Lowering Expectations: A Promising Approach to Prevent Burnout

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One of the most common contributors to burnout is poor person-job fit, where an individual’s job fails to meet their needs (1). Often these needs are psychological, such as the need to feel competent at work or having a sense of autonomy when making work-related decisions. Person-job mismatch may be limited to the organization in which an individual works, but a more unfortunate scenario is when mismatch arises between an individual and their career.

Poor person-career fit is especially problematic in health care given the investment of time and resources necessary for entry into the field. For pharmacy specifically, students must commit to at least 6 to 8 years of post-secondary education, resulting in an average student loan burden of nearly $150,000 (2). A subset will go on to pursue postgraduate training, meaning that they will enter the field with nearly a decade already committed to their career.

Given these levels of commitment, what can be done to improve person-job fit? By the time students enroll in professional school, it is unlikely that they will consider alternative careers, as less than 3% currently withdraw of their own accord (3). Certainly we can expose students to the diversity of careers in the field, but the vast majority of positions remain in community and hospital/health-system practice. Unfortunately, many students do not get realistic previews of their career until the advanced practice experiences in the later parts of the curriculum. By this point, I expect students are even less likely to consider alternatives, as research suggests that we tend to forge ahead as we get closer to a goal, regardless of the costs we’ve already sunk into it (4).

One counterintuitive approach would be to implement what are known as expectation-lowering procedures (ELPs), where students receive education about the dangers of unrealistic expectations (e.g., how they are almost always unfulfilled, how they lead to job dissatisfaction and other negative work-related outcomes) as well as common examples from practice. When used as part of employee orientation programs, ELPs have been shown to improve job satisfaction and decrease turnover (5), likely because they prevent the characteristic rise and fall in job satisfaction that occurs during the “honeymoon phase” of a new career (6). Integrating ELPs into the curriculum may address at least one common critique I hear from graduates – that the careers they are exposed to in school, including those held by most faculty members (including me), are not very representative of those in practice.

A related and perhaps more important approach is to ensure that our recruitment efforts do not inflate expectations in the first place. Since students who have already selected pharmacy as a career path are unlikely to change course, it is incredibly important that high school and undergraduate students be given realistic previews of the field. At the same time, career features that are unlikely to exist for the majority of graduates should probably be downplayed, and those that do not promote long-term career satisfaction – or, as is the case with salary, may paradoxically undermine it (7,8) – should be avoided altogether.

The number of pharmacy applicants has declined in recent years, prompting the American Association of Colleges of Pharmacy (AACP) to focus on the student pipeline as one of its strategic priorities. In collaboration with the American Pharmacists Association and other key stakeholders, AACP launched the Pharmacy is Right for Me campaign to promote the profession of pharmacy and encourage students to consider a career in the field.

I applaud the effort by AACP and others to increase the awareness of pharmacy-related careers and hope it recruits the type of individuals for whom the field would be a great fit. The growing demand for health care professionals will only be met in the long-term if efforts to expand the pipeline do not inadvertently increase the number individuals who ultimately burn out and leave. Even more dangerous are those who feel obligated to stay – to pay off their student loans, for example – as dissatisfaction affects both the individuals experiencing it as well as the patients for whom they provide care (9).

References

  1. Brandstätter V, Job V, Schulze B. Motivational Incongruence and Well-Being at the Workplace: Person-Job Fit, Job Burnout, and Physical Symptoms. Frontiers in Psychology. 2016;7:1153.
  2. Mattingly TJ, Ulbrich TR. Evaluating the Changing Financial Burdens for Graduating Pharmacists. Am J Pharm Educ [Internet]. 2017 Sep [cited 2018 Jul 22];81(7). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663654/
  3. American Association of Colleges of Pharmacy. 2016-2017 Profile of Pharmacy Students [Internet]. 2018 [cited 2018 Jul 22]. Available from: https://www.aacp.org/node/1657
  4. Moon H. Looking Forward and Looking Back: Integrating Completion and Sunk-Cost Effect Within an Escalation-of-Commitment Progress Decision. Journal of Applied Psychology. 2001 Feb;86(1):104–13.
  5. Buckley MR, Veres JG, Fedor DB, Wiese DS, Carraher SM. Investigating Newcomer Expectations and Job-Related Outcomes. Journal of Applied Psychology. 1998 Jun;83(3):452–61.
  6. Boswell WR, Shipp AJ, Payne SC, Culbertson SS. Changes in newcomer job satisfaction over time: Examining the pattern of honeymoons and hangovers. Journal of Applied Psychology. 2009 Jul;94(4):844–58.
  7. Deci EL, Koestner R, Ryan RM. A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychological Bulletin. 1999 Nov;125(6):627–68.
  8. Judge TA, Piccolo RF, Podsakoff NP, Shaw JC, Rich BL. The relationship between pay and job satisfaction: A meta-analysis of the literature. Journal of Vocational Behavior. 2010 Jan 1;77:157–67.
  9. Dyrbye LN, Shanafelt TD, Sinsky CA, Cipirano PF, Bhatt J, Ommaya A, et al. Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care [Internet]. National Academy of Medicine; 2017 [cited 2018 Jul 22]. Available from: https://nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-underrecognized-threat-to-safe-high-quality-care/

Image credits: adapted from Rain and Steps by Nick Page (CC BY 2.0)