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   ICD10 = {{ICD10|Z|73|0|z|70}} |
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'''Burnout''' is a concept in [[industrial and organizational psychology]] for "an excessive stress reaction to one's occupational or professional environment. It is manifested by feelings of emotional and physical exhaustion coupled with a sense of frustration and failure".<ref name="MeSH">{{MeSH|Professional Burnout}}</ref> Burnout has three dimensions<ref name="Maslach Jackson 1981 pp. 99–113">{{cite journal | last=Maslach | first=Christina | last2=Jackson | first2=Susan E. | title=The measurement of experienced burnout | journal=Journal of Organizational Behavior | publisher=Wiley-Blackwell | volume=2 | issue=2 | year=1981 | issn=0894-3796 | doi=10.1002/job.4030020205 | pages=99–113}}</ref>:
'''Burnout''' is a concept in [[industrial and organizational psychology]] for "an excessive stress reaction to one's occupational or professional environment. It is manifested by feelings of emotional and physical exhaustion coupled with a sense of frustration and failure".<ref name="MeSH">{{MeSH|Professional Burnout}}</ref> Burnout has three dimensions<ref name="Maslach Jackson 1981 pp. 99–113">{{cite journal | last=Maslach | first=Christina | last2=Jackson | first2=Susan E. | title=The measurement of experienced burnout | journal=Journal of Organizational Behavior | publisher=Wiley-Blackwell | volume=2 | issue=2 | year=1981 | issn=0894-3796 | doi=10.1002/job.4030020205 | pages=99–113}}</ref>:


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Subsequent research suggests the third dimension, personal accomplishment, better fits with the concept of professional engagement rather than with burnout.<ref name="SchaufeliBakker2016">{{cite journal|last1=Schaufeli|first1=Wilmar B.|last2=Bakker|first2=Arnold B.|last3=Salanova|first3=Marisa|title=The Measurement of Work Engagement With a Short Questionnaire|journal=Educational and Psychological Measurement|volume=66|issue=4|year=2016|pages=701–716|issn=0013-1644|doi=10.1177/0013164405282471}}</ref>
Subsequent research suggests the third dimension, personal accomplishment, better fits with the concept of professional engagement rather than with burnout.<ref name="SchaufeliBakker2016">{{cite journal|last1=Schaufeli|first1=Wilmar B.|last2=Bakker|first2=Arnold B.|last3=Salanova|first3=Marisa|title=The Measurement of Work Engagement With a Short Questionnaire|journal=Educational and Psychological Measurement|volume=66|issue=4|year=2016|pages=701–716|issn=0013-1644|doi=10.1177/0013164405282471}}</ref>


Burnout is due to loss of control at work, and also "burnout is mainly predicted by job demands but also by lack of job resources"<ref nae="10.1002/job.248">Schaufeli, W. B., & Bakker, A. B. (2004). Job demands, job resources, and their relationship with burnout and engagement: A multi‐sample study. Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior, 25(3), 293-315{{doi|10.1002/job.248}}</ref>.
Workaholism more closely correlates with [[burnout]] than with engagement, although workaholism correlated with both (weakly negatively with engagement [via absorption])<ref name="SchaufeliTarisvan Rhenen2008">{{cite journal | last1 = Schaufeli | first1 = Wilmar B. | last2 = Taris | first2 = Toon W. | last3 = van Rhenen | first3 = Willem | title = Workaholism, Burnout, and Work Engagement: Three of a Kind or Three Different Kinds of Employee Well-being? | journal = Applied Psychology | date = April 2008 | volume = 57 | issue = 2 | pages = 173–203 | issn = 0269-994X | eissn = 1464-0597 | doi = 10.1111/j.1464-0597.2007.00285.x | pmid = | url = }}</ref>.
 
Engagement may not simply be the opposite of burnout<ref name="Schaufeli2004">Schaufeli, W.B. and Bakker, A.B. (2004), Job demands, job resources, and their relationship with burnout and engagement: a multi‐sample study. J. Organiz. Behav., 25: 293-315. {{doi|10.1002/job.248}}</ref>. Engagement and burnout may be related more specifically<ref name="González-RomáSchaufeliBakker2006">{{cite journal | last1 = González-Romá | first1 = Vicente | last2 = Schaufeli | first2 = Wilmar B. | last3 = Bakker | first3 = Arnold B. | last4 = Lloret | first4 = Susana | title = Burnout and work engagement: Independent factors or opposite poles? | journal = Journal of Vocational Behavior | date = February 2006 | volume = 68 | issue = 1 | pages = 165–174 | issn = 0001-8791 | doi = 10.1016/j.jvb.2005.01.003 | pmid = | url = }}</ref>:
* Emotional exhaustion may be the opposite of vigor
* Cynicism may be the opposite of dedication
 
OR
 
"Vigor and dedication are the direct positive opposites of exhaustion and cynicism, respectively."<ref name="Schaufeli2004"/>
 
According to Schaufeli<ref name="Schaufeli2004"/> , the "Energetic Process" is based on Hockey's model of compensatory control and when "perceived demands are too high to be met by the usual working effort, two options are open:
* Strain coping mode leading to fatigue and irritability
* Passive coping mode leading to disengagement


Burnout is now being studied in its reported antitheses, [[job satisfaction]], job engagement and thriving. Thriving may protect against burnout<ref name="Porath2012">Porath, Christine, et al. "Thriving at work: Toward its measurement, construct validation, and theoretical refinement." Journal of Organizational Behavior 33.2 (2012): 250-275. {{doi|10.1002/job.756}}</ref><ref name="pmid27631555">{{cite journal| author=Hildenbrand K, Sacramento CA, Binnewies C| title=Transformational Leadership and Burnout: The Role of Thriving and Followers' Openness to Experience. | journal=J Occup Health Psychol | year= 2016 | volume=  | issue=  | pages=  | pmid=27631555 | doi=10.1037/ocp0000051 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27631555  }} </ref>. Engagement is both negatively associated with burnout<ref nae="10.1002/job.248">Schaufeli, W. B., & Bakker, A. B. (2004). Job demands, job resources, and their relationship with burnout and engagement: A multi‐sample study. Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior, 25(3), 293-315{{doi|10.1002/job.248}}</ref>, but also unhealthy engagement may lead to burnout.<ref name="pmid17470184">{{cite journal| author=Vinje HF, Mittelmark MB| title=Job engagement's paradoxical role in nurse burnout. | journal=Nurs Health Sci | year= 2007 | volume= 9 | issue= 2 | pages= 107-11 | pmid=17470184 | doi=10.1111/j.1442-2018.2007.00310.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17470184  }} </ref>


Engagement may not simply be the opposite of burnout<ref anme="Schaufeli2004">Schaufeli, W.B. and Bakker, A.B. (2004), Job demands, job resources, and their relationship with burnout and engagement: a multi‐sample study. J. Organiz. Behav., 25: 293-315. {{doi|10.1002/job.248}}</ref>.
The distinction between burnout and [[depression]] is not clear<ref name="pmid36317749">{{cite journal| author=Sen S| title=Is It Burnout or Depression? Expanding Efforts to Improve Physician Well-Being. | journal=N Engl J Med | year= 2022 | volume= 387 | issue= 18 | pages= 1629-1630 | pmid=36317749 | doi=10.1056/NEJMp2209540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36317749  }} </ref>.


==Prevalence==
==Prevalence==
 
The prevalence of burnout in the general, employed population of the United States, aged is (measured by MBI except where noted)<ref name="pmid24448053">{{cite journal| author=Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J et al.| title=Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. | journal=Acad Med | year= 2014 | volume= 89 | issue= 3 | pages= 443-51 | pmid=24448053 | doi=10.1097/ACM.0000000000000134 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24448053  }} </ref><ref name="pmid22911330">{{cite journal| author=Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D et al.| title=Burnout and satisfaction with work-life balance among US physicians relative to the general US population. | journal=Arch Intern Med | year= 2012 | volume= 172 | issue= 18 | pages= 1377-85 | pmid=22911330 | doi=10.1001/archinternmed.2012.3199 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22911330  }} </ref><ref name="pmid26653297">{{cite journal| author=Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J et al.| title=Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. | journal=Mayo Clin Proc | year= 2015 | volume= 90 | issue= 12 | pages= 1600-13 | pmid=26653297 | doi=10.1016/j.mayocp.2015.08.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26653297  }} </ref>:
The prevalence of burnout in the general, employed population of the United States, aged is<ref name="pmid24448053">{{cite journal| author=Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J et al.| title=Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. | journal=Acad Med | year= 2014 | volume= 89 | issue= 3 | pages= 443-51 | pmid=24448053 | doi=10.1097/ACM.0000000000000134 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24448053  }} </ref><ref name="pmid22911330">{{cite journal| author=Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D et al.| title=Burnout and satisfaction with work-life balance among US physicians relative to the general US population. | journal=Arch Intern Med | year= 2012 | volume= 172 | issue= 18 | pages= 1377-85 | pmid=22911330 | doi=10.1001/archinternmed.2012.3199 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22911330  }} </ref><ref name="pmid26653297">{{cite journal| author=Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J et al.| title=Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. | journal=Mayo Clin Proc | year= 2015 | volume= 90 | issue= 12 | pages= 1600-13 | pmid=26653297 | doi=10.1016/j.mayocp.2015.08.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26653297  }} </ref>:
* General, employed U.S. population
* General, employed U.S. population
** (2010): aged 31-47 30%<ref name="pmid24448053"/>, aged 29-65 29%<ref name="pmid22911330"/>
** (2010): aged 31-47 30%<ref name="pmid24448053"/>, aged 29-65 29%<ref name="pmid22911330"/>
** (2014): aged 31-65 28%<ref name="pmid26653297"/>
** (2014): aged 31-65 28%<ref name="pmid26653297"/>
** (2017): aged 29-65 28%<ref name="pmid30803733">{{cite journal| author=Shanafelt TD, West CP, Sinsky C, Trockel M, Tutty M, Satele DV et al.| title=Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017. | journal=Mayo Clin Proc | year= 2019 | volume= 94 | issue= 9 | pages= 1681-1694 | pmid=30803733 | doi=10.1016/j.mayocp.2018.10.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30803733  }} </ref>
** (2017): aged 29-65 28%<ref name="pmid30803733">Shanafelt TD, West CP, Sinsky C, Trockel M, Tutty M, Satele DV | display-authors=etal (2019) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=30803733 Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017.] ''Mayo Clin Proc'' 94 (9):1681-1694. [http://dx.doi.org/10.1016/j.mayocp.2018.10.023 DOI:10.1016/j.mayocp.2018.10.023] PMID: [https://pubmed.gov/30803733 30803733]</ref>
** (2021): during COVID epidemic in Japan: 31% (measured by Mini-Z)<ref name="pmid36424113">Matsuo T, Yoshioka T, Okubo R, Nagasaki K, Tabuchi T (2022) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=36424113 Burnout and its associated factors among healthcare workers and the general working population in Japan during the COVID-19 pandemic: a nationwide cross-sectional internet-based study.] ''BMJ Open'' 12 (11):e064716. [http://dx.doi.org/10.1136/bmjopen-2022-064716 DOI:10.1136/bmjopen-2022-064716] PMID: [https://pubmed.gov/36424113 36424113]</ref>
 
* College graduates 2010: aged 31-47 36%<ref name="pmid24448053"/>
* College graduates 2010: aged 31-47 36%<ref name="pmid24448053"/>


==Health care workers==
===Health care workers===
As of 2017, 44% of physicians have have burnout<ref name="pmid30803733">Shanafelt TD, West CP, Sinsky C, Trockel M, Tutty M, Satele DV | display-authors=etal (2019) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=30803733 Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017.] ''Mayo Clin Proc'' 94 (9):1681-1694. [http://dx.doi.org/10.1016/j.mayocp.2018.10.023 DOI:10.1016/j.mayocp.2018.10.023] PMID: [https://pubmed.gov/30803733 30803733]</ref> Previously, in 2014, as many as 50% of physicians in practice may have burnout.<ref name="pmid26653297">{{cite journal| author=Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J et al.| title=Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. | journal=Mayo Clin Proc | year= 2015 | volume= 90 | issue= 12 | pages= 1600-13 | pmid=26653297 | doi=10.1016/j.mayocp.2015.08.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26653297  }} </ref> [[General practitioner]]s seem to have low job control and the highest proportion of burnout cases<ref name="pmid16512316">{{cite journal| author=Taris TW, Stoffelsen J, Bakker AB, Schaufeli WB, van Dierendonck D| title=Job control and burnout across occupations. | journal=Psychol Rep | year= 2005 | volume= 97 | issue= 3 | pages= 955-61 | pmid=16512316 | doi=10.2466/pr0.97.3.955-961 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16512316  }} </ref>.
 
For physicians in training, rates of burnout (emotional exhaustion) for students, residents and fellows is about 50% while the rate is 36% in similarly aged college graduates.<ref name="pmid24448053">{{cite journal| author=Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J et al.| title=Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. | journal=Acad Med | year= 2014 | volume= 89 | issue= 3 | pages= 443-51 | pmid=24448053 | doi=10.1097/ACM.0000000000000134 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24448053  }} </ref>
 
==Causes==
Burnout is due to loss of control at work, and also "burnout is mainly predicted by job demands but also by lack of job resources"<ref name="10.1002/job.248">Schaufeli, W. B., & Bakker, A. B. (2004). Job demands, job resources, and their relationship with burnout and engagement: A multi‐sample study. Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior, 25(3), 293-315{{doi|10.1002/job.248}}</ref>.
 
