It is tough becoming a clinical audiologist. These days in the US there are the eight years of school, practicum, and politics required to obtain the credentials to work with hearing impaired patients. After such a rigorous process, the motivation to find a position and begin a practice to interact with patients each day is seemingly insurmountable. Audiologists often feel like a “kid in a candy store” with so many things to do, so many 
patients to see, so much literature to read, courses to attend and credentials to obtain, that clinic and work become an obsession created by all preparation.
After some years in the profession audiologists are, as other professions, susceptible to “burning out”. That hunger for information, new techniques, new products and the challenge of that new patient turn into “just another day” in the clinic. After some time in the clinic, no matter the country, no matter the setting, it can be difficult to rise up from sleep, get the kids off to school, get to the clinic and rise to the occasion of seeing that first patient of the day, then the next, and the next. Especially among clinicians, that fire from within wanes or burns out.
While burnout occurs in many careers, engineers, sales managers, tech support; clinicians are very susceptible and how to prevent it can be essential to a productive, forward moving career.he
What is Burnout?
According to Maslach et al ( 2001) burnout is defined as “an individuals response to chronic emotional and interpersonal stressors within the workplace”. The term “burnout syndrome” was coined 
in the early 1970s by Herbert J. Freudenberger, a New York psychoanalyst. Freudenberger had noticed that his own job, which was once so rewarding, had come to leave him feeling only fatigued and frustrated. Then he noticed that many of the physicians around him had, over time, turned into depressive cynics. As a result, those physicians increasingly treated their patients coldly and dismissively. Some sources consider burnout to be exhaustion, cynicism and inefficiency in work related issues, while others such as Freudenberger and North (2006) consider it a cycle. In a sidebar for an article in the Scientific American he felt that these burn out issues are often caused by the very ambition and hard work seen essential in clinical people, no matter what the discipline. They felt that there was a 12 stage burn out cycle:
1. A Compulsion to prove oneself. The beginning of burnout is often excessive ambition or a desire to prove themselves at work that turns into grim determination and compulsion. These clinicians must show their colleagues, and above all, themselves that they are innovative, empathetic, and clinically doing an excellent job in every way.
2. Working Harder. In an effort to meet their own high personal expectations, clinicians often take on more work, see more patients and concentrate on clinical problems. They become obsessed with handling everything themselves, demonstrating their “irreplaceability.
3. Neglecting Their Needs. Clinical schedules leave no time except for work, and they dismiss as unimportant other necessities such as sleeping, eating, and seeing friends and family. Clinicians often tell themselves that these sacrifices are proof of heroic performance and dedication to their patients and the profession.
4. Displacement of conflicts. Clinicians are aware that something is not right but cannot see the sources of their problems. To deal with the root causes of their distress they might set off a crisis, the crisis then seen as threatening. Often the first physical symptoms emerge at this stage
5. Revision of Values. Isolation, conflict avoidance and denial of basic physical needs change their perceptions. Clinicians revise their value systems, and things that were 
once important such as friends or hobbies are completely dismissed. Their only standard for evaluation of their self-worth is their job, and clinical ability. They become increasingly emotionally blunted.
6. Denial of Emerging Problems. Clinicians may develop intolerance, perceiving colleagues as stupid, lazy, demanding or undisciplined. Social contacts feel almost unbearable and cynicism and aggression become more apparent. They begin to view their increasing problems as being caused by time pressure and the amount of work they have, not by the ways in which they have changed.
7. Withdrawal. They reduce social contact to a minimum, becoming isolated and walled off, feeling increasingly without hope or direction. They work obsessively “by the book” on the job and may seek release through alcohol or drugs.
8. Obvious Behavioral Changes. Others in their immediate social circles can no longer overlook the behavioral changes. The once lively and engaged victims of clinical overload have now become fearful, shy and apathetic. Inwardly, they feel increasingly worthless.
9. Depersonalization. They lose contact with themselves. They see neither themselves nor others as valuable and no longer perceive their own needs. Their perspective of time narrows to the present. Life becomes a series of mechanical functions.
10. Inner Emptiness. Their inner emptiness expands relentlessly. To overcome this feeling, they desperately seek activity. Overreactions such as exaggerated sexuality, overeating, and drug or alcohol use emerge. Leisure time is considered to be dead time.
11. Depression. In this phase, burnout syndrome corresponds to depression. These overwhelmed clinicians become indifferent, hopeless, exhausted and believe the future holds nothing for them. Any of the symptoms of depression may be manifest, from agitation to apathy. Life loses meaning.
12. Burnout Syndrome. Almost all burnout victims now have suicidal thoughts to escape their situation. A few actually carry them out. Ultimately, they suffer total mental and physical collapse. Clinicians that have progressed to this phase require immediate medical attention.
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Next week at Hearing International we will review the symptoms so that you can see if this difficulty affects you!
References:
Craft, U. (2006). Burned Out. Scientific American Mind (June/July 2006), 17, 28-33. Retrieved November 9, 2016.
Maslach, C., Schaufeli, W. & Leiter, M. (2001). Job Burnout. Annual Review of Psychology, vol 51, No 1, pp-397-422.
Mayo Clinic Staff (2015). Job Burnout: How to spot it and take action. Healthy Lifestyle: Adult Health. Mayo Clinic. Retrieved November 9, 2016.
Images:
Clare Mann (2016). Burnout. Retrieved November 9, 2016.
