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.

Figure 1.. Study Identification and Selection

Figure 2.. Prevalence of Overall Burnout Reported by 34 Studies Stratified by Assessment Method

Studies are grouped alphabetically by screening instrument and ordered by increasing number of participants. The area of each square is proportional to the inverse variance of the estimate. Error bars indicate 95% confidence intervals of the estimate. CY, cynicism; DP, depersonalization; EE, emotional exhaustion; EX, exhaustion; HBI, Hamburg Burnout Inventory; MBI, Maslach Burnout Inventory; MBI-GS, MBI–General Survey; MBI-HSS, MBI–Human Services Survey; Mini Z, Zero Burnout Program Survey; PA, personal accomplishment; PE, professional efficacy; UBOS, Utrechtse Burnout Schaal (Dutch adaptation of the MBI).

Figure 3.. Prevalence of Emotional Exhaustion Reported by 33 Studies Stratified by Assessment Method

Studies are grouped alphabetically by screening instrument and ordered by increasing number of participants. The area of each square is proportional to the inverse variance of the estimate. Error bars indicate 95% confidence intervals of the estimate. See Figure 2 caption for assessment method abbreviation expansions.

Figure 4.. Prevalence of Depersonalization Reported by 30 Studies Stratified by Assessment Method

Studies are grouped alphabetically by screening instrument and ordered by increasing number of participants. The area of each square is proportional to the inverse variance of the estimate. Error bars indicate 95% confidence intervals of the estimate. See Figure 2 caption for assessment method abbreviation expansions.

Figure 5.. Prevalence of Low Personal Accomplishment Reported by 28 Studies Stratified by Assessment Method

Studies are grouped alphabetically by screening instrument and ordered by increasing number of participants. The area of each square is proportional to the inverse variance of the estimate. Error bars indicate 95% confidence intervals of the estimate. See Figure 2 caption for assessment method abbreviation expansions.