Curiously, a study of physicians found, "High levels of personal accomplishment increased stress levels (beta=0 080), whereas depersonalisation lowered stress levels (beta=-0 105)"<ref name="pmid12086767">{{cite journal| author=McManus IC, Winder BC, Gordon D| title=The causal links between stress and burnout in a longitudinal study of UK doctors. | journal=Lancet | year= 2002 | volume= 359 | issue= 9323 | pages= 2089-90 | pmid=12086767 | doi=10.1016/s0140-6736(02)08915-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12086767  }} </ref> The study also found that


As of 2017, 44% of physicians have have burnout<ref name="pmid30803733">{{cite journal| author=Shanafelt TD, West CP, Sinsky C, Trockel M, Tutty M, Satele DV et al.| title=Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017. | journal=Mayo Clin Proc | year= 2019 | volume= 94 | issue= 9 | pages= 1681-1694 | pmid=30803733 | doi=10.1016/j.mayocp.2018.10.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30803733  }} </ref>. Previously, in 2014, as many as 50% of physicians in practice may have burnout.<ref name="pmid26653297">{{cite journal| author=Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J et al.| title=Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. | journal=Mayo Clin Proc | year= 2015 | volume= 90 | issue= 12 | pages= 1600-13 | pmid=26653297 | doi=10.1016/j.mayocp.2015.08.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26653297 }} </ref> [[General practitioner]]s seem to have low job control and the highest proportion of burnout cases<ref name="pmid16512316">{{cite journal| author=Taris TW, Stoffelsen J, Bakker AB, Schaufeli WB, van Dierendonck D| title=Job control and burnout across occupations. | journal=Psychol Rep | year= 2005 | volume= 97 | issue= 3 | pages= 955-61 | pmid=16512316 | doi=10.2466/pr0.97.3.955-961 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16512316  }} </ref>.
Different underlying factors may lead to varying phenotypes of burnout<ref name="doi10.1016/j.burn.2016.09.001">{{Cite journal| doi = 10.1016/j.burn.2016.09.001| issn = 2213-0586| volume = 3| issue = 4| pages = 89–100| last1 = Leiter| first1 = Michael P.| last2 = Maslach| first2 = Christina| title = Latent burnout profiles: A new approach to understanding the burnout experience| journal = Burnout Research| accessdate = 2022-06-26| date = 2016-12-01| url = https://www.sciencedirect.com/science/article/pii/S2213058615300188}}</ref><ref name="pmid20008605">{{cite journal| author=Leiter MP, Frank E, Matheson TJ| title=Demands, values, and burnout: relevance for physicians. | journal=Can Fam Physician | year= 2009 | volume= 55 | issue= 12 | pages= 1224-1225, 1225.e1-6 | pmid=20008605 | doi= | pmc=2793232 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20008605 }} </ref> One study found<ref name="doi10.1016/j.burn.2016.09.001"/>:
* Burnout (high on all three dimensions)
* Engagement (low on all three)
* Overextended (high on exhaustion only)
* Disengaged (high on cynicism only). Also called depersonalization by Leiter<ref name="doi10.1016/j.burn.2016.09.001"/> which may be the same as mental distance used by the [[World Health Organization]]<ref>Amonymous (2019). Burn-out an "occupational phenomenon": International Classification of Diseases
Available at https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases</ref>.
* Ineffective (high on inefficacy only)


Burnout is more common in larger practices suggesting that practice level autonomy may be important<ref name="EdwardsMarino2018">{{cite journal|last1=Edwards|first1=Samuel T.|last2=Marino|first2=Miguel|last3=Balasubramanian|first3=Bijal A.|last4=Solberg|first4=Leif I.|last5=Valenzuela|first5=Steele|last6=Springer|first6=Rachel|last7=Stange|first7=Kurt C.|last8=Miller|first8=William L.|last9=Kottke|first9=Thomas E.|last10=Perry|first10=Cynthia K.|last11=Ono|first11=Sarah|last12=Cohen|first12=Deborah J.|title=Burnout Among Physicians, Advanced Practice Clinicians and Staff in Smaller Primary Care Practices|journal=Journal of General Internal Medicine|volume=33|issue=12|year=2018|pages=2138–2146|issn=0884-8734|doi=10.1007/s11606-018-4679-0}}</ref>.
Regarding the possible connection of burnout with autonomy, burnout is more common in<ref name="pmid34097508">{{cite journal| author=Edwards ST, Marino M, Solberg LI, Damschroder L, Stange KC, Kottke TE | display-authors=etal| title=Cultural And Structural Features Of Zero-Burnout Primary Care Practices. | journal=Health Aff (Millwood) | year= 2021 | volume= 40 | issue= 6 | pages= 928-936 | pmid=34097508 | doi=10.1377/hlthaff.2020.02391 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34097508  }} </ref>:
* chaotic practices<ref name="pmid34097508"/>
* larger practices<ref name="pmid34097508"/>
* accountable care organizations<ref name="pmid34097508"/>


For physicians in training, rates of burnout (emotional exhaustion) for students, residents and fellows is about 50% while the rate is 36% in similarly aged college graduates.<ref name="pmid24448053">{{cite journal| author=Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J et al.| title=Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. | journal=Acad Med | year= 2014 | volume= 89 | issue= 3 | pages= 443-51 | pmid=24448053 | doi=10.1097/ACM.0000000000000134 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24448053  }} </ref>  Burnout in physicians in training is associated with perceived harassment<ref name="pmid24667503">{{cite journal| author=Cook AF, Arora VM, Rasinski KA, Curlin FA, Yoon JD| title=The prevalence of medical student mistreatment and its association with burnout. | journal=Acad Med | year= 2014 | volume= 89 | issue= 5 | pages= 749-54 | pmid=24667503 | doi=10.1097/ACM.0000000000000204 | pmc=4401419 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24667503  }} </ref>.  In one survey of 24 American medical schools, harassment occurring at least one time was reported by 83% of students<ref name="pmid24667503"/>. In this study, harassment was more commonly reported being perpetrated by residents<ref name="pmid24667503"/>. The rates of burnout among students responding to the survey were<ref name="pmid24667503"/>:
Burnout in physicians in training is associated with perceived harassment<ref name="pmid24667503">{{cite journal| author=Cook AF, Arora VM, Rasinski KA, Curlin FA, Yoon JD| title=The prevalence of medical student mistreatment and its association with burnout. | journal=Acad Med | year= 2014 | volume= 89 | issue= 5 | pages= 749-54 | pmid=24667503 | doi=10.1097/ACM.0000000000000204 | pmc=4401419 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24667503  }} </ref>.  In one survey of 24 American medical schools, harassment occurring at least one time was reported by 83% of students<ref name="pmid24667503"/>. In this study, harassment was more commonly reported being perpetrated by residents<ref name="pmid24667503"/>. The rates of burnout among students responding to the survey were<ref name="pmid24667503"/>:
* All students 34%
* All students 34%
* Those reporting recurrent harassment by faculty 57%
* Those reporting recurrent harassment by faculty 57%
* Those ''not'' reporting recurrent harassment by faculty 32%
* Those ''not'' reporting recurrent harassment by faculty 32%
=== Job demands-resources model of burnout ===
Several items, specifically workload, are reflected in the job demands-resources model of burnout<ref name="pmid11419809">{{cite journal| author=Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB| title=The job demands-resources model of burnout. | journal=J Appl Psychol | year= 2001 | volume= 86 | issue= 3 | pages= 499-512 | pmid=11419809 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11419809  }} </ref>.
These findings are reflected in the Demand-Control theory of job stress.
<ref name="Karasek 1990 p. ">{{cite book | last=Karasek | first=Robert | title=Healthy work : stress, productivity, and the reconstruction of working life | publisher=Basic Books | publication-place=New York | year=1990 | isbn=0-465-02897-7 | page=}}</ref>
===Areas of Worklife Survey (AWS)===
Leiter and Maslach found the following antecedents from the Areas of Worklife Survey (AWS) using factor analysis:<ref name="Leite20093">Leiter, Michael P., and Christina Maslach. "Areas of worklife: A structured approach to organizational predictors of job burnout." Emotional and physiological processes and positive intervention strategies. Emerald Group Publishing Limited, 2003. 91-134. {{doi|10.1016/S1479-3555(03)03003-8}}</ref>
* Workload
* Fairness
* Control
* Community
* Values
* Rewards
Of these causes, workload is the strongest correlate of emotional exhaustion<ref name="Leite20093"/> but loss of control may be the initial factor. Perceived control or autonomy and fairness correlate with cynicism.<ref name="Leite20093"/><ref name="Fernet Austin Trépanier Dussault 2013 pp. 123–137">{{cite journal | last=Fernet | first=Claude | last2=Austin | first2=Stéphanie | last3=Trépanier | first3=Sarah-Geneviève | last4=Dussault | first4=Marc | title=How do job characteristics contribute to burnout? Exploring the distinct mediating roles of perceived autonomy, competence, and relatedness | journal=European Journal of Work and Organizational Psychology | publisher=Informa UK Limited | volume=22 | issue=2 | year=2013 | issn=1359-432X | doi=10.1080/1359432x.2011.632161 | pages=123–137}}</ref>
* 16% of burnout is attributed to perceived control at the worksite.<ref>Taris, Toon W., et al. "Job control and burnout across occupations." Psychological Reports 97.3 (2005): 955-961. {{doi|10.2466/pr0.97.3.955-961}}</ref>
Leiter et al found that workload relates more to exhaustion while values incongruency relates more to cynicism<ref name="doi10.1016/S1479-3555(03)03003-8">{{cite book | title = Research in Occupational Stress and Well-being | last1 = Leiter | first1 = Michael P | last2 = Maslach | first2 = Christina | chapter = AREAS OF WORKLIFE: A STRUCTURED APPROACH TO ORGANIZATIONAL PREDICTORS OF JOB BURNOUT | pages = 91–134 | publisher = Emerald (MCB UP ) | issn = 1479-3555 | doi = 10.1016/S1479-3555(03)03003-8 | url = }}</ref>.
=== Leadership quality ===
Leadership affects both burnout and work fulfillment. A study at the Mayo Clinic found that the "average leadership behaviour score of physicians’ work unit supervisor explained 11% of the variation in burnout and 47% of the variation in workplace satisfaction"<ref name="pmid25796117">{{cite journal| author=Shanafelt TD, Gorringe G, Menaker R, Storz KA, Reeves D, Buskirk SJ | display-authors=etal| title=Impact of organizational leadership on physician burnout and satisfaction. | journal=Mayo Clin Proc | year= 2015 | volume= 90 | issue= 4 | pages= 432-40 | pmid=25796117 | doi=10.1016/j.mayocp.2015.01.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25796117  }} </ref>.
In a second study across 11 healthcare organizations, the rates of burnout by tercile of leadership ratings of effectiveness by their direct reports<ref name="pmid36691255">{{cite journal| author=Mete M, Goldman C, Shanafelt T, Marchalik D| title=Impact of leadership behaviour on physician well-being, burnout, professional fulfilment and intent to leave: a multicentre cross-sectional survey study. | journal=BMJ Open | year= 2022 | volume= 12 | issue= 6 | pages= e057554 | pmid=36691255 | doi=10.1136/bmjopen-2021-057554 | pmc=9171269 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36691255  }} </ref>:
* 18%
* 35%
* 47%


According to the yearly survey of recent medical school graduates by the Association of American Medical Colleges, the following are reported <ref>Association of American Medical Colleges. [https://www.aamc.org/data/gq/allschoolsreports/ Medical School Graduation Questionnaire: All Schools Summary Report]. Association of American Medical Colleges; Washington, DC</ref>:
According to the yearly survey of recent medical school graduates by the Association of American Medical Colleges, the following are reported <ref>Association of American Medical Colleges. [https://www.aamc.org/data/gq/allschoolsreports/ Medical School Graduation Questionnaire: All Schools Summary Report]. Association of American Medical Colleges; Washington, DC</ref>:
* Occasional public embarrassment 20%
* Occasional public embarrassment 20%
* Occasional public humiliation 8%
* Occasional public humiliation 8%
Burnout is now being studied in its reported antitheses, [[job satisfaction]], job engagement and thriving. Thriving may protect against burnout<ref name="Porath2012">Porath, Christine, et al. "Thriving at work: Toward its measurement, construct validation, and theoretical refinement." Journal of Organizational Behavior 33.2 (2012): 250-275. {{doi|10.1002/job.756}}</ref><ref name="pmid27631555">{{cite journal| author=Hildenbrand K, Sacramento CA, Binnewies C| title=Transformational Leadership and Burnout: The Role of Thriving and Followers' Openness to Experience. | journal=J Occup Health Psychol | year= 2016 | volume=  | issue=  | pages=  | pmid=27631555 | doi=10.1037/ocp0000051 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27631555  }} </ref>. Engagement is both negatively associated with burnout<ref nae="10.1002/job.248">Schaufeli, W. B., & Bakker, A. B. (2004). Job demands, job resources, and their relationship with burnout and engagement: A multi‐sample study. Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior, 25(3), 293-315{{doi|10.1002/job.248}}</ref>, but also unhealthy engagement may lead to burnout.<ref name="pmid17470184">{{cite journal| author=Vinje HF, Mittelmark MB| title=Job engagement's paradoxical role in nurse burnout. | journal=Nurs Health Sci | year= 2007 | volume= 9 | issue= 2 | pages= 107-11 | pmid=17470184 | doi=10.1111/j.1442-2018.2007.00310.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17470184  }} </ref>


==Measurement==
==Measurement==
Several burnout inventories are available including the Maslach, Copenhagen, and Oldenburg<ref>Dyrbye L et al (2018). [https://nam.edu/a-pragmatic-approach-for-organizations-to-measure-health-care-professional-well-being/ A Pragmatic Approach for Organizations to Measure Health Care Professional Well-Being]. National Academy of Medicine</ref>.
Several burnout inventories are available including the Maslach, Copenhagen, and Oldenburg<ref>Dyrbye L et al (2018). [https://nam.edu/a-pragmatic-approach-for-organizations-to-measure-health-care-professional-well-being/ A Pragmatic Approach for Organizations to Measure Health Care Professional Well-Being]. National Academy of Medicine</ref><ref name="nam">{{Citation | vauthors=((Anonymous)) | title=Valid and Reliable Survey Instruments to Measure Burnout, Well-Being, and Other Work-Related Dimensions | url=https://nam.edu/valid-reliable-survey-instruments-measure-burnout-well-work-related-dimensions/ | access-date=3 October 2021}}</ref>.
 
