Burnout

• Burnout is defined as a “psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job.”¹
• Burnout consists of three components resulting from chronic stress:
  • emotional exhaustion (emotionally overwhelmed by demands);
  • depersonalization (feelings of detachment and dehumanization); and
  • decreased sense of personal accomplishment (feelings of inadequacy, failure, and poor professional self-esteem).²
• Jobs that result in greater burnout are those with a high frequency of client or patient interactions, and work duties that require a heightened need for emotional control while interacting with the public.^2,3
  • The inherent nature of MRT work and workplace factors can contribute to burnout among MRTs.
  • Job-based factors
    • Inherent stress of caring for sick and injured people.²
    • Working in a difficult emotional area such as palliative care⁴ and within trauma centres.
    • The introduction of new technologies.^4–6
    • Increased external control over healthcare organizations and services.²
  • Organization-based factors
    • A lack of career progression.⁷
    • Poor management.⁷
    • Poor working conditions including staff shortages, increased workload, interpersonal challenges, unsupported technological advancements and unreasonable demands.^5,8,9
    • Shift work.¹⁰
• Research indicates that the prevalence of burnout among MRTs is consistently high.
  • In the recent mental health survey undertaken by CAMRT with its MRT membership, emotional exhaustion and burnout were prevalent, with more than 57% of MRTs in every discipline reporting moderate or high levels of emotional exhaustion.¹¹
  • Across other literature, the prevalence of emotional exhaustion as a component of burnout ranged from 38% to 93% in surveyed MRTs in similar contexts such as Australia and the United States.^4,5,12,13
  • These results are consistent with other health professions.^4,14–17
• Prolonged periods of employee burnout have negative implications for the individual, patients under their care, and the effectiveness of the organization.²
  • Individuals may experience depression, anxiety, weight changes, headaches, mood swings, insomnia, muscle tension, hypertension, gastrointestinal disorders or flu episodes, increased substance use and even suicide.^4,18
  • Patient care may be impacted by a lack of adherence to practice guidelines or policies and procedures, increased communication errors and medical incidents, poor patient outcomes, and issues associated with other safety metrics.^19–22 Burnout among MRTs may also lead to decreased quality of patient care.^8,13,23
  • Employee burnout leads to several implications for the organization including increased absenteeism, employee intention to leave the organization, low job satisfaction, reduced productivity, and compensation claims.²

• MRTs should value their personal health and wellness and prioritize self-care.¹⁸
• MRTs can engage in individual strategies to help manage their stress and address burnout such as:
  • Increasing burnout awareness through personal screening of mental health, determining levels of stress and burnout, and keeping track of stressful events and one’s wellbeing.²
    • Such reflective practice through self-assessment can lead to acknowledging a potential problem and allow MRTs to identify healthy coping strategies (e.g., mindfulness, adaptive time management skills, and interpersonal training skills).^2,23
  • Initiating a healthier lifestyle and incorporating relaxation techniques to counteract the stressors.
    • As part of a healthy lifestyle, physical activity has been shown to be effective at preventing common mental illnesses and lessening their effects.^2,24
  • MRTs should promote a culture that recognizes and supports colleagues in need throughout training and practice.¹⁸
    • This can be achieved by encouraging help-seeking behaviours within one’s self and others.
    • Individuals who have supportive social relationships in the workplace may be able to rely on others to aid them in dealing more effectively with stressful situations.²
    • Obtaining reassurance of worth and the availability of guidance may lessen the effects of burnout.²
    • Actively seek out resources and programs available to you such as employee assistance programs.⁷

