Physician burnout

Physician burnout has been classified as a psychological syndrome that can be expressed as a prolonged response to due chronic occupational stressors.[1] In the practice of medicine, it has been known to affect a wide variety of individuals from medical students to practicing physicians; although, its impact reaches far beyond that. Because of the toll taken on the healthcare industry, various treatment and prevention strategies have been developed at individual, team, and organizational levels in hopes to seek the best method of addressing this epidemic.

## Contents

* 1 Characteristics
* 1.1 Prevalence
* 1.2 Signs
* 1.3 Causes
* 1.4 Models
* 2 Impacted populations
* 2.1 Physicians
* 2.2 Residents
* 2.3 Medical students
* 2.4 Colleagues
* 2.5 Health industry
* 3 Impact on Patients
* 3.1 Decreased Quality of Care
* 3.2 Reduced Patient Satisfaction
* 3.3 Increased Healthcare Costs
* 4 Treatment & prevention
* 4.1 Individual-approach
* 4.2 Organizational-approach
* 4.3 Regulatory-approach
* 5 References

## Characteristics

### Prevalence

Research suggests that occupational burnout among physicians exceeds 50% in the USA.[2] This refers to not only physicians currently practicing medicine, but also those in training. Signs of burnout have even been traced back to medical students who have experienced disconnect between taught professional behaviors and those witnessed in practice.

"Our data show wide variability in the prevalence of burnout by clinical specialty, and that anxiety, social support and empathy during medical school relate to the risk of burnout during residency," says Liselotte Dyrbye, M.D., a Mayo Clinic researcher and first author of the article "Association of Clinical Specialty With Symptoms of Burnout and Career Choice Regret Among US Resident Physicians[3]"

In an argument explained in Economic and Political Weekly, Edmond Fernandes, lead author stated that being motivated by the best intentions is not enough; they need to be given adequate rest. The time to regulate work hours is long overdue. With growing population in a country like India, the number of doctors remains grossly insufficient to strike this balance which leads to physician and resident fatigue ending up in medical errors and complications.[4]

### Signs

Burnout has been referred to as a compilation of cynicism, depersonalization, and a low sense of accomplishment.[5][6] Other symptoms included feelings of emotional exhaustion, inadequacy, and detachment. This is thought to be due to imbalances whether that be in regards to workload, personal values, incentive, justice, and a sense of community. Factors such as time pressure, chaotic work environments and a lack of alignment between physicians and executives have been known to exacerbate this burden.[2] These elements can cause clinicians to become frustrated and overwhelmed. Moreover, the correlation between lack of control and burnout has been explored and shows that an increased sense of lack of control has been linked to a greater risk of being affected by burnout.

One study,[7] claimed that "We found that physicians with burnout had more than twice the odds of self-reported medical error, after adjusting for specialty, work hours, fatigue and work unit safety rating(...)"

### Causes

* Changing overall healthcare landscape[8]

The healthcare landscape continues to evolve, and factors like an aging population,[9] physician shortage, change from volume-based care to value-based care,[10] Patients as customer[11] are some drivers of the change. These changes are happening rapidly and concurrently with a consequent adverse impact on physician burnout.

* Increased Pressure from Regulators and Payers

The changing overall healthcare landscape creates a situation whereby the regulators and payers demand more accountability, increased healthcare quality, and reduced cost. These demands also increase physician burnout.[12][13]

* Overall change in technological environment and consequence of the 4th industrial revolution[14]

The technological environment is experiencing a rapid evolution from analog-legacy systems to digital systems. This is fueled in part by the Mores law, which postulates that there will be a constant reduction in the price of the memory capacity of computer systems. In 1981, the cost of a gigabyte was $300,000 and by the year 2000, it had dropped to $10. In 2010, the price of storing a gigabyte of data dropped to just 10¢.[15] The 4th industrial revolution is a consequence of the digital process. The 4th Industrial Revolution is a philosophical and ideological construct by the world economic forum that postulates how digital, physical, and biological technology have uniquely combined together in our contemporary world, creating new opportunities and challenges.[16][14] Although the 4th Industrial Revolution is considered by many as a direct extension of the 3rd, the 4th differs due to the unprecedented volume and velocity of data and enhanced global interconnectivity.[17] This has impacted healthcare and all other sectors. This drive from legacy systems to digital systems demands that physicians adapt to changes quickly, which can be stressful and increase burnout