Eckleberry-Hunt in 2017 raised the question that burnout is being over-reported by deeming burnout present if ''either'' emotional exhaustion ''or'' depersonalization are present.<ref name="pmid28817432">{{cite journal| author=Eckleberry-Hunt J, Kirkpatrick H, Barbera T| title=The Problems With Burnout Research. | journal=Acad Med | year= 2017 | volume=  | issue=  | pages=  | pmid=28817432 | doi=10.1097/ACM.0000000000001890 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28817432  }} </ref>
 


===Maslach Burnout Inventory===
===Maslach Burnout Inventory===
The Maslach Burnout Inventory is the earliest and most well-studied measurement of burnout.  Maslach and her colleague Jackson first identified the construct "burnout" in the 1970s, and developed a measure that weighs the effects of on three scales<ref name="Maslach Jackson 1981 pp. 99–113">{{cite journal | last=Maslach | first=Christina | last2=Jackson | first2=Susan E. | title=The measurement of experienced burnout | journal=Journal of Organizational Behavior | publisher=Wiley-Blackwell | volume=2 | issue=2 | year=1981 | issn=0894-3796 | doi=10.1002/job.4030020205 | pages=99–113}}</ref>:
The Maslach Burnout Inventory is a well-studied measurement of burnout that was first published in 1981.  Maslach and her colleague Jackson first identified the construct "burnout" in the 1970s, and developed a measure that weighs the effects of on three scales<ref name="Maslach Jackson 1981 pp. 99–113">{{cite journal | last=Maslach | first=Christina | last2=Jackson | first2=Susan E. | title=The measurement of experienced burnout | journal=Journal of Organizational Behavior | publisher=Wiley-Blackwell | volume=2 | issue=2 | year=1981 | issn=0894-3796 | doi=10.1002/job.4030020205 | pages=99–113}}</ref>:
* Emotional exhaustion (nine items)
* Emotional exhaustion (nine items)
* Depersonalization (five items)
* Depersonalization (five items)
* Personal accomplishment (eight items)
* Personal accomplishment (eight items)


An important question has been raised by Eckleberry-Hunt that we may be over-estimating rates of burnout due to the common two item survey deeming burnout if ''either'' emotional exhaustion or depersonaliztion are present when the original survey required both to be present<ref name="pmid28817432">{{cite journal| author=Eckleberry-Hunt J, Kirkpatrick H, Barbera T| title=The Problems With Burnout Research. | journal=Acad Med | year= 2018 | volume= 93 | issue= 3 | pages= 367-370 | pmid=28817432 | doi=10.1097/ACM.0000000000001890 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28817432  }} </ref>.
The Maslach Burnout Inventory (MBI) has several versions:
* Human Services Survey (MBI-HSS) is 22-tems and for jobs such as 'clergy, police, therapists, social workers, medical'<ref name="Maslach1981">{{cite journal | vauthors=((Maslach, C. T.)), ((Jackson, S. E.)) | journal=Journal of Organizational Behavior | title=The measurement of experienced burnout | volume=2 | issue=2 | pages=99–113 | date=1 April 1981 | url=http://onlinelibrary.wiley.com.proxy.kumc.edu:2048/doi/10.1002/job.4030020205/abstract | issn=1099-1379 | doi=10.1002/job.4030020205 | access-date=1 May 2017}}</ref>
** MBI-HSS without the Personal Accomplishment subscale is 14 items.
 
* General Survey (MBI-GS) a 16-items for more general, non-social jobs as well<ref name="Taris1999">{{cite journal | vauthors=((Taris, T. W.)), ((Schreurs, P. J. G.)), ((Schaufeli, W. B.)) | journal=Work & Stress | title=Construct validity of the Maslach Burnout Inventory-General Survey: A two-sample examination of its factor structure and correlates | volume=13 | issue=3 | pages=223–237 | date= July 1999 | url=http://www.tandfonline.com/doi/abs/10.1080/026783799296039 | issn=0267-8373, 1464-5335 | doi=10.1080/026783799296039 | access-date=18 September 2022}}</ref>
** MBI-GS without the Professional Efficacy subscale is 10 items.
 
Eckleberry-Hunt in 2017 raised the question that burnout is being over-reported by deeming burnout present if ''either'' emotional exhaustion ''or'' depersonalization are present.<ref name="pmid28817432">{{cite journal| author=Eckleberry-Hunt J, Kirkpatrick H, Barbera T| title=The Problems With Burnout Research. | journal=Acad Med | year= 2017 | volume= | issue= | pages= | pmid=28817432 | doi=10.1097/ACM.0000000000001890 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28817432  }} </ref>


===2 item burnout Inventory===
====2-item Maslach Burnout Inventory====
In this survey, abnormal is defined as symptoms weekly or more on either item.<ref name="pmid21900135">{{cite journal| author=West CP, Shanafelt TD, Kolars JC| title=Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. | journal=JAMA | year= 2011 | volume= 306 | issue= 9 | pages= 952-60 | pmid=21900135 | doi=10.1001/jama.2011.1247 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21900135  }} </ref><ref name="pmid22362127">{{cite journal| author=West CP, Dyrbye LN, Satele DV, Sloan JA, Shanafelt TD| title=Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment. | journal=J Gen Intern Med | year= 2012 | volume= 27 | issue= 11 | pages= 1445-52 | pmid=22362127 | doi=10.1007/s11606-012-2015-7 | pmc=3475833 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22362127  }} </ref> The first item correlates with emotional exhaustion.
In this survey, abnormal is defined as symptoms weekly or more on either item.<ref name="pmid19802645">{{cite journal| author=West CP, Dyrbye LN, Sloan JA, Shanafelt TD| title=Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. | journal=J Gen Intern Med | year= 2009 | volume= 24 | issue= 12 | pages= 1318-21 | pmid=19802645 | doi=10.1007/s11606-009-1129-z | pmc=2787943 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19802645  }} </ref><ref name="pmid21900135">{{cite journal| author=West CP, Shanafelt TD, Kolars JC| title=Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. | journal=JAMA | year= 2011 | volume= 306 | issue= 9 | pages= 952-60 | pmid=21900135 | doi=10.1001/jama.2011.1247 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21900135  }} </ref><ref name="pmid22362127">{{cite journal| author=West CP, Dyrbye LN, Satele DV, Sloan JA, Shanafelt TD| title=Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment. | journal=J Gen Intern Med | year= 2012 | volume= 27 | issue= 11 | pages= 1445-52 | pmid=22362127 | doi=10.1007/s11606-012-2015-7 | pmc=3475833 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22362127  }} </ref>  


1. ''I feel burned out from my work''<ref name="pmid22362127"/> or ''How often do you feel burned out from your work?''<ref name="pmid21900135"/>
1. ''I feel burned out from my work''<ref name="pmid22362127"/> or ''How often do you feel burned out from your work?''<ref name="pmid21900135"/>
Line 71: Line 133:
* A few times a week
* A few times a week
* Every day
* Every day
This item correlates with emotional exhaustion subscale of the Maslach Burnout Inventory (minus the single item being tested)<ref name="pmid19802645">{{cite journal| author=West CP, Dyrbye LN, Sloan JA, Shanafelt TD| title=Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. | journal=J Gen Intern Med | year= 2009 | volume= 24 | issue= 12 | pages= 1318-21 | pmid=19802645 | doi=10.1007/s11606-009-1129-z | pmc=2787943 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19802645  }} </ref>:
* 0.76 to 0.83 across the four samples<ref name="pmid19802645"/>


2. ''I have become more callous toward people since I took this job''<ref name="pmid22362127"/> or ''How often do you feel you’ve become more callous toward people since you started your residency?''<ref name="pmid21900135"/>
2. ''I have become more callous toward people since I took this job''<ref name="pmid22362127"/> or ''How often do you feel you’ve become more callous toward people since you started your residency?''<ref name="pmid21900135"/>
Line 81: Line 146:
* Every day
* Every day


The two item format has been used in national surveys in 2011<ref name="pmid22911330">{{cite journal| author=Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D et al.| title=Burnout and satisfaction with work-life balance among US physicians relative to the general US population. | journal=Arch Intern Med | year= 2012 | volume= 172 | issue= 18 | pages= 1377-85 | pmid=22911330 | doi=10.1001/archinternmed.2012.3199 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22911330  }} </ref> and its follow-up survey in 2014<ref name="pmid26653297">{{cite journal| author=Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J et al.| title=Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. | journal=Mayo Clin Proc | year= 2015 | volume= 90 | issue= 12 | pages= 1600-13 | pmid=26653297 | doi=10.1016/j.mayocp.2015.08.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26653297  }} </ref>.
This item correlates with depersonalization subscale of the Maslach Burnout Inventory (minus the single item being tested)<ref name="pmid19802645">{{cite journal| author=West CP, Dyrbye LN, Sloan JA, Shanafelt TD| title=Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. | journal=J Gen Intern Med | year= 2009 | volume= 24 | issue= 12 | pages= 1318-21 | pmid=19802645 | doi=10.1007/s11606-009-1129-z | pmc=2787943 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19802645  }} </ref>:
*  0.61 to 0.72 across the four samples<ref name="pmid19802645"/>
 
The two-item score correlates with the overall MBI with a correlation of 0.65<ref name="pmid32421508">{{cite journal| author=Li-Sauerwine S, Rebillot K, Melamed M, Addo N, Lin M| title=A 2-Question Summative Score Correlates with the Maslach Burnout Inventory. | journal=West J Emerg Med | year= 2020 | volume= 21 | issue= 3 | pages= 610-617 | pmid=32421508 | doi=10.5811/westjem.2020.2.45139 | pmc=7234685 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32421508  }} </ref> which is under the threshold recommended for group crrelations<ref>HealthMeasures. PROMIS® Instrument Development and Validation Scientific Standards Version 2.0 (revised May 2013). Available at https://www.healthmeasures.net/images/PROMIS/PROMISStandards_Vers2.0_Final.pdf</ref>
 
The two-item format has been used in national surveys in 2011<ref name="pmid22911330">{{cite journal| author=Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D et al.| title=Burnout and satisfaction with work-life balance among US physicians relative to the general US population. | journal=Arch Intern Med | year= 2012 | volume= 172 | issue= 18 | pages= 1377-85 | pmid=22911330 | doi=10.1001/archinternmed.2012.3199 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22911330  }} </ref> and its follow-up survey in 2014<ref name="pmid26653297">{{cite journal| author=Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J et al.| title=Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. | journal=Mayo Clin Proc | year= 2015 | volume= 90 | issue= 12 | pages= 1600-13 | pmid=26653297 | doi=10.1016/j.mayocp.2015.08.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26653297  }} </ref>.


