Introduction

In today’s world, it is common for such a changing environment to generate greater pressures on organizations in matters of competitiveness through better products and services, which also translates into greater demands for the workers that integrate them. All of this promotes the appearance of diseases such as stress, which is defined by ^{Durán (2010)} as:

“an adaptive response, mediated by individual characteristics or psychological processes, which at the same time is a consequence of an action, situation, or external event that presents to the person special physical or psychological demands”.

In México, unfortunately, around 75 % of people suffer from stress and point to the labor environment as the origin (^{Morante, 2012}), which represents a constant risk for the staff to suffer psychological, medical and psychosomatic problems, placing at risk their productivity in the workplace, in addition to their health. If labor stress is maintained for long periods of time, this can become a chronic problem, called Burnout syndrome (^{Joffre, Saldívar and García, 2008}), where naturally there are ingredients such as excess work, minimum use of abilities, disinterest, among other factors, whose result is associated to situations of conflicts of interest, role ambiguity, lack of communication, among others. ^{Edelwich and Brodsky (1980)} describe it as a loss of interest related to ideals, strength and aspirations. ^{Hernández, Terán, Navarrete and León (2007)} mention that some of the individuals that suffer this, feel dissatisfied.

According to ^{Cárdenas, Méndez and González (2014)}, it is common for those who suffer this workplace pathology to show certain levels of problems with the relationship they have with their family, friends, coworkers, and other similar social groups. Likewise, negative feelings and bad attitudes towards their coworkers are generated, and in fact, towards the professional functions that they carry out, in addition to manifesting they are in an emotional state of exhaustion.

In organizations that belong to the government, although it is not exclusive to them, the Burnout syndrome is present more frequently, particularly in those workers who are in permanent contact with users to whom they offer a service. Such is the case of teachers that work in schools and universities, doctors and nurses who provide services in clinics and hospitals, and police officers who work in public safety organizations, among others. The pioneers of the study of Burnout are ^{Cristina Maslach and Susana Jackson since 1981} (^{Díaz et al., 2015}), whose research was focused on workers from public service agencies where they found that this type of workers established their expectations in function of achievements their own employers were reaching, finding that when the latter didn’t reach their goals problems of disillusionment were generated among workers, which with time became the Burnout syndrome (^{Hernández, Campos and González, 2011}).

The Burnout Syndrome

Burnout means “to be burned” and Dr. Freudenberger was the first one to recognize this workplace pathology in 1974. As the years went by, diverse conceptualizations of this construct were triggered; however, they discovered that there is an association with chronic interpersonal distress that takes place in the work practice (^{Hernández, Campos and González, 2011}). ^{Carlín (2014)} mentions that Burnout can happen at three moments: 1) imbalance between what the job demands and the individual capacity there is to deal with it; 2) the result that this aspect generates, that is, that the worker unleash a state of (emotional) exhaustion, certain level of tension, and signs of fatigue; and 3) a defensive response where changes are generated in the attitudes and behaviors of the worker towards others.

For ^{Lara (2013)}, the Burnout Syndrome is made up of three aspects or dimensions: 1) Emotional exhaustion, which describes the individual’s affective states and sensations, characterized by a lack of energy and of emotional resources; 2) Depersonalization, which is characterized by negative attitudes and sensations about others; and 3) Derealization, where the workers with this affliction experience a great discontent and dissatisfaction towards their tasks, accompanied by a negative opinion of their career progress.

Various authors coincide in arguing that workers who have more contact with people, such as doctors and nurses in hospitals, are the most prone to have Burnout Syndrome as consequence of excessive work that provokes a series of physical, behavioral, emotional symptoms, in interpersonal relationships, and low work performance. In many cases, the presence of the Burnout Syndrome is associated to work stress. Stress is a physiological process that is triggered by a specific labor situation that provokes a significant imbalance between the demand that a subject experiences and the adaptive resources that he/she has. Selye, since the 1950s, suggested two forms of stress; the first, generator of a positive activation capable of revealing the best potential in each person, which he calls eustress; and the second, of the contrary sign, called distress, resulting from feeling overwhelmed by the workplace demands and which translates into bodily sensations, feelings and thoughts that cause unease (^{Hernández, García, Carrión and Navarrete, 2015}).

Method

Results and Discussion

Table 1 shows that the highest mean scores were obtained in the dimension of Emotional Exhaustion (mean=2.24) comparatively with the score that the Depersonalization dimension showed (mean=1.27). Contrary to this, a higher score was obtained in the dimension of Derealization (mean=4.52).

