Tolerance for uncertainty, burnout, and satisfaction with the career of emergency medicine

Ann Emerg Med. 2009 Jul;54(1):106-113.e6. doi: 10.1016/j.annemergmed.2008.12.019. Epub 2009 Feb 7.


Study objective: Questions about burnout, career satisfaction, and longevity of emergency physicians have been raised but no studies have examined tolerance for uncertainty as a risk factor for burnout. Primary objectives of this study are to assess the role of uncertainty tolerance in predicting career burnout and to estimate the proportion of emergency physicians who exhibit high levels of career burnout.

Methods: A mail survey incorporating validated measures of career satisfaction, tolerance for uncertainty, and burnout was sent to a random sample of members of the American College of Emergency Physicians. Best- and worst-case scenarios of point estimates are provided to assess for the effect of nonresponse bias, and multivariable logistic regression was used to predict evidence of career burnout.

Results: One hundred ninety-three surveys were returned (response rate 43.1%). A high level of career burnout was exhibited in 62 (32.1%; best-worst case 13.8% to 64.1%) respondents. No demographic variables were associated with burnout status. The final model identified that high anxiety caused by concern for bad outcomes (odds ratio=6.35) was the strongest predictor of career burnout, controlling for all other variables.

Conclusion: A large percentage of emergency physicians in this study, 32.1%, exhibited emotional exhaustion, which is the core symptom of burnout. Emotional exhaustion was not related to age or type of practice and was not mitigated by training in emergency medicine. Physicians studied did not feel anxiety because of general uncertainty, difficulty in disclosing uncertainty to patients, or admitting errors to other physicians. High anxiety caused by concern for bad outcomes was the strongest predictor of burnout. Despite exhibiting emotional exhaustion, the majority of respondents are satisfied with the career of emergency medicine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological*
  • Adult
  • Attitude of Health Personnel
  • Burnout, Professional*
  • Emergency Medicine*
  • Female
  • Humans
  • Job Satisfaction*
  • Male
  • Physicians / psychology
  • Risk Factors
  • Surveys and Questionnaires
  • Uncertainty*
  • Work Schedule Tolerance