Background     Compared with other American workers, health care professionals suffer more burnout (1). Amongst US physicians burnout rates range from 30% to 65% across specialties, with the highest rates of burnout incurred by physicians at the front line of care (e.g. emergency medicine and primary care) and those who are frequently exposed to distressing emotional situations and profound suffering (e.g. palliative medicine) (2,3). Lack of attention to health providers’ stress responses to the witnessed suffering contributes to the high prevalence of burnout in US health professionals. This has consequences for the provider and his/her interpersonal relationships.  This Fast Fact will describe burnout and its risk factors, and review essential research regarding health professionals and burnout.  Fast Facts #168-170 will address symptoms, consequences, avoidance and assessment of burnout.

• Definitions:  Burnout is a . . .
  • “Psychological syndrome in response to chronic interpersonal stressors on the job” (7).
  • “State of mental and/or physical exhaustion caused by excessive and prolonged stress” (4).

• Common features (adapted from Maslach 1982)
  • A predominance of mental or emotional exhaustion, fatigue, and depression.
  • The symptoms are more mental and behavioral than physical.
  • The symptoms are work-related.
  • Burnout manifests in persons with no previous history of psychopathology.
  • Decreased effectiveness and work performance result from negative attitudes and behaviors.

• Situational Risk Factors
  • Physician Worklife Study:  2326 US physicians identified via AMA masterfile responded to a 38-item mailed questionnaire developed and validated for this study.  Predictors of stress were:
    • Demands of solo practice, long work hours, time pressure, and complex patients.
    • Lack of control over schedules, pace of work, and interruptions.
    • Lack of support for work/life balance from colleagues and/or spouse.
    • Isolation due to gender or cultural differences.
  • Hospital consultants in the UK:  882 gastroenterologists, radiologists, surgeons, and oncologists responded to 12-item General Health Questionnaire and Maslach Burnout Inventory.  Sources of stress were:
    • Work overload and its effect on home life.
    • Feeling poorly managed and resourced.
    • Managerial responsibility.
    • Dealing with patients’ suffering.

• Individual Risk Factors
  • At risk earlier in career
  • Lack of life-partner
  • Attribution of achievement to chance or others rather than one’s own abilities
  • Passive, defensive approach to stress
  • Lack of involvement in daily activities
  • Lack of sense of control over events
  • Not open to change

References

1. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172:1377-1385.
2. Linzer M, Levine R, Meltzer D, Poplau S, Warde C, West CP. 10 bold steps to prevent burnout in general internal medicine. J Gen Intern Med. 2014;29:18-20
3. Kamal A, Bull J, et al. Burnout among palliative care clinicians in the United States: Results of a national survey.J Clin Oncol 2014; 32: suppl; abstr e20530.
4. Girdin DA, Everly GS, Dusek DE. Controlling Stress and Tension.  Needham Heights, MA: Allyn & Bacon; 1996.
5. Linzer M, et al.  Physician stress:  results from the physician worklife study.  Stress and Health. 2002; 18: 37-42.
6. Linzer M, et al. Predicting and preventing physician burnout: results from the United States and the Netherlands. Am J Med. 2001; 111:170-175.
7. Maslach C.  Burnout:  The Cost of Caring.  Englewood Cliffs, NJ; Prentice-Hall; 1982.
8. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annual Review of Psychology. 2001; 52:397-422.
9. Ramirez AJ, et al.  Mental health of hospital consultants:  the effects of stress and satisfaction at work.  Lancet. 1996;347: 724-728.
10. Ramirez AJ, et al.  Changes in mental health of UK hospital consultants since the mid-1990s.  Lancet. 2005; 366:742-744.
11. Schaufeli WB, Maslach C, Marek T, eds. Professional Burnout:  Recent Developments in Theory and Research.  Washington, DC: Taylor & Francis; 1993. 

Version History:  This Fast Fact was originally edited by David E Weissman MD and published in November 2006. Version copy-edited in April 2009; revised again by Sean Marks MD July 2015 with references #1-3 added and incorporated into the text.