* Electronic health record and its lack of usability

The implementation of the electronic health record (EHR) is associated with physician burnout.[18][19] The reasons include lack of EHR usability, demand for standardized documentation as against free flowing narrative texts, and redundant documentation. Excessive data entry requirements, lack of interoperability, and notes geared toward billing tend to be the highest factors contributing to EHR-induced physician burnout.[20][21][19] Research indicates that the use of EHRs has increased the amount of time spent on documentation for patients by their respective doctors by 11%-22%.[22][23]

* Excessive administrative workload

One major contributor to physician burnout is the excessive administrative workload. Physicians are required to dedicate a significant portion of their time to non-clinical tasks, reducing the time they can spend with patients. On average, U.S. physicians spend 2.6 hours per week meeting external quality measures—time that could instead be used to see nine additional patients.[24] Additionally, for every hour spent face-to-face with patients, physicians spend two more hours on clerical tasks such as documentation, billing, and compliance reporting.[24] This administrative burden is a key stressor in the medical field, leading to emotional exhaustion and reduced job satisfaction. A study of 200 medical and auxiliary staff found a significant positive correlation (r = .495) between burnout and administrative workload, highlighting how these tasks contribute directly to physician stress and dissatisfaction.[25]

* Long work hours and burnout

Another major factor contributing to burnout is the long and demanding work hours that many physicians endure. The average physician in the U.S. works 51 hours per week, and about one in four works more than 60 hours weekly.[24] These intense schedules often come with limited opportunities for rest, frequent on-call shifts, and the expectation to work weekends, personal time, and even during vacations.[26] Such prolonged work hours make it difficult for physicians to maintain a healthy work-life balance, leading to higher stress levels and increased exhaustion.

* Patient interactions

### Models

Likewise, burnout has been analyzed using differing conceptual models.[1] One strategy examined burnout as a product of three stages. Stage one consists of exhaustion at work that progresses into detachment and negative feelings at work that later starts to affect patients and coworkers in stage two. Lastly, stage three is composed of feelings of inadequacy and failure. However, a more recent approach sought to choose three stages that served as a bridge between said stages and imbalances. The first groups together all job stressors such as imbalances caused by work demands while the second solely addressed individual strain in the form of anxiety and exhaustion. Lastly, the third described changes in mood and behavior as defensive coping that could be closely linked to cynicism.[27]

## Impacted populations

### Physicians

The progression of physician burnout takes a toll on the individual whether it be a medical student or practicing clinician mainly through adverse psychological affects that have lasting consequences. A concept known as asymmetrical rewards speaks of how physicians are rarely recognized for what they do well, yet there is much attention surrounding medical malpractice suits ready to capitalize on a physician's errors. In addition, clinicians become desensitized to patients and medicine resulting a perspective shift towards viewing patient care as a chore more than a desire to heal. However, the effects of burnout extend past the physicians themselves to ultimately affect anyone in contact with them.

### Residents

Burnout in physicians appears to be the highest for resident physicians. Due to the large number of hours taken on by resident physicians, they are often more prone to burnout. In addition to the long hours, residents are still in the process of learning clinical knowledge. Stressful events, such as death of a patient, managing a critically ill patient, medical error, and verbal abuse from patients, their families and/or colleagues have been reported in a study done at medical schools in the Philadelphia area.[28] In this study, researchers found that 70% of residents experienced at least one work-related stress event and that nearly 5% showed symptoms of PTSD from a stressful event at work. Similar to the work-life balance struggle physicians face, residents may struggle to manage everything going on in their lives. Negative effects of this burnout include decreased job satisfaction, being absent while at work and possibility for medical errors.[29] Some studies have even shown reduced feelings of personal accomplishment and emotional exhaustion.[12] Residents who considered themselves to be experiencing burnout report more medical errors than residents who do not.[30] In a 24 month-long study performed at Mayo Clinic in 2016, found that burnout and low job satisfaction were associated with reductions in professional work effort.[31] In 2008, the Healthcare Management Review suggested that healthcare settings that put programs in place to reduce physician burnout would see greater patient satisfaction and recovery.[32] Resident interventions aimed to improve communication and role conflict have been shown to improve self-acceptance, acceptance of aggression and inner directedness in residents, interns, and nurses.[33] Although burnout in resident physicians has become common knowledge in the medical community, few systems are in place to combat this issue. Some possible solutions are support groups, stress-management/coping training and self-care education.[29]