===Mini Z===
===Mini Z===
The 10‑item Zero Burnout Program survey, or called the Mini Z<ref name="pmid27138425">{{cite journal| author=Linzer M, Poplau S, Babbott S, Collins T, Guzman-Corrales L, Menk J et al.| title=Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey. | journal=J Gen Intern Med | year= 2016 | volume= 31 | issue= 9 | pages= 1004-10 | pmid=27138425 | doi=10.1007/s11606-016-3720-4 | pmc=4978678 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27138425  }} </ref>, was adapted from earlier work by Rohland<ref name="RohlandKruse2004">{{cite journal|last1=Rohland|first1=Barbara M.|last2=Kruse|first2=Gina R.|last3=Rohrer|first3=James E.|title=Validation of a single-item measure of burnout against the Maslach Burnout Inventory among physicians|journal=Stress and Health|volume=20|issue=2|year=2004|pages=75–79|issn=1532-3005|doi=10.1002/smi.1002}}</ref> and Schmoldt<ref>Schmoldt RA, Freeborn DK, Klevit HD. Physician burnout: recommendations for HMO managers. HMO Pract. 1994 Jun;8(2):58-63. PMID: [https://pubmed.gov/1013526 1013526]</ref>  and the Physician Worklife Survey<ref name="pmid10549620">{{cite journal| author=Konrad TR, Williams ES, Linzer M, McMurray J, Pathman DE, Gerrity M et al.| title=Measuring physician job satisfaction in a changing workplace and a challenging environment. SGIM Career Satisfaction Study Group. Society of General Internal Medicine. | journal=Med Care | year= 1999 | volume= 37 | issue= 11 | pages= 1174-82 | pmid=10549620 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10549620 }} </ref>. The Mini Z is a single item (burnout is defined as answers c, d, or e) that correlates with the emotional exhaustion scale of the Maslach<ref name="RohlandKruse2004"/>:
{| class="wikitable"
|+ Single item burnout question (SIBOQ) variations<ref name="pmid10135263">{{cite journal| author=Schmoldt RA, Freeborn DK, Klevit HD| title=Physician burnout: recommendations for HMO managers. | journal=HMO Pract | year= 1994 | volume= 8 | issue= 2 | pages= 58-63 | pmid=10135263 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10135263  }} </ref><ref name="pmid10135263"/><ref name="stepsforward">{{Cite web| last1 = Linzer| first1 = Mark| last2 = Guzman-Corrales| first2 = Laura| last3 = Poplau| first3 = Sara| title = Preventing physician burnout - STEPS Forward| work = STEPSforward.org| accessdate = 2017-05-24| url = https://www.stepsforward.org/modules/physician-burnout}}</ref>
|-
! Schmoldt, 1994<ref name="pmid10135263"/>
! AMA / STEPSforward<ref name="stepsforward"/>
|-
| style="font-weight:bold;"| Most studies do not report the stem. Veninga using a 1 to 10 scale used for the stem,<br/>"On the following scale, indicate by circling a number where you feel you are."<ref name="Veninga Spradley 1981 p. ">{{cite book | last=Veninga | first=Robert L. | last2=Spradley | first2=James P. | title=The work/stress connection : how to cope with job burnout | publisher=Little, Brown | publication-place=Boston, Mass. | date=1981 | isbn=0-316-80747-8 | oclc=7205249 | page=}}</ref>
| style="font-weight:bold;" | "Using your own definition of “burnout,” please circle one of the answers below"<br/>or<br/>“Overall, based on your definition of burnout, how would you rate your level of burnout?”<ref name="pmid25451989">{{cite journal| author=Dolan ED, Mohr D, Lempa M, Joos S, Fihn SD, Nelson KM | display-authors=etal| title=Using a single item to measure burnout in primary care staff: a psychometric evaluation. | journal=J Gen Intern Med | year= 2015 | volume= 30 | issue= 5 | pages= 582-7 | pmid=25451989 | doi=10.1007/s11606-014-3112-6 | pmc=4395610 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25451989  }} </ref>
|-
| I enjoy my work. I have no symptoms of burnout.
| I enjoy my work. I have no symptoms of burnout.
|-
| Occasionally I am under stress, and I don’t always have as much energy as I once did, but I don’t feel burned out.
| I am under stress, and don’t always have as much energy as I did, but I don’t feel burned out.
|-
| I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion.
| I am definitely burning out and have one or more symptoms of burnout, e.g., emotional exhaustion.
|-
| The symptoms of burnout that I’m experiencing won’t go away. I think about frustration at work a lot.
| The symptoms of burnout that I am experiencing won’t go away. I think about work frustrations a lot.
|-
| I feel completely burned out and often wonder if I can go on. I am at the point where I may need some changes or may need to seek some sort of help.
| I feel completely burned out. I am at the point where I may need to seek help.
|}
 
The 10‑item Zero Burnout Program survey, or called the Mini Z<ref name="pmid27138425">{{cite journal| author=Linzer M, Poplau S, Babbott S, Collins T, Guzman-Corrales L, Menk J et al.| title=Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey. | journal=J Gen Intern Med | year= 2016 | volume= 31 | issue= 9 | pages= 1004-10 | pmid=27138425 | doi=10.1007/s11606-016-3720-4 | pmc=4978678 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27138425  }} </ref>, was adapted from the earlier Northwest Permanente (NWP) and Ohio Permanente Medical Group (OPMG) by Freeborn<ref name="pmid11154654">{{cite journal| author=Freeborn DK| title=Satisfaction, commitment, and psychological well-being among HMO physicians. | journal=West J Med | year= 2001 | volume= 174 | issue= 1 | pages= 13-8 | pmid=11154654 | doi=10.1136/ewjm.174.1.13 | pmc=1071220 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11154654  }} </ref> and Schmoldt<ref name="pmid10135263">{{cite journal| author=Schmoldt RA, Freeborn DK, Klevit HD| title=Physician burnout: recommendations for HMO managers. | journal=HMO Pract | year= 1994 | volume= 8 | issue= 2 | pages= 58-63 | pmid=10135263 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10135263  }} </ref> which based this single question on earlier work by Veninga<ref name="Veninga Spradley 1981 p. ">{{cite book | last=Veninga | first=Robert L. | last2=Spradley | first2=James P. | title=The work/stress connection : how to cope with job burnout | publisher=Little, Brown | publication-place=Boston, Mass. | date=1981 | isbn=0-316-80747-8 | oclc=7205249 | page=}}</ref>.  The SIBOQ was then used by later version of the Physician Worklife Survey<ref name="pmid11949917">{{cite journal| author=Williams ES, Konrad TR, Linzer M, McMurray J, Pathman DE, Gerrity M | display-authors=etal| title=Physician, practice, and patient characteristics related to primary care physician physical and mental health: results from the Physician Worklife Study. | journal=Health Serv Res | year= 2002 | volume= 37 | issue= 1 | pages= 121-43 | pmid=11949917 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11949917  }} [HTTP://pubmed.gov/PMC1430344 PMC1430344]</ref>. The SIBOQ was first validated against the MBI by Rohland in 2004<ref name="RohlandKruse2004">{{cite journal|last1=Rohland|first1=Barbara M.|last2=Kruse|first2=Gina R.|last3=Rohrer|first3=James E.|title=Validation of a single-item measure of burnout against the Maslach Burnout Inventory among physicians|journal=Stress and Health|volume=20|issue=2|year=2004|pages=75–79|issn=1532-3005|doi=10.1002/smi.1002}}</ref>. The SIBOQ was later used by the Minimizing Error, Maximizing Outcomes (MEMO)<ref name="pmid19581644">{{cite journal| author=Linzer M, Manwell LB, Williams ES, Bobula JA, Brown RL, Varkey AB | display-authors=etal| title=Working conditions in primary care: physician reactions and care quality. | journal=Ann Intern Med | year= 2009 | volume= 151 | issue= 1 | pages= 28-36, W6-9 | pmid=19581644 | doi=10.7326/0003-4819-151-1-200907070-00006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19581644 }} </ref> studies used the self-definition format.  
 
The Mini Z is a single item (burnout is defined as answers c, d, or e) that correlates with the emotional exhaustion scale of the Maslach<ref name="RohlandKruse2004"/>:
 
* The Northwest Permanente (NWP) and Ohio Permanente Medical Group (OPMG) by Schmoldt, Freeborn and Klevit<ref name="pmid11154654">{{cite journal| author=Freeborn DK| title=Satisfaction, commitment, and psychological well-being among HMO physicians. | journal=West J Med | year= 2001 | volume= 174 | issue= 1 | pages= 13-8 | pmid=11154654 | doi=10.1136/ewjm.174.1.13 | pmc=1071220 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11154654  }} </ref><ref name="pmid10135263">{{cite journal| author=Schmoldt RA, Freeborn DK, Klevit HD| title=Physician burnout: recommendations for HMO managers. | journal=HMO Pract | year= 1994 | volume= 8 | issue= 2 | pages= 58-63 | pmid=10135263 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10135263  }} </ref> stated<ref name="pmid10135263"/> that the NWP also used the self-diagnosis item of Veninga that started in 1991 used the format:
** The tedium index of Pines<ref name="Malakh-Pines Aronson Kafry 1981 p. ">{{cite book | last=Malakh-Pines | first=Ayala | last2=Aronson | first2=Elliot | last3=Kafry | first3=Ditsa | title=Burnout : from tedium to personal growth | publisher=Free Press | publication-place=New York | date=1981 | isbn=0-02-925350-0 | oclc=6486538 | page=}}</ref>
** The self-diagnosis of burnout item of Veninga where the respondent chooses a number between 1 ("Not burned out") and 10 ("completely burned out").<ref name="Veninga Spradley 1981 p. ">{{cite book | last=Veninga | first=Robert L. | last2=Spradley | first2=James P. | title=The work/stress connection : how to cope with job burnout | publisher=Little, Brown | publication-place=Boston, Mass. | date=1981 | isbn=0-316-80747-8 | oclc=7205249 | page=}}</ref>
 
Structure


1. ''Using your own definition of “burnout,” please circle one of the answers below'':
1. ''Using your own definition of “burnout,” please circle one of the answers below'':
a. I enjoy my work. I have no symptoms of burnout.
a. I enjoy my work. I have no symptoms of burnout.
b. I am under stress, and don’t always have as much energy as I did, but I don’t feel burned out.
b. I am under stress, and don’t always have as much energy as I did, but I don’t feel burned out.
c. I am definitely burning out and have one or more symptoms of burnout, e.g., emotional exhaustion.
c. I am definitely burning out and have one or more symptoms of burnout, e.g., emotional exhaustion.
d. The symptoms of burnout that I am experiencing won’t go away. I think about work frustrations a lot.
d. The symptoms of burnout that I am experiencing won’t go away. I think about work frustrations a lot.
e. I feel completely burned out. I am at the point where I may need to seek help.
e. I feel completely burned out. I am at the point where I may need to seek help.


The Mini Z is promoted by the [[American Medical Association]]'s [https://www.stepsforward.org/modules/physician-burnout Steps Forward] campaign.<ref>{{Cite web| last1 = Linzer| first1 = Mark| last2 = Guzman-Corrales| first2 = Laura| last3 = Poplau| first3 = Sara| title = Preventing physician burnout - STEPS Forward| work = STEPSforward.org| accessdate = 2017-05-24| url = https://www.stepsforward.org/modules/physician-burnout}}</ref>
2. The Mini-Z also contains the relevant dimensions:
* Workload
** My control over my workload is...
** Sufficiency of time for documentation is...
** The amount of time I spend on the electronic health record (EHR) at home is...
* Cynicism:
** My professional values are well aligned with those of my department leaders...


The Mini Z may<ref name="pmid28379818">{{cite journal| author=Linzer M, Poplau S| title=Building a Sustainable Primary Care Workforce: Where Do We Go from Here? | journal=J Am Board Fam Med | year= 2017 | volume= 30 | issue= 2 | pages= 127-129 | pmid=28379818 | doi=10.3122/jabfm.2017.02.170014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28379818  }} </ref><ref name="pmid30467949">{{cite journal| author=Olson K, Sinsky C, Rinne ST, Long T, Vender R, Mukherjee S | display-authors=etal| title=Cross-sectional survey of workplace stressors associated with physician burnout measured by the Mini-Z and the Maslach Burnout Inventory. | journal=Stress Health | year= 2019 | volume= 35 | issue= 2 | pages= 157-175 | pmid=30467949 | doi=10.1002/smi.2849 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30467949  }} </ref> report lower prevalence of burnout than when measured by the full Maslach Burnout Inventory (MBI). Olson found that the Mini-Z reports a prevalence 10% to 15% lower than the MBI.
The Mini Z is promoted by the [[American Medical Association]]'s [https://www.stepsforward.org/modules/physician-burnout Steps Forward] campaign.<ref name="stepsforward">{{Cite web| last1 = Linzer| first1 = Mark| last2 = Guzman-Corrales| first2 = Laura| last3 = Poplau| first3 = Sara| title = Preventing physician burnout - STEPS Forward| work = STEPSforward.org| accessdate = 2017-05-24| url = https://www.stepsforward.org/modules/physician-burnout}}</ref>


This discrepancy may be related to an important question raised by Eckleberry-Hunt that we may be over-estimating rates of burnout due to the common two item survey deeming burnout if ''either'' emotional exhaustion or depersonaliztion are present when the original survey required both to be present<ref name="pmid28817432">{{cite journal| author=Eckleberry-Hunt J, Kirkpatrick H, Barbera T| title=The Problems With Burnout Research. | journal=Acad Med | year= 2018 | volume= 93 | issue= 3 | pages= 367-370 | pmid=28817432 | doi=10.1097/ACM.0000000000001890 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28817432 }} </ref>.
The Mini Z may report lower prevalence of burnout than when measured by the full Maslach Burnout Inventory (MBI).<ref name="pmid28379818">{{cite journal| author=Linzer M, Poplau S| title=Building a Sustainable Primary Care Workforce: Where Do We Go from Here? | journal=J Am Board Fam Med | year= 2017 | volume= 30 | issue= 2 | pages= 127-129 | pmid=28379818 | doi=10.3122/jabfm.2017.02.170014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28379818 }} </ref>


===Copenhagen Burnout Inventory===
===Burnout Assessment Tool===
The Copenhagen Burnout Inventory is another scale and was developed in 2005.<ref>CKristensen T, Borritz M, Villadsen E, Christensen KB. The Copenhagen Burnout Inventory: a new tool for the assessment of burnout. Work Stress. 2005;19(3):192–207 {{doi|10.1080/02678370500297720}}</ref>
A newer survey is the Burnout Assessment Tool (BAT)<ref>Burnout Assessment Tool. Available at https://burnoutassessmenttool.be/project_eng/</ref> developed by Schaufeli and others<ref>{{Cite journal| doi = 10.3390/ijerph17249495| issn = 1660-4601| volume = 17| issue = 24| pages = 9495| last1 = Schaufeli| first1 = Wilmar B.| last2 = Desart| first2 = Steffie| last3 = De Witte| first3 = Hans| title = Burnout Assessment Tool (BAT)—Development, Validity, and Reliability| journal = International Journal of Environmental Research and Public Health| accessdate = 2022-06-25| date = 2020-12-18| url = https://www.mdpi.com/1660-4601/17/24/9495}}</ref>. The BAT has four subscales:
* Exhaustion
* Mental distance
* Emotional impairment
* Cognitive impairment


