“I’m so busy and stressed now that I’m working—and I thought grad school was bad!” “I’m so tired.” “I am sick of doing a good job and not being valued.” “Stick a (tuning) fork in me, I’m done!” A single term can describe what these individuals are feeling—burnout. Burnout is related to stress, frustration, and exhaustion that is emotional (Glasberg et al, 2007; Lavinder, 2005), physical (Felton, 1998), psychological (Jacobs et al, 2012), and/or spiritual (Crandell and Kreisman, 2004). Regardless of how broad the definition of burnout, studies agree that burnout results in “lowered production, and increases in absenteeism, health-care costs, and personnel turnover,” and produces “both physical and behavioral changes” (Felton, 1998, p. 237). While much has been written about burnout in the general population, this article will discuss the sources of burnout, susceptibility to burnout, and possible solutions to burnout for audiologists.
Sources of Burnout
Burnout inventories assess general factors that relate to burnout. One measure often used is the Maslach Burnout Inventory (MBI) (Maslach et al, 1996). The MBI consists of the following three subscales:
- Emotional exhaustion
- Depersonalization—“an unfeeling and impersonal response toward recipients of one’s service, care, treatment, or instruction” (Maslach et al, 1996, p. 194)
- Personal accomplishment
Higher emotional exhaustion, higher depersonalization, and lower ranks of competence and one’s personal accomplishments are correlated to burnout. Another questionnaire that provides a useful general framework is The Copenhagen Burnout Inventory (CPI) (Borritz et al, 2006). The CPI has questions related to three different aspects of burnout: personal burnout, work-related burnout, and client-related burnout. Adapting the CPI model, I propose that there are four sources of burnout for audiologists: (1) personal, (2) work-related, (3) client-related, and (4) audiology-specific. It is helpful to discuss the stressors within these sources of burnout separately, keeping in mind that stressors may overlap categories and can have a cumulative effect on an individual.
Life stressors are the primary source of personal burnout. One method of assessing our life stress is the Social Readjustment Rating Scale (SRRS) (Holmes and Rahe, 1967). The SSRS assigns values to each life event and then the total stress of an individual can be calculated—the higher the overall number, the more stress the individual may be experiencing. We often do not realize that positive events in our lives (e.g., graduating, starting a new job, moving, and getting married) can be sources of stress. The addition of negative life stressors, such as illnesses or deaths of family members or close friends, add further stress. While personal burnout is a gestalt of non-work and work-related stressors, work-related burnout is often evaluated separately.
Work-related burnout can happen to anyone who is employed or volunteers. Work-related stressors may stem from a perceived lack of support, recognition or autonomy from one’s colleagues, supervisors, or from the organization itself (Gupta et al, 2012; McLaughlin et al, 2008). An employee who feels their employer has unreasonable demands in terms of workload or expectations, or who disagrees with some of the policies or procedures of the organization and therefore has to “deaden one’s conscience” (Glassberg et al, 2007, p. 399) to remain employed there is more prone to burnout.
All professionals who work with clients, especially in health care, can be susceptible to client-related burnout. Client-related stressors are related to issues that limit perceived effectiveness when working with clients (McLaughlin et al, 2008). Depending on your setting, lack of autonomy in providing care to clients may be a major stressor (Gupta et al, 2012; McLaughlin et al, 2008). Other client-related stressors may include time allotted for both clinical appointments and non-clinical responsibilities, and meeting expectations of clients and families (Glassberg et al, 2007; Gupta et al, 2012).
Audiology-specific burnout is associated with the specific work-related and client-related activities of audiologists. Audiology was ranked as one of the top-ten least stressful jobs every year from 2011–2016, according to CareerCast.com, because audiologists “usually are in control of their schedules and work in a quiet environment” (CareerCast.com, 2015), and “The job is not typically physically demanding or stressful, but it does require a keen attention to detail and focused concentration” (CareerCast.com, 2012).
Although outsiders providing such rankings may not be very familiar with audiology, our field presents unique stressors and challenges. For example, Severn et al (2012) found six main factors that accounted for much of the stress for audiologists: time demands, audiological management, patient contact, clinical protocols, accountability, and administration or equipment. To summarize, audiologists would experience stressors and challenges unique to audiology that fall within the other three sources of burnout, as shown in FIGURE 1.
