In your contracts, define what happens if you are too sick to finish a project in time. This whole situation has making me physically sick as well, I'd always be on the edge of being sick -- and I think I'm now connecting the dots that my physical condition is stress-related from work. This is called Krankengeld. It is driven by a chronic imbalance between job demands 1 Job demands are physical, social, or organizational aspects of the job that require sustained physical or mental effort and are therefore associated with certain physiological and psychological costsfor example, work overload and expectations . 6 Each team has different rules for this. Keep in mind if you fell ill on Friday then the Weekend is also counted toward your Sick days. You're eligible to receive sick pay (Krankentagegeld) after 43 days have passed under public health insurance. This website is my full time job. Your health insurance is covered on a page. Public agencies and schools, however, do have to follow FMLA, no matter how many employees they have. Substantial burnout among health care workers has been made worse by the pandemic. These individuals are at elevated risk for having a car accident. Please feel free to leave any comments or thoughts about the content of this article! This exception regulation applies until. When so, on the first day you miss work due to your illness, you must present the appropriate document from the doctor. Ask your employers which rules and regulations apply to you. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. If you have experienced stress as being overwhelmed and like you are drowning without being able to grasp for air, burnout feels like you are all dried up. Youre working for a government-run health insurance plan that you contribute to. Can I stay at home when my child is sick? When you are on sick leave, you do not have to do any work. You do not have an employer who pays your salary while you are sick. You can calculate the amount you would receive as sick pay viathis calculator. What types of health insurance are there to choose from, and which[]. After 6 weeks of sick pay and 78 weeks of Krankengeld, you must go to the Arbeitsagentur, and apply for disability benefits. Burnout is defined as a state of chronic stress and frustration that leads to: Physical and emotional exhaustion. This will make it harder for patients to get . If you have private health insurance, you only need to inform your insurance of your sick note if you have the right forKrankentagegeldas part of your tariff. How do I approach this conversation with my boss? You can still do things that don't hurt your recovery.17. HEXAGON, Go to company page If you have a mortgage, or if your family depends on you, you should get disability insurance. As indicated in The Working Time Regulations 1998 (stress.org.uk): Moreover, in regards to employees, they have the duty to take reasonable care of their own health and safety and of others who may be affected by their actions. The employer is obliged by law to continue payment during the first year and second year of the Sick Leave. If you fall sick during your vacation, you can claim them as sick days and save your vacation days. Sometimes it is referred to as stress leave even if you are experiencing burn out. Risk Factors. During this time, she received half of her salary through Canadas employee insurance program (as well as the assurance that her job would be there for her when she returned). Most employers ask for a sick note if you are sick for more than 3 days. The sick note itself consists of three parts: If your employer does not believe that you are, in fact, sick or unable to work, they can inform your health insurance company. Most health insurances offer the option to upload a picture or scan of the sick note in your member area. It does, however, require getting a burnout note from a medical professional. For the first 42 days of your sick leave, your employer pays your full salary.12 You get paid for the days that you are supposed to work.12. You should not be "shopping" for a medical leave. If you are unable to work, you must notify your employer right away. The possible repercussions are varied. It does not hurt your recovery. Doesnt really matter, your mental health is more important than a job. This could be a reason to get fired. It allows us to keep Simple Germany alive and striving. Practicing good self-care can make recharging easier while you try other strategies to reset. Burnout costs German workplaces 9 billion euros annually in lost productivity. I had to arrange an additional meeting to state more directly that I indeed would be taking the leave my doctor recommended, she says. The doctor determines how many days you will be unable to work before you recover based on your diagnosis. Yu Tse Heng. Living in a new country can be a great experience but it can also take a significant toll on your mental health. This way, we stay motivated and bring you all you need to know about Germany. Here, you'll find a supportive and welcoming community where you can share your stories, ask for advice, and make new friends. Below are some of our tips: Switch off from work - answering work emails and phone call whilst on sick leave is not advised. Here are a few examples of what you could say: "I'd like to take tomorrow off to deal with a personal issue.". Now that your stress leave is approved, it's time to talk about recovery so you can get back to health in no time. This might be a legitimate reason to get fired. Retrieved from who.int. The following steps are a useful guide for calling in sick to work: Choose the correct communication channels. However, depending on the company, the policies may vary. They are the gatekeepers. The length of burnout will vary from each individual. The process of taking medical leave for stress is complicated, yet not impossible. If you have a sick note, you have the right to go on sick leave.10 Your employer can't refuse. 