• Managers or other leaders in an organization should exhibit good leadership qualities including recognizing efforts, providing support, promoting work-life balance, and encouraging confidence and productivity to decrease the potential for burnout among MRTs.⁹
• Leaders can increase engagement and collaboration in the workplace, which can influence positive organizational psychology and contribute to staff satisfaction, health, and wellbeing⁹ through implementing collaborative decision-making, staff recognition, debriefing, incentive programs, open space meetings, sharing organizational goals, and giving effective feedback.^8,9
• Organizations can improve working conditions that contribute to burnout such as staffing levels, pay, flexibility, development opportunities, and department structure.⁹
• Organizations, by offering comprehensive employee assistance programs, can provide the following to prevent, address and mitigate burnout among MRTs:
  • Emotional and instrumental support at work such as peer support groups or peer group supervision (PGS).^2,7,9
    • PGS was found to be especially effective for early-career MRTs with 1-5 years’ experience.⁷
  • Access to treatment for mental health concerns and burnout, such as referral to psychotherapy or counselling, or stress-management in-services.^2,8,9
  • Staff resiliency training or other similar educational training programs.^8,9
  • Additional workplace strategies for mental health and burnout have been identified by the Canada Life Assurance Company.²⁵
• Leaders can increase awareness of available services that address burnout, and eliminate institutional and cultural barriers to access.¹⁸

Case Study – Burnout

Case Study – Burnout During a Pandemic

1. Maslach C, Leiter MP. Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103-111. doi:10.1002/wps.20311
2. Akroyd D, Caison A, Adams RD. Burnout in radiation therapists: The predictive value of selected stressors. Int J Radiat Oncol Biol Phys. 2002;52(3):816-821. doi:10.1016/s0360-3016(01)02688-8
3. Cordes CL, Dougherty TW. A review and an integration of research on job burnout. Acad Manage Rev. 1993;18(4):621-656. doi:10.2307/258593
4. Guerra J, Patrício M. Burnout in radiation therapists: Systematic review with meta-analysis. Eur J Cancer Care (Engl). 2019;28(3):e12938. doi:10.1111/ecc.12938
5. Singh N, Wright C, Knight K, et al. Occupational burnout among radiation therapists in Australia: Findings from a mixed methods study. Radiogr Lond Engl 1995. 2017;23(3):216-221. doi:10.1016/j.radi.2017.03.016
6. Clarke S, Goetz D. Unrelieved job stress can lead to burnout. Radiol Technol. 1996;68(2):159-160.
7. Dungey G, Neser H, Sim D. New Zealand radiation therapists’ perceptions of peer group supervision as a tool to reduce burnout symptoms in the clinical setting. J Med Radiat Sci. Published online 2020:1-8. doi:10.1002/jmrs.398
8. Sciacchitano M, Goldstein MB, DiPlacido J. Stress, burnout and hardiness in RTs. Radiol Technol. 2001;72(4):321-328.
9. Hunter D, Wright C, Pearson S. Employing positive psychology to improve radiation therapy workplace culture. J Med Radiat Sci. 2019;66(2):139-144. doi:10.1002/jmrs.321
10. Vidotti V, Ribeiro RP, Galdino MJQ, Martins JT. Burnout Syndrome and shift work among the nursing staff. Rev Lat Am Enfermagem. 2018;26. doi:10.1590/1518-8345.2550.3022
11. Canadian Association of Medical Radiation Technologists. A look into the CAMRT mental health survey results. CAMRT News. 2019;37(3):6-7.
12. Joaquim A, Custódio S, Savva-Bordalo J, et al. Burnout and occupational stress in the medical residents of oncology, haematology and radiotherapy: A prevalence and predictors study in Portugal. Psychol Health Med. 2018;23(3):317-324. doi:10.1080/13548506.2017.1344256
13. Probst H, Griffiths S, Adams R, Hill C. Burnout in therapy radiographers in the UK. Br J Radiol. 2012;85(1017):e760-765. doi:10.1259/bjr/16840236
14. Dall’Ora C, Ball J, Reinius M, Griffiths P. Burnout in nursing: A theoretical review. Hum Resour Health. 2020;18. doi:10.1186/s12960-020-00469-9
15. Ayyala RS, Ahmed FS, Ruzal-Shapiro C, Taylor GA. Prevalence of burnout among pediatric radiologists. J Am Coll Radiol JACR. 2019;16(4 Pt A):518-522. doi:10.1016/j.jacr.2018.08.016
16. Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of burnout among physicians. JAMA. 2018;320(11):1131-1150. doi:10.1001/jama.2018.12777
17. McCormack HM, MacIntyre TE, O’Shea D, Herring MP, Campbell MJ. The prevalence and cause(s) of burnout among applied psychologists: A systematic review. Front Psychol. 2018;9.