Burnout

Clinician burnout is a national problem. Over 50% of US physicians have been estimated to show symptoms of burnout with a 10% increase in the incidence of burnout across all medical specialties between 2010 and 2014 (Shanafelt 2015). A high incidence of burnout has been reported in medical residents and students (Drybye 2014) and in nurses and other health care professionals (Drybye 2017). Burnout results in poorer patient care, increased medical errors, and negative effects on the health of the practitioner, including suicide and addiction.

What is Burnout?

Burnout is defined as a state marked by increased emotional exhaustion and increased depersonalization (cynicism and detachment from patients), and decreased feelings of personal accomplishment. It is most commonly assessed by the Maslich Burnout Index (MBI), a 22-question survey that measures each of the three symptoms. For example, in a recent large study of physicians (Shanafelt 2015), 46.9% had high scores for emotional exhaustion, 34.6% high scores for depersonalization, and 16.3% low scores for personal achievement; overall 54.5% of those surveyed showed at least one symptom of burnout. Although there is some discussion of the interpretation of MBI data (Eckleberry-Hunt 2018), there is no doubt that the incidence of burnout in health care practitioners is very high.

What Causes Burnout?

Burnout in clinicians has been attributed to multiple causes, including the continued stress of working with people who are suffering, pressure to meet time and productivity measures, lack of control over working conditions, lack of reward and recognition, disruption of work-life balance, and the intrusion of technology, such as the electronic medical record, into daily practice.

Key References on Burnout

Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Shanafelt TD et al., Mayo Clinic Proceedings 90: 1600-1613 (2015). Journal link (full text not available at UMass Chan).
Widely referenced study showing a recent increase in the incidence of burnout in physicians.

Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care. Drybye LN et al. Discussion Paper, National Academy of Medicine (2017). Journal link
A summary of burnout and its causes across all health care professionals.

Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Drybye LN et al. Academic Medicine 89: 443–51 (2014). Journal link
Burnout occurs throughout the stages of physician training.

The Problems With Burnout Research. Eckleberry-Hunt J, Kirkpatrick H, and Barbera T. Academic Medicine Academic Medicine 93: 367–70 (2018). Journal link
Careful discussion of the use of the MBI in measuring physician burnout.