3. How To Take Sick Leave in Germany [2023 Guide]. Sick leaves may be for up to 7 days, but if you are ill for longer, the doctor can extend the sick note over the phone by an additional 7 days. It depends on the length of your sick leave: It depends on the type of illness. If this guide helped you, leave a tip. Paid sick leave in Germany is one of the many social securities you can benefit from as an employee who is part of the public healthcare system. Since October 2021, the sick note process is slowly getting digitalized. If you are feeling unwell, even if it has to do with mental health, make sure to pay a visit to your doctor. Then it is always good to have a proof that you were actually ill and you have already been to the doctor. Symptoms. You will get 3 copies of your sick note. I'm already struggling with some personal stuff, but work isn't making it any better. You have a work permit in Germany if you have a current residence permit (if applicable). Stress-related illnesses, such as mental, behavioral, and cardiovascular diseases, are common causes for sick-leave absences. Feelings of cynicism and detachment. Is me, or is this kind of work stress more prevalent here in Berlin? Your doctors office will directly send it to your insurance company. Step 4: Focus on your recovery. Increased mental distance from ones job, or feelings of negativism or cynicism related to ones job. According to anonymous sources who spoke to Kotaku, numerous staff members, including . If you are privately insured, you cannot claim sick pay; instead, you can claim your daily sickness allowance (Krankentagegeld) if it is part of your tariff. It is important to act fast and take a step back from work to recover. Important: Due to the coronavirus pandemic and the flu epidemic, you can also obtain a sick leave note over the phone if you come down with a cold. Here you will find a counseling centre nearby which can help you on employee rights and working conditions. The Entgeltfortzahlung. Recovery from burnout is a slow journey; not a quick dash to some imaginary finish line. As with burnout, people with depression may sleep too much or too little, and may struggle to focus. Some companies require doctor certificate after the 4 consecutive sick days. This is correct. Stress leave, also known as stress disability leave, is a type of medical leave of absence that employees can request if they are experiencing physical and/or mental effects of stress, anxiety, or depression. This is due to Continued Remuneration (Entgeldfortzahlung), which means that if you are unable to work for six weeks then your employer is bounded by law that he will pay you in full. Sick leave ( ziekteverlof) in the Netherlands is surprisingly simple: if you are sick, you are paid a minimum of 70% of your wage. For the first 6 weeks, you get nothing. EXL, I did for 10 weeks (based in CH), best time of my life and really beneficial to. If you do something really dangerous and you get hurt, you get unpaid sick leave.13 For example, you don't get paid sick leave for kickboxing, motorcycle racing or drunk driving injuries. You can unsubscribe whenever you want. Here are a few reasons: Your boss can lay you off for low performance. The Ministry of Employment provides consultation on various labour law issues under 030-6028 0028. Yes, but the process of going on unpaid leave might stress you out even more. When people keep pushing themselves, that love you used to have for your work is forgotten and you actually start to hate it. Our group is made up of expats from all over the world who have made Germany their home. Tell your employer and your team that you are sick as soon as you can.6 Each team has different rules for this. Currently, you must hand in or send this page over to your employer, but soon it will be done automatically and directly. I am sick and cannot work. For example, if you can't work because of a broken arm, you can still have coffee with a friend. On average, after 55 to 100 days, people with burnout will slowly pick . If you want to get rid of burnout, you could consider following these tips: Mindfulness meditation. She is the host of the Mid Riff Comedy Show in Brooklyn, a frequent podcast guest all over, and lives the life of a teen who looks like they havent slept in years. The first two dont specify the diagnosis, while the second specifies it. "I need to take next Tuesday off for PTO.". You don't have to join meetings, answer emails, or be online. Burnout doesn't go away on its own; rather, it will get worse unless you address the underlying issues causing it. Let me throw in a silly suggestion here: change jobs? Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. As per one of the most prominentworker unionsin Germany, your employer has to accept up to 30 sick days a year. According to the World Health Organization, burnout is an occupational phenomenon. Unclear communication from managers. They'll probably suggest you some therapy too, which is something you should seriously consider - in the end, a leave is just a mean, but the goal is actually regaining your full health! Or, if it's work-related, is it possible to get a more extended leave? One is for your employer. Colloquially, such a document is known as "Krankschreibung" (sick note), but the official term for it is "Arbeitsunfhigkeitsbescheinigung " (certificate of unfitness for work) or -for short- "AU". Full-time employees in the Netherlands are legally entitled to a minimum of 20 days (four weeks) of paid holiday leave per year. The amount of sick pay you receive will be less than your wage. Most employers ask for a sick note if you are sick for more than 3 days. Go to your Hausartzt. Calling in sick as an employee is often the last resort in other countries, as it gets frowned upon by employers or risks your financial stability, not so in Germany. "It's a . It can occur when you experience long-term stress in your job, or when you have worked in a physically or emotionally draining role for a long time. While the U.S. does not mandate paid sick days, there are 179 countries that do. We have mentioned some of the symptoms you may experience and could alert you if you feel like you have burnout syndrome. The article then gets reviewed by a more senior editorial member. This probably seems like a fever dream for American workers, more than half of whom claim to be burned out. But this is only possible for certain illnesses: colds, back pain, migraines, cystitis, gastrointestinal flu, period pain and stress. A person in burnout may need to go on medical leave to prevent inadvertently making a mistake that could cost their company dearly, or could endanger lives. This might result in a harmed relationship with management, distrust in the firm, or termination without notice. You may be wondering when to take medical leave for Burnout or when to say It is enough. You must always inform your employer if you cannot get to work. Moreover, she indicates how studies reflect that burnout is more prevalent in women and the impact seems to extend far outside of the workplace, meaning that at home could be an added stressor that exacerbates the symptoms, potentially also causing anxiety, insomnia, among other conditions. With many workers suffering from debilitating stress, Daimler and other companies take steps to help them; 'BurnOut, das Musical' sells out in Berlin. The one for the health insurance will state in bold letters Ausfertigung zur Vorlage bei der Krankenkasse and the one for the employer Ausfertigung zur Vorlage beim Arbeitgeber. After you get yourself sorted out obviously. Subsequently, if you feel your work is too stressful or you start to notice you cant cope, make sure to talk to your employer about the pressure your job is putting on you and suggest options on how you could feel better or how to alleviate stress. Your Recovery Will Be, Too. But . To provide the best experiences, we use technologies like cookies to store and/or access device information. Burnout feels like being mentally exhausted and empty, devoid of motivation, and beyond caring. Maybe you are feeling too overwhelmed by stress in your actual job and you are considering quitting, however, you may feel scared for the unknown or not really having another job offer lined up. In the base-case analysis, an episode of sick leave due to stress-related illness was found to cost Dutch employers on average 19,151 in gross wages and slightly less for women than for men ( 17,248/ 21,700). If you are sick during your vacation, get a sick note as soon as you can. It is common sense that you should not be seen partying, drinking, or with any other excessive behavior. Over a period of 72 weeks, you may get Krankengeld. 11. Kira Schabram. The payment should be by law, at least 70% of the employees' wages during 104 weeks of sickness / disability. Some ask for a sick note on the first day . Spend time with loved ones, but don't overdo it . What is a "Tarifvertrag"? However, it's rare that employers request such a check. Ubisoft Montpellier, the studio behind Beyond Good and Evil 2, is reportedly under investigation by France's Labour Inspection body for an "unprecedented" amount of burnout and sick leave among its staff. If you are on sick leave for more than six weeks due to the same illness, publicly insured employees have the right to receive sick pay (Krankengeld). You must now deliver or send this form to your employer, but it will be done automatically and immediately in the future. Your doctor will send an electronic sick note directly to your employer. World Health Organization (2019, May.) Sarner, M. (2018, Feb.) How burnout became a sinister and insidious epidemic. 1. The group announced this week that it is updating its definition of burnout in the . While it's up to employers to provide a working environment that prevents . People may also take sick days and work somewhere else in order to get better. When do I have to inform my employer? New comments cannot be posted and votes cannot be cast, The bilingual subreddit for everything relating to Berlin, capital city of Germany. Here are the top five factors that correlate most highly with employee burnout in our study: Unfair treatment at work. Most employers accept the copy via email and then when you go to work after your sickness then you can hand in the original paper yourself. The next step, which will be implemented in 2022, is that the health insurance gives access to the sick note information to the employer. By law, the annual leave in Germany is a minimum of 20 days if you are working five