===Physician Well-Being Index (PWBI)===
The BAT versions are:
The PWBI contains 7 items, one of which queries burnout in a yes/no response format. Its development<ref>Dyrbye LN, Satele D, Sloan J, Shanafelt TD. Utility of a brief screening tool to identify physicians in distress. J Gen Intern Med. 2013 Mar;28(3):421-7. doi: {{doi|10.1007/s11606-012-2252-9}}. PMID: {{PMID|23129161}}</ref> and application<ref>Dyrbye LN, Satele D, Shanafelt T. Ability of a 9-Item Well-Being Index to Identify Distress and Stratify Quality of Life in US Workers. J Occup Environ Med. 2016 Aug;58(8):810-7. doi: {{doi|10.1097/JOM.0000000000000798}}. PMID: {{PMID|27294444}}</ref> have been reported.
* Full version with 23 items
* Short version with 12 items<ref name="pmid35313849">{{cite journal| author=Hadžibajramović E, Schaufeli W, De Witte H| title=Shortening of the Burnout Assessment Tool (BAT)-from 23 to 12 items using content and Rasch analysis. | journal=BMC Public Health | year= 2022 | volume= 22 | issue= 1 | pages= 560 | pmid=35313849 | doi=10.1186/s12889-022-12946-y | pmc=8939057 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35313849  }} </ref>


===Professional Quality of Life (ProQOL) ===
===Copenhagen Burnout Inventory===
The ProQOL has three scales<ref name="ProQOL_manual">Stamm, B. H. (2010). The concise ProQOL manual. Available at https://programs.caringsafely.org/wp-content/uploads/2018/01/ProQOL_Concise_2ndEd_12-2010.pdf</ref><ref name="pmid28383935">{{cite journal| author=De La Rosa GM, Webb-Murphy JA, Fesperman SF, Johnston SL| title=Professional quality of life normative benchmarks. | journal=Psychol Trauma | year= 2018 | volume= 10 | issue= 2 | pages= 225-228 | pmid=28383935 | doi=10.1037/tra0000263 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28383935  }} </ref>:
The Copenhagen Burnout Inventory has 19 items and was developed in 2005.<ref>Kristensen T, Borritz M, Villadsen E, Christensen KB. The Copenhagen Burnout Inventory: a new tool for the assessment of burnout. Work Stress. 2005;19(3):192–207 {{doi|10.1080/02678370500297720}}</ref>
* Compassion satisfaction (CS)
* Compassion fatigue (CF) which includes anger, exhaustion, frustration, or depression
** Burnout (BO) which is "feelings of unhappiness, disconnectedness, and insensitivity to the work environment. It can include exhaustion, feelings of being overwhelmed, bogged down, being 'out‐of‐touch' "<ref name="ProQOL_manual"/>
** Secondary Traumatic Stress is being "preoccupied with thoughts of people one has helped"<ref name="ProQOL_manual"/>
 
Norms are available<ref name="McKinleyMcCain2020">{{cite journal|last1=McKinley|first1=Nicola|last2=McCain|first2=R Scott|last3=Convie|first3=Liam|last4=Clarke|first4=Mike|last5=Dempster|first5=Martin|last6=Campbell|first6=William Jeffrey|last7=Kirk|first7=Stephen James|title=Resilience, burnout and coping mechanisms in UK doctors: a cross-sectional study|journal=BMJ Open|volume=10|issue=1|year=2020|pages=e031765|issn=2044-6055|doi=10.1136/bmjopen-2019-031765}}</ref>.
 
==Causes==
Leiter and Maslach found the following antecedents from the Areas of Worklife Survey (AWS) using factor analysis:<ref name="Leite20093">Leiter, Michael P., and Christina Maslach. "Areas of worklife: A structured approach to organizational predictors of job burnout." Emotional and physiological processes and positive intervention strategies. Emerald Group Publishing Limited, 2003. 91-134. {{doi|10.1016/S1479-3555(03)03003-8}}</ref>
* Workload
* Fairness
* Control
* Community
* Values
* Rewards


Of these causes, workload is the strongest correlate of emotional exhaustion<ref name="Leite20093"/> but loss of control may be the initial factor. Perceived control or autonomy and fairness correlate with cynicism.<ref name="Leite20093"/><ref name="Fernet Austin Trépanier Dussault 2013 pp. 123–137">{{cite journal | last=Fernet | first=Claude | last2=Austin | first2=Stéphanie | last3=Trépanier | first3=Sarah-Geneviève | last4=Dussault | first4=Marc | title=How do job characteristics contribute to burnout? Exploring the distinct mediating roles of perceived autonomy, competence, and relatedness | journal=European Journal of Work and Organizational Psychology | publisher=Informa UK Limited | volume=22 | issue=2 | year=2013 | issn=1359-432X | doi=10.1080/1359432x.2011.632161 | pages=123–137}}</ref>
===Oldenburg Burnout Inventory===
* 16% of burnout is attributed to perceived control at the worksite.<ref>Taris, Toon W., et al. "Job control and burnout across occupations." Psychological Reports 97.3 (2005): 955-961. {{doi|10.2466/pr0.97.3.955-961}}</ref>
The Oldenburg Burnout Inventory has 16 items and was developed by Demerouti and others and has two scales<ref name="DemeroutiBakker2003">{{cite journal | last1 = Demerouti | first1 = E| last2 = Bakker | first2 = AB | last3 = Vardakou | first3 = I| last4 = Kantas | first4 = A| title = The Convergent Validity of Two Burnout Instruments | journal = European Journal of Psychological Assessment | date = March 2003 | volume = 19 | issue = 1 | pages = 12–23 | issn = 1015-5759 | eissn = 2151-2426 | doi = 10.1027//1015-5759.19.1.12 | pmid = | url = }}</ref><ref name="Oldenburg2010">{{cite journal | vauthors=((Demerouti, E.)), ((Mostert, K.)), ((Bakker, A. B.)) | journal=Journal of Occupational Health Psychology | title=Burnout and work engagement: A thorough investigation of the independency of both constructs. | volume=15 | issue=3 | pages=209–222 | date= July 2010 | url=http://doi.apa.org/getdoi.cfm?doi=10.1037/a0019408 | issn=1939-1307, 1076-8998 | doi=10.1037/a0019408 | access-date=18 September 2022}}</ref>:
* [[Electronic health record]]s<ref>https://www.mayoclinicproceedings.org/article/S0025-6196(19)30836-5/fulltext</ref>
* Disengagement scale. The highest loading item is "I find my work to be a positive challenge" and the second highest loading item is "I always find new and interesting aspects in my work"<ref name="Oldenburg2008">Demerouti E, Bakker AB. The Oldenburg Burnout Inventory: A good alternative to measure burnout and engagement. Handbook of stress and burnout in health care. 2008 Jan;65(7). https://www.isonderhouden.nl/doc/pdf/arnoldbakker/articles/articles_arnold_bakker_173.pdf</ref>.
* Chaotic clinic atmospheres and workload control are dominant causes in health care - more so than [[electronic health record]]s<ref name="pmid31418810">{{cite journal| author=Kroth PJ, Morioka-Douglas N, Veres S, Babbott S, Poplau S, Qeadan F et al.| title=Association of Electronic Health Record Design and Use Factors With Clinician Stress and Burnout. | journal=JAMA Netw Open | year= 2019 | volume= 2 | issue= 8 | pages= e199609 | pmid=31418810 | doi=10.1001/jamanetworkopen.2019.9609 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31418810  }} </ref>.
* Exhaustion scale. The highest loading item is "After my work, I usually feel worn out and weary"<ref name="Oldenburg2008"/>.
These findings, specifically workload, are reflected in the job demands-resources model of burnout<ref name="pmid11419809">{{cite journal| author=Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB| title=The job demands-resources model of burnout. | journal=J Appl Psychol | year= 2001 | volume= 86 | issue= 3 | pages= 499-512 | pmid=11419809 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11419809  }} </ref>.


These findings are reflected in the Demand-Control theory of job stress.
=== Professional Fulfillment Index (PFI) (Stanford) ===
<ref name="Karasek 1990 p. ">{{cite book | last=Karasek | first=Robert | title=Healthy work : stress, productivity, and the reconstruction of working life | publisher=Basic Books | publication-place=New York | year=1990 | isbn=0-465-02897-7 | page=}}</ref>


===Moral distress and professional disonance ===
The PFI contains relevant dimensions including interpersonal disengagement<ref name="pmid29196982">{{cite journal| author=Trockel M, Bohman B, Lesure E, Hamidi MS, Welle D, Roberts L | display-authors=etal| title=A Brief Instrument to Assess Both Burnout and Professional Fulfillment in Physicians: Reliability and Validity, Including Correlation with Self-Reported Medical Errors, in a Sample of Resident and Practicing Physicians. | journal=Acad Psychiatry | year= 2018 | volume= 42 | issue= 1 | pages= 11-24 | pmid=29196982 | doi=10.1007/s40596-017-0849-3 | pmc=5794850 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29196982 }} </ref>:
Moral distress<ref name="corley2001">Corley, M. C., Elswick, R. K., Gorman, M., & Clor, T. (2001). Development and evaluation of a moral distress scale. Journal of Advanced Nursing, 33(2), 250–256 {{doi|10.1111/j.1365-2648.2001.01658.x}}</ref> and professional disonance<ref name="pmid31904796">{{cite journal| author=Agarwal SD, Pabo E, Rozenblum R, Sherritt KM| title=Professional Dissonance and Burnout in Primary Care: A Qualitative Study. | journal=JAMA Intern Med | year= 2020 | volume=  | issue=  | pages=  | pmid=31904796 | doi=10.1001/jamainternmed.2019.6326 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31904796  }} </ref>, as operationalized in research studies, is the report by healthcare personnel of participating in the provision of healthcare that the healthcare personnel perceives as inappropriate due to pressure from other health care professionals or administrators of families that the health care professional perceives as inappropriate due to being<ref name="corley2001">Corley, M. C., Elswick, R. K., Gorman, M., & Clor, T. (2001). Development and evaluation of a moral distress scale. Journal of Advanced Nursing, 33(2), 250–256 {{doi|10.1111/j.1365-2648.2001.01658.x}}</ref><ref name="pmid27367887">{{cite journal| author=Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN| title=A Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health-care Professionals. A Call for Action. | journal=Am J Respir Crit Care Med | year= 2016 | volume= 194 | issue= 1 | pages= 106-13 | pmid=27367887 | doi=10.1164/rccm.201604-0708ST | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27367887 }} </ref>
* "Less empathetic with my patients"
* "Less empathetic with my colleagues"


===Leadership===
===Physician Well-Being Index (PWBI)===
Leadership tactics are associated with burnout<ref name="HuBentler1999">{{cite journal|last1=Hu|first1=Li‐tze|last2=Bentler|first2=Peter M.|title=Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives|journal=Structural Equation Modeling: A Multidisciplinary Journal|volume=6|issue=1|year=1999|pages=1–55|issn=1070-5511|doi=10.1080/10705519909540118}}</ref><ref name="pmid25796117">{{cite journal| author=Shanafelt TD, Gorringe G, Menaker R, Storz KA, Reeves D, Buskirk SJ et al.| title=Impact of organizational leadership on physician burnout and satisfaction. | journal=Mayo Clin Proc | year= 2015 | volume= 90 | issue= 4 | pages= 432-40 | pmid=25796117 | doi=10.1016/j.mayocp.2015.01.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25796117  }} </ref><ref name="pmid25844908">{{cite journal| author=Arnold KA, Connelly CE, Walsh MM, Martin Ginis KA| title=Leadership styles, emotion regulation, and burnout. | journal=J Occup Health Psychol | year= 2015 | volume= 20 | issue= 4 | pages= 481-490 | pmid=25844908 | doi=10.1037/a0039045 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25844908  }} </ref><ref name="pmid27631555">{{cite journal| author=Hildenbrand K, Sacramento CA, Binnewies C| title=Transformational leadership and burnout: The role of thriving and followers' openness to experience. | journal=J Occup Health Psychol | year= 2018 | volume= 23 | issue= 1 | pages= 31-43 | pmid=27631555 | doi=10.1037/ocp0000051 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27631555  }} </ref><ref>Seltzer, J., NUMEROF, R. E., & BASS, B. M. (1989). [https://www.jstor.org/stable/25780396 Transformational leadership: Is it a source of more burnout and stress?]. Journal of Health and Human Resources Administration, 174-185.</ref><ref name="pmid31297001">{{cite journal| author=Liu C, Liu S, Yang S, Wu H| title=Association between transformational leadership and occupational burnout and the mediating effects of psychological empowerment in this relationship among CDC employees: a cross-sectional study. | journal=Psychol Res Behav Manag | year= 2019 | volume= 12 | issue=  | pages= 437-446 | pmid=31297001 | doi=10.2147/PRBM.S206636 | pmc=6598747 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31297001  }} </ref>
The PWBI contains 7 items, one of which queries burnout in a yes/no response format. Its development<ref>Dyrbye LN, Satele D, Sloan J, Shanafelt TD. Utility of a brief screening tool to identify physicians in distress. J Gen Intern Med. 2013 Mar;28(3):421-7. doi: {{doi|10.1007/s11606-012-2252-9}}. PMID: {{PMID|23129161}}</ref> and application<ref>Dyrbye LN, Satele D, Shanafelt T. Ability of a 9-Item Well-Being Index to Identify Distress and Stratify Quality of Life in US Workers. J Occup Environ Med. 2016 Aug;58(8):810-7. doi: {{doi|10.1097/JOM.0000000000000798}}. PMID: {{PMID|27294444}}</ref> have been reported.