### Medical students

An estimated 43-45% of medical student students report feelings of burnout.[34] It has been proposed that physician burnout originates from physicians years' in medical school.[35] In 2010, a study was done by Emory School of Medicine and Vanderbilt School of Medicine to understand the prevalence and factors of burnout in medical students. Here, burnout was defined as emotional exhaustion, depersonalization and decreased physical exhaustion. The study administered the Maslach Burnout Inventory Human Services Survey to 249 medical students. This survey asked questions about stress levels, workload, relaxation habits, support systems and demographics. The study found that 21% of first-year students, 41% of second-year students, 43% of third-year, and 31% of fourth-year students felt symptoms of burnout. Factors associated with a higher rate of burnout include lower support, higher stress, and feelings of lack of control over one's life. There is no single solution to this issue, but easing student and physician workload and promoting wellness and resilience in the medical field has been shown to help.[36] Specifically in medical students, mindfulness-based meditation sessions have been shown to improve mood disturbance.[37]

### Colleagues

Friends and family often feel the burden when interacting with burned-out clinicians since most of these individuals will be disengaged and can exhibit symptoms of major depressive disorder. Coworkers are also likely to be impacted. For example, burnout initiated by a chaotic, unsupportive work environment results in higher rates of miscommunication and unresolved conflicts. It has also been shown that a workforce afflicted by burnout contributes to an overall greater hostile atmosphere.

### Health industry

Other impacted populations include the patients and healthcare industry seeing as burnout results in decreased quality of care.[38] Research has generated evidence supporting an inverse correlation between burnout and productivity. Thus the shift in decreased productivity sometimes ends in decreased physician retention due to low job satisfaction and decreased mental health. Since successful medical interactions are based on trust between providers and patients, this constant staff turnover can go on to reflect poorly upon the institution.

## Impact on Patients

### Decreased Quality of Care

Physician burnout significantly contributes to decreased quality of care, primarily due to its impact on clinical decision-making, which can lead to increased medical errors.[39] Burnout leads to mental and physical exhaustion, which in turn impairs cognitive function.[40] Physicians suffering from burnout are less able to critically analyze clinical information, making them more likely to overlook important details or make poor decisions under pressure.[41] Burned-out physicians are more likely to miss small but important clinical signs or fail to adhere to clinical guidelines.[42] When physicians are tired and disengaged, they may not engage deeply with patient histories or may be less likely to question diagnostic hypotheses, which contributes to errors.[43] Burnout affects a physician's ability to communicate effectively with colleagues and patients. Poor communication leads to errors in the exchange of critical patient information, which can exacerbate diagnostic mistakes, incorrect treatments, or delayed interventions.[44] When physicians are exhausted and emotionally drained, they may not engage in collaborative decision-making, and may make errors in interpreting or sharing patient data.[45]

### Reduced Patient Satisfaction

Physician burnout can lead to reduced patient satisfaction as exhausted and emotionally drained doctors may become detached or less empathetic in their interactions.[46] When clinicians experience burnout, they may struggle to engage meaningfully with patients, leading to rushed consultations, diminished communication, and a perceived lack of compassion.[39] This disengagement can erode patient trust and weaken the doctor-patient relationship, making patients feel unheard or undervalued.[39]

### Increased Healthcare Costs

Physician burnout significantly increases healthcare costs by driving inefficiencies in patient care and contributing to medical errors, malpractice claims, and prolonged hospital stays. Burned-out clinicians are more prone to making mistakes, leading to costly complications, additional treatments, and readmissions.[47] Studies have shown that hospitals with high levels of burnout experience greater rates of diagnostic errors, unnecessary testing, and procedural mistakes, all of which inflate healthcare expenditures.[48] Additionally, burnout-related malpractice claims place a financial burden on healthcare systems through legal fees and settlements.[47] Increased staff turnover due to burnout further exacerbates costs, as recruiting and training new healthcare professionals require substantial investment.[47]

## Treatment & prevention

### Individual-approach

Treatment strategies first focused on addressing the individual. Physician-oriented approaches ranged from cognitive behavioral techniques (CBT) such as meditation and coping strategies to professional coaching which aimed at reinforcing individual resilience. Because of the high incidence of physician burnout, the field of physician coaching[49] has emerged. Physician coaching involves the implementation of mentors, usually former physicians, that would guide physicians out of burnout. Gazelle, Liebschutz, and Riess discussed the benefits of physician coaching as being able to cater to each provider using his or her own previous experiences therefore personalizing the intervention as opposed to CBT which delivers treatment in a standardized manner. On the other hand, Dr. Kelly speaks of how altering perception of patients from chores and potential litigation sources to opportunities to heal is key to the reversal of burnout.