Susceptibility to Burnout
Keep in mind that individuals differ in their susceptibility to burnout. A set of circumstances and events that may cause one person to experience total burnout may cause another person only minimal burnout symptoms. Burnout appears to transcend cultures (e.g., Brännström et al, 2016; Gupta et al, 2012; Severn et al, 2012; Sihag and Bidlan, 2014). In addition, people with different responsibilities within the same work setting, as well as across different work settings, may be prone to burnout. For example, Borritz et al (2006) reported data on work-related and client-related burnout for employees in human service work. Participants included office assistants, social care assistants, physicians, nurses and supervisors, in settings as diverse as psychiatric prisons, hospitals, and urban and rural home health. Results suggested that there were differences in the amounts of work-related burnout and client-related burnout across the various employees’ positions and across different settings, but all employees experienced some combination of these stressors (Borritz et al, 2006). Research suggests that the career stage of the audiologist and the practice settings and responsibilities may correlate to burnout.
Career Stage of Audiologists
Audiologists across career stages may experience the symptoms of burnout. At least one study found a greater susceptibility for burnout amongst audiologists in the field for less than 10 years when compared with their more experienced colleagues, specifically for emotional exhaustion (Blood et al, 2008). In contrast, Severn et al (2012) stated that “the increasing age of the audiologist was found to predict higher levels of burnout” (p. 6). Each career stage, from student to seasoned audiologist, has some unique stressors.
Students can experience burnout even before beginning their careers (Bresó et al, 2011). The stress can begin as undergraduate students making a decision to choose audiology over speech-language pathology. Suddenly, these students may feel that they are outsiders, especially at undergraduate programs that do not have a doctoral degree in audiology. Doctoral programs present their own unique stressors in terms of didactic and clinical training. Once graduated, audiologists experience other stressors.
Practicing audiologists may experience different stressors as new practitioners, mid-career audiologists, and clinicians approaching retirement. While these signs and symptoms are not exclusive to experience level, certain issues may affect individuals more in one group than another. Recent AuD graduates may feel the stress of a new position along with stressors from other life issues that often accompany the transition from student to professional such as moving, student loans, and other expenses, etc.
In terms of work-related stressors, new audiologists “have to become acquainted with new bosses, new colleagues, and perhaps different equipment than they were trained on. Procedures and protocols may not be the most efficacious or expedient, but they have not necessarily gained the confidence to discuss them or the “right” to be heard. They may need to fit hearing aids from companies whose products and software they are not as familiar with or perhaps don’t prefer. All of their patients are new and unfamiliar at this point, and some may take younger audiologists less seriously. Other stressors may involve financial issues resulting from student loans, or taking on more responsibility and a greater patient load than they feel comfortable with because they may not think they can talk about workload with their boss.
Mid-career audiologists may experience boredom due to the redundancy of the job or because they may start to treat audiograms rather than individuals (“This is the fifth symmetrical, high-frequency, sloping hearing loss I’ve seen this week!”). They may gradually begin to provide equipment rather than to promote empowerment to their clients. Another contributor to burnout could be the perceived lack of career growth or advancement within the practice or company. Change within an institution is usually stressful. However, a perceived lack of needed change, adaptation, growth, or progress can lead to further stress and lower job satisfaction.
Audiologists closer to retirement may experience burnout due to the changing technological demands of the job; for example, having to switch from a standard desktop audiometer to a CPU audiometer or from paper-based to electronic medical records. They may feel like their methods are being questioned or challenged from students, colleagues, or supervisors. They may also feel a lack of respect or value that they think is deserved based on their years of experience. A decline in their own health or physical changes due to aging that affect their job performance may further add to stress.