Table 2 shows the levels of Burnout Syndrome identified in the medical staff surveyed, as well as the number of corresponding cases. According to the Maslach measuring scale, the average of Emotional Exhaustion was 35.8 (high level) for a total of 76 cases, equivalent to 50.7 % of the sample total; 20.9 (medium level) for a total of 50 cases, and 8.9 (low level) for 24 cases, corresponding to 33.3 % and 16.0%, respectively.

For the case of the dimension of Depersonalization, a score of 17.4 (high level) was obtained in 15 cases (10.0 % of the sample); 10.5 (medium level) in 45 cases and a value of 3.0 points (low level) in 90 cases, corresponding to 30.0 % and 60.0 %, respectively, of the total analyzed.

For the dimension of Derealization, a score of 22.8 (high level) was obtained in 12 cases, equivalent to 8.0 % of the sample total; 32.6 points (medium level) in 36 cases, and 40.8 points (low level) in 102 cases, corresponding to 24.0% and 68.0%, respectively, of the total analyzed.

Importantly, and with the purpose of testing the main hypothesis of the study, the following statistical tests were performed:

Mann-Whitney. To calculate the U statistics, each one of the values of the two samples is assigned its range, where n ₁ and n ₂ are the respective sizes of each sample and R ₁ and R ₂ are the sum of the ranges of the observations from samples 1 and 2, respectively. Performing the test it was found that with a confidence of 95 % there is evidence that there is Burnout in the doctors.

The Kruskal-Wallis test is the most adequate method to compare populations whose distributions are not normal. In fact, when the populations are normal, this contrast functions very well. This is also adequate when the typical deviations of the different groups are not equal between each other. The null hypothesis of the Kruskal-Wallis test mentions that the median k’s are equal. The result from the test confirms the existence of Burnout.

According to Table 2, hypothesis 1 is partially accepted: “there is a level that ranges from medium to high of Burnout Syndrome in medical staff of a public sector hospital in Hidalgo, with the Emotional Exhaustion dimension being the one that predominates most, according to the MBI model”, since effectively the dimension of Emotional Exhaustion is the one from the MBI where the Burnout cases are most appreciated, which range from medium level to high, that is, 126 doctors present Burnout (84 %). However, in the two remaining dimensions, in more than 90 % of the cases their levels of Burnout are not alarming, that is, they are still at low levels.

The emotional exhaustion present in the medical staff is due perhaps to a certain type of discomfort and physical fatigue, due primarily to the total of hours that they work in their shift and the dynamics that they have particularly when they go from one area to another to revise their patients, although we cannot rule out some other important motives, for which it is necessary to include some other variables in the instrument and perform more empirical tests. On the other hand, it is important to mention that when a doctor is affected by the syndrome in its main dimension, which is emotional exhaustion, he/she shows attitudes that have an impact on the patients, with coworkers and their own work, because the way of facing it is fragile and insufficient (^{Magalhães et al., 2013}).

Additionally, according to the Mann-Whitney and Kruskal-Wallis statistical tests, it was possible to confirm that there is the presence of Burnout in the medical staff of a public health institution in the state of Hidalgo, which opens the possibility of having a certain level of interference in their work performance.

There is a positive relationship between the emotional exhaustion dimension with the Burnout Syndrome present in the doctors, that is, it is the dimension that is potentiating most the level of stress, by taking it little by little over time to a chronic state. In relation to the literature consulted, the Burnout is increasingly more present in health workers, affecting their work performance, presenting similar results in relation to Emotional Exhaustion in countries like México and Spain (^{Castillo, Orozco and Alvis, 2015}).

Conclusions

In this study, it was identified that the prevalence of the Burnout Syndrome in the medical staff of a public sector hospital is present in levels that range from medium to high, primarily in one of the three dimensions analyzed: emotional exhaustion, which can be having an effect in the work performance of the health staff. The early and timely identification, as well as the implementation of a program for prevention and treatment, are priority.

It is advisable that in future studies, performing Burnout Syndrome studies should be considered for all of the staff that works in health institutions, including directive and operative staff in different categories of work, as well as correlating the levels of Burnout with some sociodemographic variables. The literature consulted coincides with the fact that doctors carry an excessive workload throughout the week, primarily in hours when there is more demand, which implies a reduction of the workdays or making pauses (^{Carrillo, Gómez and Espinoza, 2012}). In relation to the authors ^{Magalhães et al. (2013)}, it is considered important to be able to analyze the seniority and years of service of the medical staff in relation to the dominion of emotions in face of stressful situations.