Prevalence of Burnout Among Physicians: A Systematic Review
- PMID: 30326495
- PMCID: PMC6233645
- DOI: 10.1001/jama.2018.12777
Prevalence of Burnout Among Physicians: A Systematic Review
Abstract
Importance: Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown.
Objective: To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout.
Data sources and study selection: Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018.
Data extraction and synthesis: Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively.
Main outcomes and measures: Point or period prevalence of burnout assessed by questionnaire.
Results: Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined.
Conclusions and relevance: In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.
Conflict of interest statement
Figures
Comment in
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Physician Burnout-A Serious Symptom, But of What?JAMA. 2018 Sep 18;320(11):1109-1110. doi: 10.1001/jama.2018.11703. JAMA. 2018. PMID: 30422283 No abstract available.
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Quality & safety in the literature: May 2019.BMJ Qual Saf. 2019 May;28(5):424-428. doi: 10.1136/bmjqs-2019-009401. Epub 2019 Mar 6. BMJ Qual Saf. 2019. PMID: 30842266 No abstract available.
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Literature Commentary: Take Two!J Neuroophthalmol. 2019 Jun;39(2):279-285. doi: 10.1097/WNO.0000000000000803. J Neuroophthalmol. 2019. PMID: 31022066
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Is "burnout" a dangerous, misleading label?R I Med J (2013). 2020 Nov 2;103(9):8-9. R I Med J (2013). 2020. PMID: 33126778 No abstract available.
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Burnout urgently needs robust research.Nature. 2021 Apr;592(7853):188. doi: 10.1038/d41586-021-00896-1. Nature. 2021. PMID: 33824518 No abstract available.
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