debilitating—even career-ending—and its warning signs should be red flags for all pharmacists.

Defining Burnout

Burnout, a multidimensional syndrome, is generally recognized only after symptoms wreak havoc. Acute burnout does not exist; slowly developing symptoms worsen progressively. Burnout's 3 core domains to recognize are as follows:

• Cynicism—negative job and workplace attitude, often directed at staff and clients, which leads to depersonalization (eg, a cold, distant attitude); considered by many as burnout's distinguishing characteristic
• Emotional exhaustion—feeling physically and emotionally depleted, apathetic, and indifferent
• Ineffectiveness—with time, a sense of inadequacy, which leads to devaluing one's own work and causes anxiety and trepidation from a belief that new work tasks are meaningless¹,²

Burnout and stress differ. Stress may cause emotional exhaustion, but burnout always generates cynicism and a sense of inadequacy (characteristics that are absent from normal job-related stress). Job stress, however, generally includes somatic symptoms (eg, anxiety) that are not necessarily present with burnout. One also is usually aware of stress reactions but does not always notice burnout (symptoms can take months to surface).

When workplace expectations and realities are disparate, burnout is a given. The following 6 areas are often troublesome for pharmacies:

• Work overload—when workload chronically exceeds realistic levels, staff is taxed with additional job responsibilities, and work–family boundaries become blurred, often exacerbated by on-call demands and e-mail communications
• Lack of control—inflexibility cramps novel approaches, job sharing, and innovation as staff struggles to stay within the limits of rigid procedures
• Breakdown in community—without a sense of belonging and job security, staff cohesiveness declines
• Unfairness—evaluations fail to recognize outstanding performance, or meager rewards are given randomly and without apparent reason
• Insufficient rewards—management rewards staff only rarely or emphasizes negative outcomes (ignoring successful efforts)
• Value conflict—the organization's actions differ from its public façade (eg, management emphasizes screening for drug interactions and safety in advertisements but provides antiquated technology), or increasingly an employee's values might be ignored (eg, an organization provides the morning-after pill but offers no conscience clause for employees to opt out of filling these prescriptions)²

Pharmacy is fertile ground for burnout due to chronic staffing shortages, the heavily regulated environment, excessive documentation, the inability to control requests, a focus on negative outcomes (eg, prescription errors), incongruence between expertise and job components (eg, certified in disease management but performing peel-and-stick bench work), lack of positive feedback (eg, drug-use reviews rarely commented on), and few rewards for improved patient care or preventing contraindications. Inadequate pharmacy resources seem to reach epidemic proportions. In a recent pharmacy poll, 61.5% of respondents indicated their employer has unrealistic expectations regarding work that can be accomplished in an 8-hour day.³

Burnout's Warning Signs

Although >30 signs of burnout exist, the box highlights 10 classic signs that relate to pharmacists. Not all will experience each symptom; most experience at least 1 in each of burnout's 3 domains. Identifying with ≥1 of the signs listed in the box occasionally or regarding specific incidents is normal. When it becomes constant, action is needed, or burnout will consume and debilitate.

Interventions

Pharmacists with burnout must self-assess, looking for workplace conditions that fuel burnout. The following are some effective strategies for each workplace antecedent:

Workplace Overload. Avoid focusing on quantity or working harder; instead, examine the process used to complete tasks with an eye to change. Explore job sharing or trading assignments with colleagues. Overhaul daily routine and reshuffle tasks.

Lack of Control. Define and separate work and home life. Avoid working while eating. Take breaks but avoid discussing and reading work-related material. Learn to say "no" when asked to voluntarily take on more assignments.

Insufficient Rewards. Seek positive feedback. Inform supervisors that both positive and negative feedback are important to you.

Lack of Community. Seek others suffering from burnout and form a peer support group. Initiate actions that foster interpersonal relationships; talk to a career-seasoned mentor.

Unfairness. Work with supervisors to improve the workplace. Document personal accomplishments to help ensure fairness.

Value Conflict. Seek out value-compatible assignments. Focus on the intrinsic value of your work, not on organizational constraints. Explore potential transfers. If the value conflict is irreconcilable, seek counseling or make a career change.¹

Young Professionals Take Note

Studies demonstrate that burnout affects younger professionals disproportionately, especially in the first 5 years of their career. Young or struggling pharmacists may hesitate to discuss concerns with supervisors, confusing feeling overwhelmed with personal inadequacy.^1,2 Because most managers rarely discuss burnout, the staff struggles. Some find successful interventions or a mentor to help; others quit the job or the profession. Adopting prevention strategies to ward off or minimize burnout is a key component of ensuring job satisfaction.

Table

Adapted from references 1, 2, and 4.

References

1. Maslach C. Burnout, The Cost of Caring. Cambridge, MA: Malor Books; 2003.
2. Maslach C, Leiter M. The Truth About Burnout. San Francisco, CA: John Wiley & Sons; 1997.
3. Smith M, Jaffe-Gill E, Segal R. Burnout: signs, symptoms, and prevention. www.helpguide.org/mental/burnout_signs_symptoms.htm. Accessed October 26, 2007.
4. PharmacyOneSource. Poll Results: Do you feel your employer has unrealistic expectations of what you can accomplish in an 8-hour day? www.pharmacyonesource.com/members/surveys/se/poll/results.asp?survey_id=557. Accessed October 8, 2007.