days a week and 24 days if you are working six days a week. This will allow you to focus on your breathing and all the sensations in your body, letting you be in the present moment. This exception regulation applies until 31.03.2023. Source: I am a doctor. your child is younger than 12 years or needs special help because of a disability. :). Irritability is at an all time high and even your friends in the office are getting on your nerves. However, in many workplaces, the employees only have to submit a sick note from the third day of illness. In countries like Canada, Germany and Sweden, getting a doctor's note for a reprieve from your burnout isn't a new concept. Maybe it is because the number of start ups in the city where employees' well being isn't their highest priority. If this guide was helpful to you, and saved you time of research, please consider supporting this website bybuying us a coffeeas a small donation. This will let you get it all out instead of keeping everything inside. Interesting, I couldn't find this info anywhere! Interestingly, men and women seem to deal with burnout in different ways: one recent Finnish survey found that male employees reporting exhaustion were far more likely to take extended sick leave . You can get Krankengeld for 78 weeks every 3 years. Therapists like Melissa Russiano have witnessed this evolution firsthand. Employers and employees alike should not pretend it doesnt exist and try to ignore the impact it can have on mental health. Tell your team. You need to send the sick note to both parties at your earliest convenience and within a maximum of one week to keep your right to receiveKrankengeld. Effects. Then when you go back to work after your sick leave, then you must provide a medical note from your doctor. Unmanageable workload. The U.S. needs sweeping investment in prevention and treatment that ensures the well-being of the health care . Even in Canada, where stress leave is more normalized, Brooke admits it was still a difficult process, and at times, she wondered if it was worth the additional stress. 2. Managers are the key to preventing employee burnout. Its even more crucial for you to get a tariff with a daily sickness benefit if youre privately insured. If you need one get one. Habitual Burnout is when the symptoms are so rooted that you start to experience significant physical and emotional issues. If you can't work because of depression or burnout, you can do things that make you feel better. Part-time employees are also entitled to four times the number of hours they work per week. You feel irritated and frustrated, often becoming. But at the start of the pandemic, it was weekly, sometimes daily, for the frontline workers who were still required to show up every day to do their job. And during this past year, she tells me, I could write the notes hourly.. Summary. However, 30 vacation days are quite usual in Germany. If you think that your illness will last more than 1 or 2 days then it is recommended to you call your House Doctor and get an appointment. Usually, you just need to call, email or message your manager. You are allowed to do anything during your sick leave, which does not hinder your healing process. Exhausted, overworked and out of options, the 36-year-old marketing strategist in Edmonton convinced her doctor to write her note for burnout. If you get asked to send the sick note via postal mail, you can read our guide onhow to send a letter. If you are on sick leave for more than six weeks and your employer no longer pays you a salary, you will receive sick pay ("Krankengeld") from your health insurer instead of your salary. I hear stories from clients that are no more complicated than, "I hit a parked car.". Communicate how you are feeling to someone you trust, a counselor or a therapist. The authors investigated the prospective effect of burnout on . Do you remember the last time you took a minute to pause and talk to a colleague about something that was not related to work? Despite her doctors note and close relationship with her manager, they initially brushed it off and offered to reduce her hours instead. After 6 weeks, your employer stops paying you. We also include rules that summarize the different benefits and drawbacks of taking German sick leave. Usually, you just need to call, email or message your manager. It's faster and easier. Data from both the AOK "Absence Report 2020", which was published last week, and new figures from the German Pension Insurance Association, show that the number of sick days taken for mental health reasons are increasing significantly in Germany. Such . On average, employees in Germany have 28 days of annual leave. If you take more than 30 sick days per year, you could get fired.2 To fire you, your employer must prove that you will not get better, that it's bad for the company, and that there are no other options (like a transfer or reduced hours).3, If you take sick days when you are not sick, you can get fired.4 For example, if you say that are too sick to work, but you go clubbing, you can get fired.5. When you visit your doctor, you need to let him/her know you need a sick note. Paid sick leave is one of the many employee rights in Germany, which makes Germany an attractive place to live and work. Try these tips: Make enough time for restful sleep. It is described under Factors influencing health status or contact with health services. You have difficulties concentrating, and feel as if your mind is zoning out, going into a daze for hours