Background for FF #167     Compared with other American workers, health care professionals are at higher risk for burnout (1). Amongst US clinicians, burnout rates range from 30% to 65% across specialties, with the highest rates of burnout incurred by clinicians at the front line of care (e.g., emergency medicine, primary care) and those who are frequently exposed to distressing emotional situations and profound suffering (e.g., critical care, 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 Fact #168, Fast Fact #169, and Fast Fact #170 will address symptoms, consequences, avoidance, and assessment of burnout. 

Definitions:  Burnout is a syndrome of emotional exhaustion, depersonalization, and a sense of low personal accomplishment in response to chronic work-related stressors that leads to decreased effectiveness at work.  

Key dimensions: 

• Overwhelming exhaustion 
• Feelings of cynicism and detachment from job 
• Sense of ineffectiveness and lack of accomplishment 

Situational Risk Factors 

• Private practice, long work hours, time pressure, and patients with a high complexity of illness 
• 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. 
• High volume of clinical work leading to a feeling of work overload. 
• Feeling poorly managed and resourced. 
• Managerial responsibilities. 
• Frequently responding to patients’ suffering. 

Individual Risk Factors 

• 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 
• Inflexibility to change. 

Consequences of burnout: 

• Decreased job satisfaction 
• Absenteeism 
• High turnover in personnel  
• Work-related cynicism 
• Effects on personal life – feeling unhappy, anxious, depressed, isolated, substance misuse, tense interpersonal relationships. 
• Medical errors 
• Impaired quality of life 

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.   
12. Maslach, C., & Leiter, M. P. Understanding the burnout experience: recent research and its implications for psychiatry. World psychiatry, 2016; 15(2):103-111. 
13. Maslach, C., Jackson, S. E., & Leiter, M. P. Maslach burnout inventory. 1997; Scarecrow Education. 
14. De Hert, S. Burnout in healthcare workers: prevalence, impact and preventative strategies. Local and regional anesthesia, 2020:171-183. 

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, then again in February 2024 by Maria Olex PsyD
Conflicts of Interest: None to report