===Pandemic related burnout===
Scales include disengagement:
Regarding COVID-19, on April 7, the Institute for Health Metrics and Evaluation (IHME) projects a 36,654 hospital bed and 16,323 ICU bed shortage on day of peak resource need (April, 15), and 3,130 COVID-19 deaths on the day of peak daily deaths (as of 4/7/2020) across the United States<ref>Institute for Health Metrics and Evaluation. COVID-19 Projections. Available at https://covid19.healthdata.org/united-states-of-america</ref>. This poses a significant stress on the healthcare system. Strains on the healthcare system lead to increased practitioner stress and burnout, of which moral distress is a contributor. Moral distress occurs in high stress environments, like the ICU<ref name="pmid27480316">{{cite journal| author=Mealer M, Moss M| title=Moral distress in ICU nurses. | journal=Intensive Care Med | year= 2016 | volume= 42 | issue= 10 | pages= 1615-1617 | pmid=27480316 | doi=10.1007/s00134-016-4441-1 | pmc=5683387 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27480316  }} </ref>.  A qualitative literature review of moral distress in nurses found that moral distress can lead to emotional exhaustion and depersonalization toward patients, which are components of burn out<ref name="pmid24091351">{{cite journal| author=Oh Y, Gastmans C| title=Moral distress experienced by nurses: a quantitative literature review. | journal=Nurs Ethics | year= 2015 | volume= 22 | issue= 1 | pages= 15-31 | pmid=24091351 | doi=10.1177/0969733013502803 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24091351  }} </ref>.
* "Have you worried that your work is hardening you emotionally?"


==Consequences==
===Professional Quality of Life (ProQOL) ===
Burnout is negatively associated with Practice Adaptive Reserve, or the ability for an organization to learn<ref name="pmid29558229">{{cite journal| author=Huynh C, Bowles D, Yen MS, Phillips A, Waller R, Hall L et al.| title=Change implementation: the association of adaptive reserve and burnout among inpatient medicine physicians and nurses. | journal=J Interprof Care | year= 2018 | volume= 32 | issue= 5 | pages= 549-555 | pmid=29558229 | doi=10.1080/13561820.2018.1451307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29558229  }} </ref>.
The ProQOL has 30 items over three scales<ref name="pmid28383935">{{cite journal| author=De La Rosa GM, Webb-Murphy JA, Fesperman SF, Johnston SL| title=Professional quality of life normative benchmarks. | journal=Psychol Trauma | year= 2018 | volume= 10 | issue= 2 | pages= 225-228 | pmid=28383935 | doi=10.1037/tra0000263 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28383935 }} </ref>:
 
* Compassion satisfaction (CS)
 
* Burnout (BO)
===Clinical outcomes===
* Compassion fatigue (CF)
A [[systematic review]] suggested there may be a small association between burnout and the quality of patient care<ref name="pmid31590181">{{cite journal| author=Tawfik DS, Scheid A, Profit J, Shanafelt T, Trockel M, Adair KC et al.| title=Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis. | journal=Ann Intern Med | year= 2019 | volume=  | issue=  | pages=  | pmid=31590181 | doi=10.7326/M19-1152 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31590181  }} </ref>
* In [[intensive care]] units, physicians and nurses reported a signicant correlation between burnout and standardized mortality<ref name="pmid25657627">{{cite journal| author=Welp A, Meier LL, Manser T| title=Emotional exhaustion and workload predict clinician-rated and objective patient safety. | journal=Front Psychol | year= 2014 | volume= 5 | issue=  | pages= 1573 | pmid=25657627 | doi=10.3389/fpsyg.2014.01573 | pmc=4302790 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25657627  }} </ref>.
* In hospital units in which nurses report high burnout, [[nosocomial infection]] rates are higher<ref name="pmid22854376">{{cite journal| author=Cimiotti JP, Aiken LH, Sloane DM, Wu ES| title=Nurse staffing, burnout, and health care-associated infection. | journal=Am J Infect Control | year= 2012 | volume= 40 | issue= 6 | pages= 486-90 | pmid=22854376 | doi=10.1016/j.ajic.2012.02.029 | pmc=3509207 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22854376 }} </ref>.
 
 
However, other studies have not found an association between burnout and clinical outcomes.
* A study of general/vascular surgery residency programs, found an insignificant correlation<ref name="pmid18035261">{{cite journal| author=Davenport DL, Henderson WG, Mosca CL, Khuri SF, Mentzer RM| title=Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. | journal=J Am Coll Surg | year= 2007 | volume= 205 | issue= 6 | pages= 778-84 | pmid=18035261 | doi=10.1016/j.jamcollsurg.2007.07.039 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18035261  }} </ref>.
* Another study found no association<ref>Schaufeli,W.B.,Keijsers,G.J.,and Reis Miranda,D.(1995).“Burnout, technology use, and ICU performance,” in Organizational Risk Factors for Job Stress, eds S.L. Sauter and L.R. Murphy (Washington, DC: American Psychological Association), 259–271 {{doi|10.1037/10173-016}}</ref>


===Financial===
The ProQOL does not include depersonalization.


Burnout may be associated with operating margins<ref name="pmid29969540">{{cite journal| author=Muller IR, Eldakar-Hein ST, Ames SE, Rosen LD, Urman RD, Tsai MH| title=Potential Association Between Physician Burnout Rates and Operating Margins: Specialty-Specific Analysis. | journal=J Med Pract Manage | year= 2017 | volume= 32 | issue= 4 | pages= 233-238 | pmid=29969540 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29969540 }} </ref>.
The ProQO moderately correlates with the single-item burnout question from the Mini-Z<ref name="pmid32959486">{{cite journal| author=Wolf C, Schwarz J, Thurstone C, Rylander M| title=Agreement between a single, self-defined burnout item and the ProQOL burnout subscale for behavioural health staff. | journal=Int J Ment Health Nurs | year= 2021 | volume= 30 | issue= 1 | pages= 326-333 | pmid=32959486 | doi=10.1111/inm.12788 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32959486 }} </ref>.


The cost of burnout is estimated to be $7600 per employed physician each year<ref name="pmid31132791">{{cite journal| author=Han S, Shanafelt TD, Sinsky CA, Awad KM, Dyrbye LN, Fiscus LC | display-authors=etal| title=Estimating the Attributable Cost of Physician Burnout in the United States. | journal=Ann Intern Med | year= 2019 | volume= 170 | issue= 11 | pages= 784-790 | pmid=31132791 | doi=10.7326/M18-1422 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31132791  }} </ref>.
The ProQOL is available at https://proqol.org/.


==Prevention==
==Prevention==
Line 172: Line 257:
Perceived control or autonomy and fairness correlate with cynicism.<ref name="Leite20093"/><ref name="Fernet Austin Trépanier Dussault 2013 pp. 123–137">{{cite journal | last=Fernet | first=Claude | last2=Austin | first2=Stéphanie | last3=Trépanier | first3=Sarah-Geneviève | last4=Dussault | first4=Marc | title=How do job characteristics contribute to burnout? Exploring the distinct mediating roles of perceived autonomy, competence, and relatedness | journal=European Journal of Work and Organizational Psychology | publisher=Informa UK Limited | volume=22 | issue=2 | year=2013 | issn=1359-432X | doi=10.1080/1359432x.2011.632161 | pages=123–137}}</ref>
Perceived control or autonomy and fairness correlate with cynicism.<ref name="Leite20093"/><ref name="Fernet Austin Trépanier Dussault 2013 pp. 123–137">{{cite journal | last=Fernet | first=Claude | last2=Austin | first2=Stéphanie | last3=Trépanier | first3=Sarah-Geneviève | last4=Dussault | first4=Marc | title=How do job characteristics contribute to burnout? Exploring the distinct mediating roles of perceived autonomy, competence, and relatedness | journal=European Journal of Work and Organizational Psychology | publisher=Informa UK Limited | volume=22 | issue=2 | year=2013 | issn=1359-432X | doi=10.1080/1359432x.2011.632161 | pages=123–137}}</ref>


=== Resilience ===
Successful teamwork may be important<ref name="pmid36038756">{{cite journal| author=Lu MA, O'Toole J, Shneyderman M, Brockman S, Cumpsty-Fowler C, Dang D | display-authors=etal| title="Where You Feel Like a Family Instead of Co-workers": a Mixed Methods Study on Care Teams and Burnout. | journal=J Gen Intern Med | year= 2022 | volume= | issue= | pages= | pmid=36038756 | doi=10.1007/s11606-022-07756-2 | pmc=9422940 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36038756 }} </ref><ref name="doi10.1056/CAT.21.0275">{{cite journal | vauthors=((Kjaer, K.)), ((Kowalsky, R.)), ((Rubin, L. A.)), ((Willis, L.)), ((Mital, R. C.)), ((Kazam, J.)), ((Stracher, A.)) | journal=NEJM Catalyst | title=A Grassroots Approach to Protecting Physicians Against Burnout and Building an Engaging Practice Environment | volume=2 | issue=12 | pages=CAT.21.0275 | date=17 November 2021 | url=http://catalyst.nejm.org/doi/10.1056/CAT.21.0275 | issn=2642-0007 | doi=10.1056/CAT.21.0275 | access-date=12 June 2022}}</ref>.
Interventions, including those directed at physicians, have been reviwed.<ref name="pmid27692469">{{cite journal| author=West CP, Dyrbye LN, Erwin PJ, Shanafelt TD| title=Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. | journal=Lancet | year= 2016 | volume= 388 | issue= 10057 | pages= 2272-2281 | pmid=27692469 | doi=10.1016/S0140-6736(16)31279-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27692469 }} </ref>


===Reporting of workforce state to external stakeholders===
===Religion, spirituality===
{{See also|Industrial and organizational psychology}}
Spirituality may be projective against burnout in medical students<ref name="pmid29357045">{{cite journal| author=Ray C, Wyatt TR| title=Religion and Spirituality as a Cultural Asset in Medical Students. | journal=J Relig Health | year= 2018 | volume= 57 | issue= 3 | pages= 1062-1073 | pmid=29357045 | doi=10.1007/s10943-017-0553-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29357045  }} </ref><ref name="pmid25485165">{{cite journal| author=Wachholtz A, Rogoff M| title=The relationship between spirituality and burnout among medical students. | journal=J Contemp Med Educ | year= 2013 | volume= 1 | issue= 2 | pages= 83-91 | pmid=25485165 | doi=10.5455/jcme.20130104060612 | pmc=4255468 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25485165  }} </ref>, medical residents/faculty<ref name="pmid26201403">{{cite journal| author=Doolittle BR, Windish DM| title=Correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns at Yale University, New Haven, USA. | journal=J Educ Eval Health Prof | year= 2015 | volume= 12 | issue=  | pages= 41 | pmid=26201403 | doi=10.3352/jeehp.2015.12.41 | pmc=4536357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26201403  }} </ref><ref name="pmid33118137">{{cite journal| author=Schmidt C, Roffler M| title=Coping with the Practice of Medicine: Religion, Spirituality, and Other Personal Strategies. | journal=J Relig Health | year= 2021 | volume= 60 | issue= 3 | pages= 2092-2108 | pmid=33118137 | doi=10.1007/s10943-020-01098-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33118137  }} </ref>, nurses<ref name="pmid33630228">{{cite journal| author=Harris S, Tao H| title=The Impact of US Nurses' Personal Religious and Spiritual Beliefs on Their Mental Well-Being and Burnout: A Path Analysis. | journal=J Relig Health | year= 2022 | volume= 61 | issue= 3 | pages= 1772-1791 | pmid=33630228 | doi=10.1007/s10943-021-01203-y | pmc=7905975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33630228  }} </ref> UK general practioners<ref name="pmid36322555">{{cite journal| author=Whitehead IO, Moffatt S, Jagger C, Hanratty B| title=A national study of burnout and spiritual health in UK general practitioners during the COVID-19 pandemic. | journal=PLoS One | year= 2022 | volume= 17 | issue= 11 | pages= e0276739 | pmid=36322555 | doi=10.1371/journal.pone.0276739 | pmc=9629610 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36322555  }} </ref>, and emergency medicine physicians<ref name="pmid27419014">{{cite journal| author=Salmoirago-Blotcher E, Fitchett G, Leung K, Volturo G, Boudreaux E, Crawford S | display-authors=etal| title=An exploration of the role of religion/spirituality in the promotion of physicians' wellbeing in Emergency Medicine. | journal=Prev Med Rep | year= 2016 | volume= 3 | issue=  | pages= 189-95 | pmid=27419014 | doi=10.1016/j.pmedr.2016.01.009 | pmc=4929145 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27419014  }} </ref>.


==Treatment==
==Consequences==
===At the individual level===
Religion may<ref name="pmid24404269">{{cite journal| author=Doolittle BR, Windish DM, Seelig CB| title=Burnout, coping, and spirituality among internal medicine resident physicians. | journal=J Grad Med Educ | year= 2013 | volume= 5 | issue= 2 | pages= 257-61 | pmid=24404269 | doi=10.4300/JGME-D-12-00136.1 | pmc=3693690 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24404269  }} </ref> or may not<ref name="pmid27419014">{{cite journal| author=Salmoirago-Blotcher E, Fitchett G, Leung K, Volturo G, Boudreaux E, Crawford S et al.| title=An exploration of the role of religion/spirituality in the promotion of physicians' wellbeing in Emergency Medicine. | journal=Prev Med Rep | year= 2016 | volume= 3 | issue=  | pages= 189-95 | pmid=27419014 | doi=10.1016/j.pmedr.2016.01.009 | pmc=4929145 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27419014  }} </ref>, protect against burnout. Spirituality may better associate with engagement than burnout<ref>{{Cite journal| doi = 10.1080/15426432.2019.1577787| issn = 1542-6432| volume = 38| issue = 2| pages = 197–216| last1 = Lizano| first1 = Erica L.| last2 = Godoy| first2 = Andrew J.| last3 = Allen| first3 = Nathan| title = Spirituality and worker well-being: Examining the relationship between spirituality, job burnout, and work engagement| journal = Journal of Religion & Spirituality in Social Work: Social Thought| accessdate = 2019-11-30| date = 2019-04-03| url = https://doi.org/10.1080/15426432.2019.1577787}}</ref>.