Practice Setting and Responsibilities
Research has suggested that audiologists’ practice setting can have an effect on burnout, although the trends are not clear. One study found that most educational audiologists reported relatively low amounts of stress and rated their job burnout as low or average (Blood et al, 2008). However, another study reported that pediatric audiologists reported higher stress associated with audiological management than audiologists working with adults (Severn et al, 2012). The highest levels of stress were reported by audiologists working in public hospitals, in part due to the heavy workload and requirements for documentation (Severn et al, 2012; Swidler and Ross, 1993). In this setting, stressors may include busy workloads that may limit quality interaction with patients, time allotted to work on reports, and dealing with grief reactions of patients, parents, or family members.
Solutions to Burnout
Like many health issues, burnout prevention is a much healthier option than treatment once it has occurred. To limit the effects of personal- and audiology-related burnout symptoms, you must have awareness of the problems or stressors, ability to change, and agility to change quickly enough to mitigate the effects of the stressors.
Awareness. Being aware of your situation and how you think and feel about events is important to recognize and reduce stressors. One measure to quickly evaluate the different facets of your life and to determine which areas might need a little more attention is the Balance Beam (Crandell and Kreisman, 2004). Specifically, the Balance Beam helps you to evaluate satisfaction in the areas of friends and family, career development, money and finances, home and physical environment, health and fitness, and romance and significant other (i.e., intimacy). Evaluating these life areas may help you become more mindful of which areas you are doing well and which areas might need a little more attention.
Ability. Once you are aware of your more specific stressors that may lead to burnout, you should assess your ability to change. You can prioritize personal and professional needs. You may be able to change the stressors themselves; however, more often you may have a greater ability to change the way you think about the stressors. Reflecting on how to change the stressors that you are able to change, understanding the stressors that you cannot change, and discerning the difference will help focus your physical and emotional resources.
Agility. Burnout symptoms take some time to develop and they will also take some time to overcome. Prioritize your actions to reduce stressors. It is better to take some more immediate, smaller steps to help—steps that you have the ability and agility to do. Once these steps have been implemented, the more reflective, slower-to-achieve steps may be worked on over time. It may be useful to seek counseling for the larger steps if one feels it would be helpful. As larger steps tend to be more involved and individualized, you will focus more on the initial steps. These steps may seem simple, but they can have a synergistic effect on alleviating some stressors.
Using the various life areas of the Balance Beam, here are some examples of things you can do to bring your life into balance.
Family and Friends
- Try initiating one contact per week (by phone or e-mail) to build these relationships.
- Set a goal to spend at least 10 minutes of quality time with each child per day.
Home and Physical Environment
- Take positive actions to change the environment if possible, such as staying organized and keeping the home clean.
- Inexpensive upgrades, such as paint, can change the feel of a room or house without much cost.
Money and Finance
- Discuss finances with a significant other and set a budget, if necessary.
- Many books on personal finance will suggest saving money in an emergency fund and then paying down credit card debt as a couple of first steps toward healthier finances.
Health and Fitness
- Try taking some small steps toward healthier eating.
- One simple exercise goal is to try to get 10,000 steps per day. If that seems overwhelming, attempt an average baseline of steps for a week and then add 2,000 steps as a goal, or around a half-hour of additional walking. Being intentional about getting exercise will help prioritization.
Fun and Recreation
- Consider getting a new, enjoyable hobby.
- Plan TV watching—watch a show and then turn off the TV.
Romance and Significant Other (Intimacy)
- Plan a date night every two weeks.
- Quality time can increase the quality of communication between significant others. If finances are an issue, make it a fun challenge to design quality date nights with few financial resources.
Personal and Spiritual Growth
- Schedule quality time for yourself to do something that refreshes you.
- Recognize the sources of pain and stress in life and practice forgiveness. Forgiveness does not mean that you forget the negative things someone did, but rather choose to no longer hold those things against the person. Sometimes, it may make sense to talk with the person about the hurts he or she may have caused—other times, just forgiving that person within yourself is enough.
Taking steps in your personal life to alleviate stressors will help guard against burnout. Likewise, you need to evaluate our audiology-specific stressors (i.e., work-related and client-related stressors).
Awareness. Stressors that are audiology-specific may include time demands, audiological management, patient contact, clinical protocols, accountability, and administration or equipment (Severn et al, 2012). When you are feeling the symptoms of burnout related to your job, you should think through these categories to try to determine which areas are the primary stressors.