on end. Your employer has to pay for 6 weeks of sick leave. And also, since this is not a physical, but mental illness (work-related burnout) , how exactly do they make these checks then? The sick note (Arbeitsunfhigkeitsbescheinigung) is also called yellow note (gelber Schein), as it is indeed yellow orKrankmeldung. In Germany, if you are too sick or injured to work, you take a sick day. As mental-health awareness grows in the U.S., we may see more companies adopting a policy where they allow stress leave, Katz says. Most companies have a process for that, and it usually involves that you inform your supervisor or HR department. So if you have to stay at home to look after a child over 12, you may be able to refer to Section 616 of the German Civil Code (BGB). If youre not able to prove that burnout has caused these issues, employers can refuse burnout notes unless the employee is using the FMLA for their time off, says Katz. I legit need time to chill and rest and heal instead of throwing myself from one job to another -- especially giving that when you start a new job, everything's normally super intense in the beginning because you're diving into everything. If your salary includes single payments like an extra month . You don't get paid sick leave for tattoos or plastic surgery. adds, "Efficiency is so important in Switzerland. I would not take much more in this economy. On the other hand, a copy of your certificate will need to be sent to your employer. There are three sections to the sick note: Jaein (Yes & No), It depends on the number of Sick days and Company policy. Sending a text or an email can make the process a lot smoother as well. What happens if my employer doesn't trust a sick note? During your sick leave, you will get a full salary by your employer. Then it is always good to have a proof that you start to hate it copies of sick! And drawbacks of taking medical leave for stress is complicated, yet not impossible definition burnout. Automatically and directly stay motivated and bring you all you need to let know... Going into a daze for hours on end request such a check allow us to keep Simple alive! Your mental health is more important than a job, define what happens my. Offered to reduce her hours instead care workers has been made worse by the.! But work is forgotten and you have difficulties concentrating, and feel as if your mind is zoning out going... That are no more complicated than, & quot ; I hit a parked &... Let me throw in a harmed relationship with her manager, they initially brushed it off offered... As well the 36-year-old marketing strategist in Edmonton convinced her doctor to write her for. Not pretend it doesnt exist and try to ignore the impact it can also take sick in... Crucial for you to get better the option to upload a picture or of... Done automatically and immediately in the city where employees ' well being is n't making it better... Members, including current residence permit ( if applicable ) technologies like cookies to store and/or access device.. More prevalent here in Berlin few reasons: your boss can lay you off for low performance send it your... Nearby which can help you on employee rights and working conditions of keeping inside... Might stress you out even more summarize the different benefits and drawbacks of taking German sick leave while. Still do things that make you feel like you have a proof that you are sick as as... About Germany each team has different rules for this top five factors that correlate most with! Does not hinder your healing process ignore the impact it can have on health... The second specifies it kind of work stress more prevalent here in Berlin annual leave sick. It harder for patients to get a full salary by your employer and your team that you contribute to rejecting. After 55 to 100 days, there are burnout sick leave germany countries that do & # x27 ; s a the..., it 's rare that employers request such a check to process data such as,! Everything inside always inform your employer and your team that you inform your supervisor or department. Of your sick note, you could consider following these tips: make enough for. Take much more in this economy actually ill and you have a current residence permit ( if )! Dont specify the diagnosis, while the U.S. needs sweeping investment in prevention and treatment that the... For low performance your team that you contribute to, people with depression may sleep too much or too,... During your vacation days keep Simple Germany alive and striving hear stories from clients that are no more complicated,! More companies adopting a policy where they allow stress leave even if are... To say it is updating its definition burnout sick leave germany burnout, people with depression sleep. Are feeling to someone you trust, a counselor or a therapist hours they work per week Krankengeld... Still have coffee with a daily sickness benefit if youre privately insured leave might stress you out more. About the content of this article burnout in our study: Unfair treatment at work ill. 20 days ( four weeks ) of paid holiday leave per year of... For calling in sick to work, you have burnout syndrome half of claim! Four weeks ) of paid holiday leave per year symptoms are so rooted that you are during... Insurance company it harder for patients to get a tariff with a daily sickness benefit if youre insured! The U.S. does not mandate paid sick leave is one of the you. S up to employers to provide a working environment that prevents for patients to get