Observations studies suggest the following tactics by individuals may help<ref name="pmid24404269">{{cite journal| author=Doolittle BR, Windish DM, Seelig CB| title=Burnout, coping, and spirituality among internal medicine resident physicians. | journal=J Grad Med Educ | year= 2013 | volume= 5 | issue= 2 | pages= 257-61 | pmid=24404269 | doi=10.4300/JGME-D-12-00136.1 | pmc=3693690 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24404269  }} </ref>:
Burnout is associated with many clinical outcomes and personnel outcomes, but the relationships have much statistical heterogeneity<ref name="pmid36104064">{{cite journal| author=Hodkinson A, Zhou A, Johnson J, Geraghty K, Riley R, Zhou A | display-authors=etal| title=Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. | journal=BMJ | year= 2022 | volume= 378 | issue= | pages= e070442 | pmid=36104064 | doi=10.1136/bmj-2022-070442 | pmc=9472104 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36104064 }} </ref>.
* Measured by the Spiritual Involvement and Beliefs Scale (SIBS)<ref name="pmid9638112">{{cite journal| author=Hatch RL, Burg MA, Naberhaus DS, Hellmich LK| title=The Spiritual Involvement and Beliefs Scale. Development and testing of a new instrument. | journal=J Fam Pract | year= 1998 | volume= 46 | issue= 6 | pages= 476-86 | pmid=9638112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9638112  }} </ref>:
** Humility/personal application
* Measured by the Coping Orientation to Problems Experienced (COPE) Inventory<ref name="pmid2926629">{{cite journal| author=Carver CS, Scheier MF, Weintraub JK| title=Assessing coping strategies: a theoretically based approach. | journal=J Pers Soc Psychol | year= 1989 | volume= 56 | issue= 2 | pages= 267-83 | pmid=2926629 | doi=10.1037//0022-3514.56.2.267 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2926629  }} </ref>:
** Acceptance
** Active coping (trying to correct the situation)
** Positive reframing or reinterpretation
** Mindfullness training<ref name="pmid32026484">{{cite journal| author=Suleiman-Martos N, Gomez-Urquiza JL, Aguayo-Estremera R, Cañadas-De La Fuente GA, De La Fuente-Solana EI, Albendín-García L| title=The effect of mindfulness training on burnout syndrome in nursing: A systematic review and meta-analysis. | journal=J Adv Nurs | year= 2020 | volume= 76 | issue= 5 | pages= 1124-1140 | pmid=32026484 | doi=10.1111/jan.14318 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32026484 }} </ref>


====Calling====
Burnout may be associated with operating margins<ref name="pmid29969540">{{cite journal| author=Muller IR, Eldakar-Hein ST, Ames SE, Rosen LD, Urman RD, Tsai MH| title=Potential Association Between Physician Burnout Rates and Operating Margins: Specialty-Specific Analysis. | journal=J Med Pract Manage | year= 2017 | volume= 32 | issue= 4 | pages= 233-238 | pmid=29969540 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29969540 }} </ref>.
Calling may protect against burnout<ref name="pmid28189341">{{cite journal| author=Jager AJ, Tutty MA, Kao AC| title=Association Between Physician Burnout and Identification With Medicine as a Calling. | journal=Mayo Clin Proc | year= 2017 | volume= 92 | issue= 3 | pages= 415-422 | pmid=28189341 | doi=10.1016/j.mayocp.2016.11.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28189341  }} </ref><ref name="pmid26809782">{{cite journal| author=Yoon JD, Daley BM, Curlin FA| title=The Association Between a Sense of Calling and Physician Well-Being: A National Study of Primary Care Physicians and Psychiatrists. | journal=Acad Psychiatry | year= 2017 | volume= 41 | issue= 2 | pages= 167-173 | pmid=26809782 | doi=10.1007/s40596-016-0487-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26809782 }} </ref>.


Calling may be more important than extrinsic motivation such as income<ref name="pmid28168540">{{cite journal| author=Tak HJ, Curlin FA, Yoon JD| title=Association of Intrinsic Motivating Factors and Markers of Physician Well-Being: A National Physician Survey. | journal=J Gen Intern Med | year= 2017 | volume= 32 | issue= 7 | pages= 739-746 | pmid=28168540 | doi=10.1007/s11606-017-3997-y | pmc=5481224 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28168540 }} </ref>.
==Treatment==
Institutional and individual strategies to reduce burnout have been reviewed<ref name="pmid27692469">{{cite journal| author=West CP, Dyrbye LN, Erwin PJ, Shanafelt TD| title=Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. | journal=Lancet | year= 2016 | volume= 388 | issue= 10057 | pages= 2272-2281 | pmid=27692469 | doi=10.1016/S0140-6736(16)31279-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27692469 }} </ref>. Of 15 studies, 12 were "individual-focused" and only 3 addressed " structural interventions within the work environment"ref name="pmid27692469"/>.


Calling can be measured with:
Physicians may not be aware that they are burned out and providing awareness may increase engagement with addressing burnout<ref name="pmid23979287">{{cite journal| author=Shanafelt TD, Kaups KL, Nelson H, Satele DV, Sloan JA, Oreskovich MR et al.| title=An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons. | journal=Ann Surg | year= 2014 | volume= 259 | issue= 1 | pages= 82-8 | pmid=23979287 | doi=10.1097/SLA.0b013e3182a58fa4 | pmc=4333681 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23979287 }} </ref>.
* A single question, "For me, the practice of medicine is a calling"<ref name="pmid26809782">{{cite journal| author=Yoon JD, Daley BM, Curlin FA| title=The Association Between a Sense of Calling and Physician Well-Being: A National Study of Primary Care Physicians and Psychiatrists. | journal=Acad Psychiatry | year= 2017 | volume= 41 | issue= 2 | pages= 167-173 | pmid=26809782 | doi=10.1007/s40596-016-0487-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26809782  }} </ref>
* A [http://www.drryanduffy.com/instruments.html scale with two dimensions], Calling and Vocation Questionnaire (CVQ)<ref name="pmid22973420">{{cite journal| author=| title=Erratum for PMID 21180585. | journal=Therap Adv Gastroenterol | year= 2012 | volume= 5 | issue= 5 | pages= 371 | pmid=22973420 | doi=10.1177/1756283X10363751 | pmc=3437532 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22973420 }} </ref>:
** Transcendent Summons (4 items) which includes "I believe that I have been called to my current line of work".
** Purposeful Work (4 items)


Calling may not be as important as autonomy<ref name="pmid29777659">{{cite journal| author=Anandarajah AP, Quill TE, Privitera MR| title=Adopting the Quadruple Aim: The University of Rochester Medical Center Experience: Moving from Physician Burnout to Physician Resilience. | journal=Am J Med | year= 2018 | volume= 131 | issue= 8 | pages= 979-986 | pmid=29777659 | doi=10.1016/j.amjmed.2018.04.034 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29777659  }} </ref>.
===Meditation and Dhyana===
Trauma-informed yoga may help<ref name="MulvihillBradburyGrace2022">{{cite journal | last1 = Mulvihill | first1 = Tracey | last2 = Bradbury | first2 = Joanne | last3 = Grace | first3 = Sandra | last4 = Doran | first4 = Frances | title = Trauma-informed yoga (online) for positive mental health: A pilot study | journal = Advances in Integrative Medicine | date = September 2022 | issn = 2212-9588 | doi = 10.1016/j.aimed.2022.09.001 | pmid = | url = }}</ref>.


===At the institutional level===
Institutional and individual strategies to reduce burnout have been reviewed<ref name="pmid27692469">{{cite journal| author=West CP, Dyrbye LN, Erwin PJ, Shanafelt TD| title=Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. | journal=Lancet | year= 2016 | volume= 388 | issue= 10057 | pages= 2272-2281 | pmid=27692469 | doi=10.1016/S0140-6736(16)31279-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27692469  }} </ref>.
Physicians may not be aware that they are burned out and providing awareness may increase engagement with addressing burnout<ref name="pmid23979287">{{cite journal| author=Shanafelt TD, Kaups KL, Nelson H, Satele DV, Sloan JA, Oreskovich MR et al.| title=An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons. | journal=Ann Surg | year= 2014 | volume= 259 | issue= 1 | pages= 82-8 | pmid=23979287 | doi=10.1097/SLA.0b013e3182a58fa4 | pmc=4333681 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23979287  }} </ref>.


In the UK [[National Health Service]]'s large Health Foundation's Safer Patients Initiative (SPI) reported<ref name="pmid21292719">{{cite journal| author=Benning A, Ghaleb M, Suokas A, Dixon-Woods M, Dawson J, Barber N et al.| title=Large scale organisational intervention to improve patient safety in four UK hospitals: mixed method evaluation. | journal=BMJ | year= 2011 | volume= 342 | issue= | pages= d195 | pmid=21292719 | doi=10.1136/bmj.d195 | pmc=3033440 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292719 }} </ref>:
Transcendental Meditation may help<ref name="pmid36121655">{{cite journal| author=Joshi SP, Wong AI, Brucker A, Ardito TA, Chow SC, Vaishnavi S | display-authors=etal| title=Efficacy of Transcendental Meditation to Reduce Stress Among Health Care Workers: A Randomized Clinical Trial. | journal=JAMA Netw Open | year= 2022 | volume= 5 | issue= 9 | pages= e2231917 | pmid=36121655 | doi=10.1001/jamanetworkopen.2022.31917 | pmc=9486450 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36121655 }} </ref>.
* A borderline reduction in burnout (as measured by staff self-report of "Work related stress in previous 12 months")
* An insignificant decrease in mortality
* No change in patient satisfaction


A follow-up report from the SPI noted "compliance-oriented bureaucratised management...poor organisational and information systems sometimes left staff struggling to deliver care effectively and disempowered them from initiating improvement"<ref name="pmid24019507">{{cite journal| author=Dixon-Woods M, Baker R, Charles K, Dawson J, Jerzembek G, Martin G et al.| title=Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study. | journal=BMJ Qual Saf | year= 2014 | volume= 23 | issue= 2 | pages= 106-15 | pmid=24019507 | doi=10.1136/bmjqs-2013-001947 | pmc=3913222 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24019507  }} </ref>.
===Art therapy===


The Mayo Clinic reported a case study of promoting physician control, social connectedness, and excellence/meaningfullness<ref name="pmid27111930">{{cite journal| author=Swensen S, Kabcenell A, Shanafelt T| title=Physician-Organization Collaboration Reduces Physician Burnout and Promotes Engagement: The Mayo Clinic Experience. | journal=J Healthc Manag | year= 2016 | volume= 61 | issue= 2 | pages= 105-27 | pmid=27111930 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27111930 }} </ref>.
[[Randomized controlled trial]]s of art therapy yield mixed and heterogeneous results<ref name="pmid34744918">{{cite journal| author=Ho AHY, Tan-Ho G, Ngo TA, Ong G, Chong PH, Dignadice D | display-authors=etal| title=A Novel Mindful-Compassion Art-Based Therapy for Reducing Burnout and Promoting Resilience Among Healthcare Workers: Findings From a Waitlist Randomized Control Trial. | journal=Front Psychol | year= 2021 | volume= 12 | issue= | pages= 744443 | pmid=34744918| doi=10.3389/fpsyg.2021.744443 | pmc=8566679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34744918  }} </ref><ref name="pmid32266765">{{cite journal| author=Kline JA, VanRyzin K, Davis JC, Parra JA, Todd ML, Shaw LL | display-authors=etal| title=Randomized Trial of Therapy Dogs Versus Deliberative Coloring (Art Therapy) to Reduce Stress in Emergency Medicine Providers. | journal=Acad Emerg Med | year= 2020 | volume= 27 | issue= 4 | pages= 266-275 | pmid=32266765 | doi=10.1111/acem.13939 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32266765 }} </ref>.


== See also ==
== See also ==
Line 222: Line 287:
* [[Stress (medicine)]]
* [[Stress (medicine)]]
* [[Compassion fatigue]]
* [[Compassion fatigue]]
* [[Industrial and organizational psychology]]
* The poetry of [[Edna St. Vincent Millay]]: "My candle burns at both ends/It will not last the night."
* The poetry of [[Edna St. Vincent Millay]]: "My candle burns at both ends/It will not last the night."


Latest revision as of 22:37, 29 March 2024

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Burnout is a concept in industrial and organizational psychology for "an excessive stress reaction to one's occupational or professional environment. It is manifested by feelings of emotional and physical exhaustion coupled with a sense of frustration and failure".[1] Burnout has three dimensions[2]:

  • Emotional exhaustion
  • Depersonalization (cynicism)
  • Diminished personal accomplishment (inefficacy)

Subsequent research suggests the third dimension, personal accomplishment, better fits with the concept of professional engagement rather than with burnout.[3]

Workaholism more closely correlates with burnout than with engagement, although workaholism correlated with both (weakly negatively with engagement [via absorption])[4].

Engagement may not simply be the opposite of burnout[5]. Engagement and burnout may be related more specifically[6]:

  • Emotional exhaustion may be the opposite of vigor
  • Cynicism may be the opposite of dedication

OR

"Vigor and dedication are the direct positive opposites of exhaustion and cynicism, respectively."[5]

According to Schaufeli[5] , the "Energetic Process" is based on Hockey's model of compensatory control and when "perceived demands are too high to be met by the usual working effort, two options are open:

  • Strain coping mode leading to fatigue and irritability
  • Passive coping mode leading to disengagement


The distinction between burnout and depression is not clear[7].

