Beth DeJongh, PharmD, BCPS, BCPP
Director of Continuing Professional Development
American Association of Psychiatric Pharmacists
At AAPP 2023, Dr. Jason Bonner, PhD presented on “Burnout Among Psychiatric Pharmacists: A Discussion of Drivers and Evidence-Based/informed Interventions to Improve Clinician Well-Being.” Dr. Bonner is a Clinical Health Psychologist in Primary Care-Mental Health Integration with the U.S. Department of Veterans Affairs (VA) at the Durham VA Health Care System. He is a subject matter expert on stress, burnout, coping, well-being and resilience for pharmacy residency training and provides guidance on issues intersecting wellness and pharmacy training.
Dr. Bonner reviewed the dimensions and drivers of burnout. Dimensions of burnout include exhaustion (stress), cynicism (negative attitude, withdrawal from the organization’s goals and values), and inefficacy (low morale and job satisfaction). Drivers of burnout include workplace, intrapersonal, and external factors. Mismatches in areas of worklife contribute to workplace factors of burnout as described in the slides below:
Intrapersonal factors that contribute to burnout may include personality traits, internalized core beliefs, medical/psychiatric history, and interactions with sociodemographic factors. Factors outside the workplace (external factors) also drive burnout. Examples include the COVID-19 Pandemic, social justice issues, and political upheaval and polarization.
While there are studies with clinical pharmacists demonstrating consistently high levels of burnout across all domains (exhaustion, cynicism, inefficacy), there are no studies on burnout looking exclusively at psychiatric pharmacists. The lack of literature examining the prevalence of burnout and potential mitigation interventions is a unique challenge to psychiatric pharmacists. Another unique challenge for psychiatric pharmacists is the increased number of patients seeking mental health care since the onset of the pandemic, coupled with a system that was already fractured, underfunded, understaffed, overworked, and burned out. Empirical literature suggests that as a cohort, pharmacists hold more stigmatized beliefs about seeking mental health support, have less awareness of mental health resources, and access mental health services at lower rates than the general population despite having higher rates of distress and mental health symptoms than the general population and other healthcare professionals.
There are individual and organization level interventions that can help prevent and address burnout. At the individual level, active coping skills such as proper nutrition, regular physical activity, proper sleep, active relaxation (e.g., medication, yoga), engagement in pleasurable activities, and social interaction are beneficial. Values-based living is helpful for targeting cynicism and inefficacy. Individuals should try to live their lives aligned with their values, which requires awareness of and connection to what is valued. Goals aligned with values should be developed, pursued, and re-evaluated from time to time. Finally, using mental health resources, developing resilience, and role modeling active coping and help-seeking skills are important individual-level strategies.
While individual strategies to address burnout are important, they often have limited long-term effects without sustainable organizational change. There are several evidence-based organizational-level interventions that should be considered:
Finally, a hybrid individual/organizational strategy shown to reduce burnout and improve engagement is job crafting. Job crafting allows the employee to shape their work practice to align with their personal interests and values. Types of job crafting include cognitive, task, and relationship crafting.
A limited body of evidence indicates both organizational-level and individual-level strategies are need to successfully mitigate and prevent burnout.