### Organizational-approach

However, some research suggests that a combination of individual, team, and organization approaches is the only way to address all levels of burnout and successfully put an end to this epidemic.[50] The entire health care system requires transformational change[51][52][53] and organizational approaches have shown much promise as successful treatment options by reducing workloads and distributing more flexible schedules among employees. A shift to realign goals between physicians and executive administrators could also contribute to reducing the risk of burnout. A systematic review analyzing individual and organizational strategies found that organization-oriented approaches were more effective.[54] Other examples of team approaches are the implementation of honest discussions between caregivers to emphasize compassion as well as organization-wide events to enhance workforce well-being. While Gazelle and Panagioti concluded that organizational approaches were superior to individualized interventions, the final verdict has not yet been reached as Wuest's combined intervention addressing burnout at the individual, team, and organizational levels might be the key. Institutions across the nation are coming up with various innovative ways of reducing the EHR and technology induced physician burnout.[19] One of the approaches carried out was by the Mount Sinai hospital New York in a project called beyond getting rid of stupid stuff in the EHR(Beyond-GROSS).[19] Beyond-GROSS project seeks to get direct feedback from physicians about aspects of EHR that need improvement. This project was modelled after the Hawaii Pacific hospital's getting rid of unnecessary equipment in the EHR(GROSS)[55] Some organizations are outsourcing services, like medical scribing, to relieve the documentation burden on physicians and free up time.[56]

### Regulatory-approach

Due to the fact that physician burnout can impact overall quality of care, many regulatory bodies are also trying to reduce the adverse effect of burnout by putting forward regulations to counter its identified etiologies like unnecessary physician documentations. Centers for Medicare and Medicaid Services (CMS) initiated the "patient over paperwork" initiative to reduce the burden of unnecessary documentations on clinicians.[57]