Ability. As with personal stressors, you will have an ability to change some of your audiology-specific stressors more easily than others. It is essential to begin focusing on the positive aspects of your work (Gupta et al, 2012; McLaughlin et al, 2008). One easy technique is to think of three positive things that happen each day on the job. For example, three positive things at work might be: a particular client finally being able to hear better after the eighth adjustment session, contributing to developing a better protocol for the clinic, and getting caught up on chart notes. Consider the implementation of new technology, equipment, or protocols as a welcomed challenge rather than a rude disruption. Again, by recognizing the stressors, you may be able to change and implement a successful outcomes plan.
Agility. Agility to change your audiology-specific stressors involves taking some more immediate, smaller steps to help limit some stressors. Small actions can have a synergistic effect in dealing with audiology-specific burnout. Below are some suggested steps to take, based on the factors of Severn et al (2012), while you develop longer-term plans to reduce other stressors.
Time demands were the highest audiology-specific stressor (Severn et al, 2012) and are often an issue across our personal and professional settings. One quick change is to take a short break so that you can refresh yourself a little bit. Your patients will survive if you are five minutes late because you took a short break to eat lunch instead of skipping it again. Would you be as physically and mentally healthy without that break? Another method to stay on schedule is to state the amount of time you have with our patient at the beginning of the session and to give them a 10-minute warning toward the end to be sure they stay focused and ask the questions that are of highest priority to them, so that you can end each appointment on time.
Audiological management, patient contact, and patient accountability are all related. You probably got into this profession to help others. It’s too easy to get into a pattern of treating audiograms and not clients. Try to think outside of the box. For example, ask a new follow-up question during your case history, such as, “Tell me about a favorite activity that you don’t do anymore but you would do again if you could hear better.”
Think about how you can empower, not just equip. How do you provide value-added service to your clients and get off of your “treatment treadmill?” If you don’t currently use a questionnaire to measure outcomes, you may want to start. By getting back in touch with the individuals you work with, you will likely regain some level of fulfillment that got you started in this profession.
In addition, gather data to demonstrate your effectiveness. Taking time to counsel your patients and provide better outcomes may actually save time in the long run with lower device return rates, less follow-up appointments, etc.
The way that you choose to deal with emotionally charged events, such as telling parents about their child’s hearing loss, can impact your personal and professional well-being. Consider being present in the moment. If you can enter into the grief of the family, it may also be easier to exit out of the grief rather than carrying it with you. Being able to monitor whether you are fully engaging with clients is important to prevent against “the depersonalization of the provider-patient relationship” (Felton, 1998).
Clinical protocols should be reviewed yearly to ensure that they are efficient and efficacious. Questions that should be asked might include
- Are there more expedient ways to do the test while still getting accurate results? For example, step masking may be more time efficient than the plateau method.
- What additional information is gained from this test, that you would not otherwise have, to reach a diagnosis?
Another method of indirectly reviewing your clinical protocols is by taking on a preceptor role. Teaching others forces us to think through the rationale for every procedure and intervention. Attending conferences and seminars to increase your knowledge may also help in this area.
Unless you own a private practice, you have to deal with administration and the equipment they provide. Try to be polite, open, and honest with your supervisors about areas in the practice that might be improved. If they listen, some stressors may be alleviated. Other stressors may take longer before you can alleviate them or may not be alleviated completely. For example, you may be able to delegate certain tasks to an audiology assistant, administrative assistant, or student; however, you need to take the time to train the individual first so that you can feel comfortable delegating.
Lastly, you may need to consider changing your work setting. Sometimes a setting that seems busy and exciting at first can eventually wear you out. If you have tried other strategies to prevent burnout and are still experiencing symptoms, a change of work setting may be the last alternative to ensure that you do not burn out. Keep in mind, however, that there is also some stress with new job settings, as previously discussed.
Ultimately, no one can know your individual life stressors better than you. No one can determine the life areas that need more attention better than you. No one knows what steps to take to protect yourself against burnout better than you. By becoming aware of your stressors, knowing that you have the ability to change, and having the agility to make small changes quickly while you begin to work on longer-term changes, may help you to prevent burnout.