Susie’s situation shows how burnout works as a syndrome. The three aspects—exhaustion, cynicism, and diminished efficacy—influence one another, as my research with Christina Maslach has demonstrated. Exhaustion is not an end to a process. In addition to contributing to poor mental health and physical illnesses, exhaustion is associated with greater cynicism. To some extent, people stop caring about their work to avoid committing any more energy. To some extent, people jealously guard their remaining energy rather than squander it on a job that makes too many demands, provides too little support, and betrays all too often. In contrast with these people who have some energy, but they don’t want to invest it in this activity, some lack any energy to invest in anything. The critical issue is that employees’ capacity and their willingness for involvement in their work rests to some degree on their available energy.
The second major link in the burnout syndrome is between involvement and confidence. It’s hard to feel great about your work unless you’re involved profoundly. Professional efficacy comes from confidence in having excellent skills, knowledge, and ability. It also rests on confidence in making a valuable contribution.
In its pure form, burnout is the full combination: exhaustion, cynicism, and low confidence. When all three aspects are in full bloom, people experience serious problems. But, although the three aspects of burnout tend to travel together, they are not in lock step. Fairly frequently, people experience problems with only one or two aspects without encountering the full burnout syndrome.
For example, people may feel exhausted without necessarily losing their involvement. Emergency medicine requires extended periods of intense effort, often interfering with sleep, relaxation, and personal relationships. But the work is involving. It motivates people to apply highly developed skills that make a difference in their patients’ lives. This type of work wears people out but increases their efficacy by supporting their effect on others and the importance of their contribution through their work. So, it is not at all surprising to find people working in emergency medicine who report high exhaustion combined with low cynicism and high efficacy.
Rosa, a trauma centre physician in a metropolitan area, worked long shifts and worked them often. The trauma center had difficulties maintaining enough qualified physicians, so they regularly called upon Rosa to work extra shifts. For a few years this arrangement worked well with Rosa feeling exhilarated by the novelty of the position. Although some people overcome difficult circumstances through dedication and talent, some are crushed under the load of excessive work. What will become of Rosa?
We’ll take that up in the next post.