## References

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38. ↑ "How does burnout affect physician productivity? A systematic literature review". BMC Health Services Research 14: 325. July 2014. doi:10.1186/1472-6963-14-325. PMID 25066375.
39. ↑ 39.0 39.1 39.2 ChenMed. "The Impact of Physician Burnout on Patient Trust" (in en). https://www.chenmed.com/blog/impact-physician-burnout-patient-trust#:~:text=Physician burnout has significant impacts,the well-being of physicians.
40. ↑ Michel, Alexandra (2016-01-29). "Burnout and the Brain" (in en). APS Observer 29. https://www.psychologicalscience.org/observer/burnout-and-the-brain#:~:text=Just as the impact of,neuroendocrine systems — eventually leading to.
41. ↑ National Academies of Sciences, Engineering; Medicine, National Academy of; Well-Being, Committee on Systems Approaches to Improve Patient Care by Supporting Clinician (2019-10-23), "Factors Contributing to Clinician Burnout and Professional Well-Being" (in en), Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being (National Academies Press (US)), https://www.ncbi.nlm.nih.gov/books/NBK552615/, retrieved 2025-03-24
42. ↑ Panagioti, Maria; Geraghty, Keith; Johnson, Judith; Zhou, Anli; Panagopoulou, Efharis; Chew-Graham, Carolyn; Peters, David; Hodkinson, Alexander et al. (2018-10-01). "Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis". JAMA Internal Medicine 178 (10): 1317–1331. doi:10.1001/jamainternmed.2018.3713. ISSN 2168-6114. PMID 30193239. (Retracted, see doi:10.1001/jamainternmed.2020.1755, PMID 32421149, Retraction Watch. If this is an intentional citation to a retracted paper, please replace `{{Retracted}}` with `{{Retracted|intentional=yes}}`.)
43. ↑ Garcia, Cíntia de Lima; Abreu, Luiz Carlos de; Ramos, José Lucas Souza; Castro, Caroline Feitosa Dibai de; Smiderle, Fabiana Rosa Neves; Santos, Jaçamar Aldenora Dos; Bezerra, Italla Maria Pinheiro (2019-08-30). "Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis". Medicina (Kaunas, Lithuania) 55 (9): 553. doi:10.3390/medicina55090553. ISSN 1648-9144. PMID 31480365.
44. ↑ Howick, Jeremy; Bennett-Weston, Amber; Solomon, Josie; Nockels, Keith; Bostock, Jennifer; Keshtkar, Leila (2024-05-27). "How does communication affect patient safety? Protocol for a systematic review and logic model". BMJ Open 14 (5). doi:10.1136/bmjopen-2024-085312. ISSN 2044-6055. PMID 38802275.
45. ↑ Shin, Philip; Desai, Vimal; Conte, Antonio Hernandez; Qiu, Chunyuan (2023-06-15). "Time Out: The Impact of Physician Burnout on Patient Care Quality and Safety in Perioperative Medicine". The Permanente Journal 27 (2): 160–168. doi:10.7812/TPP/23.015. ISSN 1552-5775. PMID 37278062.
46. ↑ Underdahl, Louise; Ditri, Mary; Duthely, Lunthita M. (2024). "Physician Burnout: Evidence-Based Roadmaps to Prioritizing and Supporting Personal Wellbeing". Journal of Healthcare Leadership 16: 15–27. doi:10.2147/JHL.S389245. ISSN 1179-3201. PMID 38192639.
47. ↑ 47.0 47.1 47.2 Cross Country Search (January 28, 2025). "The Hidden Costs of Understaffing in Healthcare: A Critical Call for Hospitals and Medical Facilities". https://www.crosscountrysearch.com/blogs/a-critical-call-for-hospitals-and-medical-facilities#:~:text=Overworked staff are more prone,diagnosing conditions or providing treatments.
48. ↑ Ryu, I. Seul; Shim, JaeLan (2021-11-20). "The Influence of Burnout on Patient Safety Management Activities of Shift Nurses: The Mediating Effect of Compassion Satisfaction". International Journal of Environmental Research and Public Health 18 (22). doi:10.3390/ijerph182212210. ISSN 1660-4601. PMID 34831966.
49. ↑ Gazelle, Gail (2023-02-22). "Physician Burnout - The ULTIMATE Guide | Gail Gazelle MD, MCC" (in en-US). https://gailgazelle.com/the-ultimate-guide-to-physician-burnout/.
50. ↑ "Clinical Faceoff: Physician Burnout-Fact, Fantasy, or the Fourth Component of the Triple Aim?". Clinical Orthopaedics and Related Research 475 (5): 1309–1314. May 2017. doi:10.1007/s11999-016-5193-5. PMID 27933444.
51. ↑ Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, D.C.: National Academies Press. 2019-12-02. doi:10.17226/25521. ISBN 978-0-309-49547-9. https://www.nap.edu/catalog/25521.
52. ↑ "Charter on Physician Well-being". JAMA 319 (15): 1541–1542. April 2018. doi:10.1001/jama.2018.1331. PMID 29596592.
53. ↑ "The Business Case for Investing in Physician Well-being". JAMA Internal Medicine 177 (12): 1826–1832. December 2017. doi:10.1001/jamainternmed.2017.4340. PMID 28973070.
54. ↑ "Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis". JAMA Internal Medicine 177 (2): 195–205. February 2017. doi:10.1001/jamainternmed.2016.7674. PMID 27918798. http://eprints.keele.ac.uk/2676/1/C Chew Graham - Controlled Interventions to reduce burnout in physicians.pdf.
55. ↑ "Getting Rid of Stupid Stuff". The New England Journal of Medicine 379 (19): 1789–1791. November 2018. doi:10.1056/NEJMp1809698. PMID 30403948.
56. ↑ Management, HealthData (2022-03-31). "Scribe support may help alleviate documentation, trim physician burnout" (in en-US). https://aquitysolutions.com/articles/scribing/scribe-support-may-help-alleviate-documentation-trim-physician-burnout/.
57. ↑ "CMS Finalizes Changes to Advance Innovation, Restore Focus on Patients | CMS". https://www.cms.gov/newsroom/press-releases/cms-finalizes-changes-advance-innovation-restore-focus-patients.

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