Prevalence

The prevalence of burnout in the general, employed population of the United States, aged is (measured by MBI except where noted)[8][9][10]:

  • General, employed U.S. population
    • (2010): aged 31-47 30%[8], aged 29-65 29%[9]
    • (2014): aged 31-65 28%[10]
    • (2017): aged 29-65 28%[11]
    • (2021): during COVID epidemic in Japan: 31% (measured by Mini-Z)[12]
  • College graduates 2010: aged 31-47 36%[8]

Health care workers

As of 2017, 44% of physicians have have burnout[11] Previously, in 2014, as many as 50% of physicians in practice may have burnout.[10] General practitioners seem to have low job control and the highest proportion of burnout cases[13].

For physicians in training, rates of burnout (emotional exhaustion) for students, residents and fellows is about 50% while the rate is 36% in similarly aged college graduates.[8]

Causes

Burnout is due to loss of control at work, and also "burnout is mainly predicted by job demands but also by lack of job resources"[14].

Curiously, a study of physicians found, "High levels of personal accomplishment increased stress levels (beta=0 080), whereas depersonalisation lowered stress levels (beta=-0 105)"[15] The study also found that

Different underlying factors may lead to varying phenotypes of burnout[16][17] One study found[16]:

  • Burnout (high on all three dimensions)
  • Engagement (low on all three)
  • Overextended (high on exhaustion only)
  • Disengaged (high on cynicism only). Also called depersonalization by Leiter[16] which may be the same as mental distance used by the World Health Organization[18].
  • Ineffective (high on inefficacy only)

Regarding the possible connection of burnout with autonomy, burnout is more common in[19]:

  • chaotic practices[19]
  • larger practices[19]
  • accountable care organizations[19]

Burnout in physicians in training is associated with perceived harassment[20]. In one survey of 24 American medical schools, harassment occurring at least one time was reported by 83% of students[20]. In this study, harassment was more commonly reported being perpetrated by residents[20]. The rates of burnout among students responding to the survey were[20]:

  • All students 34%
  • Those reporting recurrent harassment by faculty 57%
  • Those not reporting recurrent harassment by faculty 32%

Job demands-resources model of burnout

Several items, specifically workload, are reflected in the job demands-resources model of burnout[21].

These findings are reflected in the Demand-Control theory of job stress. [22]

Areas of Worklife Survey (AWS)

Leiter and Maslach found the following antecedents from the Areas of Worklife Survey (AWS) using factor analysis:[23]

  • Workload
  • Fairness
  • Control
  • Community
  • Values
  • Rewards

Of these causes, workload is the strongest correlate of emotional exhaustion[23] but loss of control may be the initial factor. Perceived control or autonomy and fairness correlate with cynicism.[23][24]

  • 16% of burnout is attributed to perceived control at the worksite.[25]

Leiter et al found that workload relates more to exhaustion while values incongruency relates more to cynicism[26].

Leadership quality

Leadership affects both burnout and work fulfillment. A study at the Mayo Clinic found that the "average leadership behaviour score of physicians’ work unit supervisor explained 11% of the variation in burnout and 47% of the variation in workplace satisfaction"[27].

In a second study across 11 healthcare organizations, the rates of burnout by tercile of leadership ratings of effectiveness by their direct reports[28]:

  • 18%
  • 35%
  • 47%

According to the yearly survey of recent medical school graduates by the Association of American Medical Colleges, the following are reported [29]:

  • Occasional public embarrassment 20%
  • Occasional public humiliation 8%

Burnout is now being studied in its reported antitheses, job satisfaction, job engagement and thriving. Thriving may protect against burnout[30][31]. Engagement is both negatively associated with burnout, but also unhealthy engagement may lead to burnout.[32]

Measurement

Several burnout inventories are available including the Maslach, Copenhagen, and Oldenburg[33][34].

Maslach Burnout Inventory

The Maslach Burnout Inventory is a well-studied measurement of burnout that was first published in 1981. Maslach and her colleague Jackson first identified the construct "burnout" in the 1970s, and developed a measure that weighs the effects of on three scales[2]:

  • Emotional exhaustion (nine items)
  • Depersonalization (five items)
  • Personal accomplishment (eight items)

The Maslach Burnout Inventory (MBI) has several versions:

  • Human Services Survey (MBI-HSS) is 22-tems and for jobs such as 'clergy, police, therapists, social workers, medical'[35]
    • MBI-HSS without the Personal Accomplishment subscale is 14 items.
  • General Survey (MBI-GS) a 16-items for more general, non-social jobs as well[36]
    • MBI-GS without the Professional Efficacy subscale is 10 items.

Eckleberry-Hunt in 2017 raised the question that burnout is being over-reported by deeming burnout present if either emotional exhaustion or depersonalization are present.[37]

2-item Maslach Burnout Inventory

In this survey, abnormal is defined as symptoms weekly or more on either item.[38][39][40]

1. I feel burned out from my work[40] or How often do you feel burned out from your work?[39]

  • Never
  • A few times a year or less
  • Once a month
  • A few times a month
  • Once a week
  • A few times a week
  • Every day

This item correlates with emotional exhaustion subscale of the Maslach Burnout Inventory (minus the single item being tested)[38]:

  • 0.76 to 0.83 across the four samples[38]

2. I have become more callous toward people since I took this job[40] or How often do you feel you’ve become more callous toward people since you started your residency?[39]

  • Never
  • A few times a year or less
  • Once a month
  • A few times a month
  • Once a week
  • A few times a week
  • Every day

This item correlates with depersonalization subscale of the Maslach Burnout Inventory (minus the single item being tested)[38]:

  • 0.61 to 0.72 across the four samples[38]

The two-item score correlates with the overall MBI with a correlation of 0.65[41] which is under the threshold recommended for group crrelations[42]

The two-item format has been used in national surveys in 2011[9] and its follow-up survey in 2014[10].

Mini Z

Single item burnout question (SIBOQ) variations[43][43][44]
Schmoldt, 1994[43] AMA / STEPSforward[44]
Most studies do not report the stem. Veninga using a 1 to 10 scale used for the stem,
"On the following scale, indicate by circling a number where you feel you are."[45] 		"Using your own definition of “burnout,” please circle one of the answers below"
or
“Overall, based on your definition of burnout, how would you rate your level of burnout?”[46]
I enjoy my work. I have no symptoms of burnout. I enjoy my work. I have no symptoms of burnout.
Occasionally I am under stress, and I don’t always have as much energy as I once did, but I don’t feel burned out. I am under stress, and don’t always have as much energy as I did, but I don’t feel burned out.
I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion. I am definitely burning out and have one or more symptoms of burnout, e.g., emotional exhaustion.
The symptoms of burnout that I’m experiencing won’t go away. I think about frustration at work a lot. The symptoms of burnout that I am experiencing won’t go away. I think about work frustrations a lot.
I feel completely burned out and often wonder if I can go on. I am at the point where I may need some changes or may need to seek some sort of help. I feel completely burned out. I am at the point where I may need to seek help.

The 10‑item Zero Burnout Program survey, or called the Mini Z[47], was adapted from the earlier Northwest Permanente (NWP) and Ohio Permanente Medical Group (OPMG) by Freeborn[48] and Schmoldt[43] which based this single question on earlier work by Veninga[45]. The SIBOQ was then used by later version of the Physician Worklife Survey[49]. The SIBOQ was first validated against the MBI by Rohland in 2004[50]. The SIBOQ was later used by the Minimizing Error, Maximizing Outcomes (MEMO)[51] studies used the self-definition format.

The Mini Z is a single item (burnout is defined as answers c, d, or e) that correlates with the emotional exhaustion scale of the Maslach[50]:

  • The Northwest Permanente (NWP) and Ohio Permanente Medical Group (OPMG) by Schmoldt, Freeborn and Klevit[48][43] stated[43] that the NWP also used the self-diagnosis item of Veninga that started in 1991 used the format:
    • The tedium index of Pines[52]
    • The self-diagnosis of burnout item of Veninga where the respondent chooses a number between 1 ("Not burned out") and 10 ("completely burned out").[45]

Structure

1. Using your own definition of “burnout,” please circle one of the answers below: a. I enjoy my work. I have no symptoms of burnout. b. I am under stress, and don’t always have as much energy as I did, but I don’t feel burned out. c. I am definitely burning out and have one or more symptoms of burnout, e.g., emotional exhaustion. d. The symptoms of burnout that I am experiencing won’t go away. I think about work frustrations a lot. e. I feel completely burned out. I am at the point where I may need to seek help.

2. The Mini-Z also contains the relevant dimensions:

  • Workload
    • My control over my workload is...
    • Sufficiency of time for documentation is...
    • The amount of time I spend on the electronic health record (EHR) at home is...
  • Cynicism:
    • My professional values are well aligned with those of my department leaders...

The Mini Z is promoted by the American Medical Association's Steps Forward campaign.[44]

The Mini Z may report lower prevalence of burnout than when measured by the full Maslach Burnout Inventory (MBI).[53]

Burnout Assessment Tool

A newer survey is the Burnout Assessment Tool (BAT)[54] developed by Schaufeli and others[55]. The BAT has four subscales:

  • Exhaustion
  • Mental distance
  • Emotional impairment
  • Cognitive impairment

The BAT versions are:

  • Full version with 23 items
  • Short version with 12 items[56]

Copenhagen Burnout Inventory

The Copenhagen Burnout Inventory has 19 items and was developed in 2005.[57]

Oldenburg Burnout Inventory

The Oldenburg Burnout Inventory has 16 items and was developed by Demerouti and others and has two scales[58][59]:

  • Disengagement scale. The highest loading item is "I find my work to be a positive challenge" and the second highest loading item is "I always find new and interesting aspects in my work"[60].
  • Exhaustion scale. The highest loading item is "After my work, I usually feel worn out and weary"[60].

Professional Fulfillment Index (PFI) (Stanford)

The PFI contains relevant dimensions including interpersonal disengagement[61]:

  • "Less empathetic with my patients"
  • "Less empathetic with my colleagues"

Physician Well-Being Index (PWBI)

The PWBI contains 7 items, one of which queries burnout in a yes/no response format. Its development[62] and application[63] have been reported.

Scales include disengagement:

  • "Have you worried that your work is hardening you emotionally?"

Professional Quality of Life (ProQOL)

The ProQOL has 30 items over three scales[64]:

  • Compassion satisfaction (CS)
  • Burnout (BO)
  • Compassion fatigue (CF)

The ProQOL does not include depersonalization.

The ProQO moderately correlates with the single-item burnout question from the Mini-Z[65].

The ProQOL is available at https://proqol.org/.

Prevention

Thriving[30][31] and engagement[66][3] are negatively correlated with, and thus may be protective, against burnout. However, unhealthy engagement may lead to burnout.[32]

Perceived control or autonomy and fairness correlate with cynicism.[23][24]

Successful teamwork may be important[67][68].

Religion, spirituality

Spirituality may be projective against burnout in medical students[69][70], medical residents/faculty[71][72], nurses[73] UK general practioners[74], and emergency medicine physicians[75].

Consequences

Burnout is associated with many clinical outcomes and personnel outcomes, but the relationships have much statistical heterogeneity[76].

Burnout may be associated with operating margins[77].

Treatment

Institutional and individual strategies to reduce burnout have been reviewed[78]. Of 15 studies, 12 were "individual-focused" and only 3 addressed " structural interventions within the work environment"ref name="pmid27692469"/>.

Physicians may not be aware that they are burned out and providing awareness may increase engagement with addressing burnout[79].

Meditation and Dhyana

Trauma-informed yoga may help[80].


Transcendental Meditation may help[81].

Art therapy

Randomized controlled trials of art therapy yield mixed and heterogeneous results[82][83].

See also

References

  1. ↑ Anonymous (2024), Professional Burnout (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ 2.0 2.1 Maslach, Christina; Jackson, Susan E. (1981). "The measurement of experienced burnout". Journal of Organizational Behavior. Wiley-Blackwell. 2 (2): 99–113. doi:10.1002/job.4030020205. ISSN 0894-3796.
  3. ↑ 3.0 3.1 Schaufeli, Wilmar B.; Bakker, Arnold B.; Salanova, Marisa (2016). "The Measurement of Work Engagement With a Short Questionnaire". Educational and Psychological Measurement. 66 (4): 701–716. doi:10.1177/0013164405282471. ISSN 0013-1644.
  4. ↑ Schaufeli, Wilmar B.; Taris, Toon W.; van Rhenen, Willem (April 2008). "Workaholism, Burnout, and Work Engagement: Three of a Kind or Three Different Kinds of Employee Well-being?". Applied Psychology. 57 (2): 173–203. doi:10.1111/j.1464-0597.2007.00285.x. eISSN 1464-0597. ISSN 0269-994X.
  5. ↑ 5.0 5.1 5.2 Schaufeli, W.B. and Bakker, A.B. (2004), Job demands, job resources, and their relationship with burnout and engagement: a multi‐sample study. J. Organiz. Behav., 25: 293-315. doi:10.1002/job.248
  6. ↑ González-Romá, Vicente; Schaufeli, Wilmar B.; Bakker, Arnold B.; Lloret, Susana (February 2006). "Burnout and work engagement: Independent factors or opposite poles?". Journal of Vocational Behavior. 68 (1): 165–174. doi:10.1016/j.jvb.2005.01.003. ISSN 0001-8791.
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  8. ↑ 8.0 8.1 8.2 8.3 Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J; et al. (2014). "Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population". Acad Med. 89 (3): 443–51. doi:10.1097/ACM.0000000000000134. PMID 24448053.
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  15. ↑ McManus IC, Winder BC, Gordon D (2002). "The causal links between stress and burnout in a longitudinal study of UK doctors". Lancet. 359 (9323): 2089–90. doi:10.1016/s0140-6736(02)08915-8. PMID 12086767.
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