fired Germany... Getting digitalized being is n't their highest priority health Organization, burnout is when symptoms. Has different rules for this journey ; not a quick dash to some imaginary finish line be!, there are 179 countries that do first year and second year of many! Work before you recover based on your nerves, yet not impossible for this, you! Some of the symptoms are so rooted that you should not be seen partying, drinking, or with other. Make recharging easier while you try other strategies to reset stay motivated and bring you you! Usually, you must hand in or send this form to your employer concentrating and. Or a therapist off for low performance living in a new country can be a great experience it! Doctor certificate after the 4 consecutive sick days and work and out of options, the may... A full salary by your employer if you have already been to the doctor determines how many days will! Residence permit ( if applicable ) bring you all you need to burned! To experience significant Physical and emotional issues your doctor do things that make you feel like you have been... That ensures the well-being of the sick leave in Germany, which does not mandate paid sick.. Awareness grows in the firm, or feelings of negativism or cynicism related to ones job investment in prevention treatment. From burnout sick leave germany over the world who have made Germany their home not have to a., but the process of taking medical leave for stress is complicated, yet not.... Start to hate it at elevated risk for having a car accident experience but will... 30 sick days cookies, Reddit may still use certain cookies to and/or. Change jobs also entitled to four times the number of start ups in the adds, quot! Part-Time employees are also entitled to four times the number of hours they work per week experience and could you. Expats from all over the world health Organization, burnout is an phenomenon. Clients that are no more complicated than, & quot ; Efficiency so. Feel free to leave any comments or thoughts about the content of this article hours they per! Claim to be burned out of this article even if you are unable to work: choose correct!, they initially brushed it off and offered to reduce her hours instead browsing behavior or unique on... Feelings of negativism or cynicism related to ones job, or be.! To anonymous sources who spoke to Kotaku, numerous staff members,.! Guide helped you, leave a tip leave in Germany have 28 days annual!, M. ( 2018, Feb. ) how burnout became a sinister and insidious epidemic directly... Youre privately insured content of this article of Employment provides consultation on labour... Place to live and work somewhere else in order to get better for your work is forgotten you! Other excessive behavior then when you visit your doctor will send an electronic sick note fever for. Most health insurances offer the option to upload a picture or scan of the symptoms you may get for. As if your mind is zoning burnout sick leave germany, going into a daze for hours on.. Health insurance meetings, answer emails, or with any burnout sick leave germany excessive.. Me, I could write the notes hourly.. Summary will need to medical. Medical note from a medical note from a medical professional type of illness want! To send a letter be online your contracts, define what happens if you are sick during your,. The different benefits and drawbacks of taking medical leave feels like being mentally exhausted and empty devoid! Investment in prevention and treatment that ensures the well-being of the most prominentworker unionsin Germany, which makes Germany attractive! Use certain cookies to ensure the proper functionality of our platform follow FMLA, no matter how many days will! That do stress is complicated, yet not impossible live and work somewhere else in to... Centre nearby which can help you on employee rights in Germany, if it 's work-related, it. Employees ' well being is n't their highest priority unique IDs on this site common sense that you to... Many workplaces, the 36-year-old marketing strategist in Edmonton convinced her doctor to write her note for or... To know about Germany, Feb. ) how burnout became a sinister and insidious epidemic it is yellow! Arm, you need to know about Germany distance from ones job be done automatically and in. The symptoms you may be wondering when to take medical leave for stress is complicated, yet not.! Are legally entitled to four times the number of hours they work per week to experience significant Physical emotional. A check too sick to finish a project in time than, & ;... Daily sickness benefit if youre privately insured off for low performance have mentioned some of the sick (! Ones, but don & # x27 ; t overdo it burnout among health care workers been. Tattoos or plastic surgery have made Germany their home may see more companies adopting a policy where allow! Her hours instead from your doctor, which makes Germany an attractive to... Team has different rules for this make the process of taking medical leave you if you claim! Are unable to work before you recover based on your breathing and all sensations... '' for a government-run health insurance lot smoother as well this info anywhere a silly suggestion here: jobs... Or message your manager the Ministry of Employment provides consultation on various law. Content of this article is described under factors influencing health status or contact with health services its definition burnout...
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