Burnout (psychology): Difference between revisions

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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". According to the [[World Health Organization]] (WHO), "Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition." <ref name="who">World Health Organization. Burn-Out an “Occupational Phenomenon”: International Classification of Diseases. Available online:
https://www.who.int/mental_health/evidence/burn-out/en/</ref>
 
Burnout has three dimensions:


* Emotional exhaustion
* Emotional exhaustion
Line 14: Line 17:
* Diminished personal accomplishment (inefficacy)
* Diminished personal accomplishment (inefficacy)


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>
The WHO describes the three dimensions as<ref name="who"/>:
* Feelings of energy depletion or exhaustion;
* Increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and
* Reduced professional efficacy
Subsequent research suggests the third dimension, personal accomplishment, better fits with the concept of professional engagement rather than with burnout.


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>.
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".


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


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>.
Engagement may not simply be the opposite of burnout.


==Prevalence==
==Prevalence==


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>:
The prevalence of burnout in the general, employed population of the United States, aged is:
* 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%
** (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>
* College graduates 2010: aged 31-47 36%<ref name="pmid24448053"/>
 
==Health care workers==
 
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>.
 
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>.
 
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"/>:
* All students 34%
* Those reporting recurrent harassment by faculty 57%
* Those ''not'' reporting recurrent harassment by faculty 32%
 
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 humiliation 8%
 
Burnout is more common in physicians and dvanced practice clinicians (nurse practitioners and physician assistants, APCs) than non-clinical staff<ref name="pmid30276654">{{cite journal| author=Edwards ST, Marino M, Balasubramanian BA, Solberg LI, Valenzuela S, Springer R | display-authors=etal| title=Burnout Among Physicians, Advanced Practice Clinicians and Staff in Smaller Primary Care Practices. | journal=J Gen Intern Med | year= 2018 | volume= 33 | issue= 12 | pages= 2138-2146 | pmid=30276654 | doi=10.1007/s11606-018-4679-0 | pmc=6258608 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30276654  }} </ref>.
 
==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>.
 
These scores have been crosswalked to allow comparison of rates of burnouts as measured in different populations using different metrics<ref name="pmid33791938">{{cite journal| author=Brady KJS, Ni P, Carlasare L, Shanafelt TD, Sinsky CA, Linzer M | display-authors=etal| title=Establishing Crosswalks Between Common Measures of Burnout in US Physicians. | journal=J Gen Intern Med | year= 2021 | volume=  | issue=  | pages=  | pmid=33791938 | doi=10.1007/s11606-021-06661-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33791938  }} </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===
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>:
* Emotional exhaustion (nine items)
* Depersonalization (five 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>.
 
===2 item 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.
 
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"/>
* 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
 
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"/>
* 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
 
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> and a separate survey of emergency medicine residents<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>.
 
===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"/><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>:
 
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.
 
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>
 
The Mini Z may<ref name="pmid29869142">{{cite journal| author=Knox M, Willard-Grace R, Huang B, Grumbach K| title=Maslach Burnout Inventory and a Self-Defined, Single-Item Burnout Measure Produce Different Clinician and Staff Burnout Estimates. | journal=J Gen Intern Med | year= 2018 | volume= 33 | issue= 8 | pages= 1344-1351 | pmid=29869142 | doi=10.1007/s11606-018-4507-6 | pmc=6082224 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29869142  }} </ref><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.
 
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>.
 
===Burnout Assessment Tool (BAT)===
The BAT contains<ref name="pmid33352940">{{cite journal| author=Schaufeli WB, Desart S, De Witte H| title=Burnout Assessment Tool (BAT)-Development, Validity, and Reliability. | journal=Int J Environ Res Public Health | year= 2020 | volume= 17 | issue= 24 | pages=  | pmid=33352940 | doi=10.3390/ijerph17249495 | pmc=7766078 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33352940  }} </ref>:
* "the total BAT contains 33 items and consists of the BAT-C and BAT-S." (BAT core and secondary deminstions)
** "The BAT-C assesses the four core dimensions—exhaustion, mental distance, impaired emotional, and cognitive control—and contains 23 items,
** "while the BAT-S assesses the two secondary dimensions—psychological and psychosomatic complaints—and contains 10 items"
 
===Copenhagen Burnout Inventory===
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>
The Copenhagen includes items for tired, worn out, and both physical and emotional exhaustion.
 
===Oldenburg Burnout Inventory (OBI)===
The OBI is a 16-item survey developed in Germany in 2002 and publically available in the published article<ref name="pmid12140354">{{cite journal| author=Klapow J, Kroenke K, Horton T, Schmidt S, Spitzer R, Williams JB| title=Psychological disorders and distress in older primary care patients: a comparison of older and younger samples. | journal=Psychosom Med | year= 2002 | volume= 64 | issue= 4 | pages= 635-43 | pmid=12140354 | doi=10.1097/01.psy.0000021942.35402.c3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12140354  }} </ref>.
 
===Physician Well-Being Index (PWBI)===
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.
 
===Professional Quality of Life (ProQOL) ===
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>:
* 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>.
 
===Biomarkers===
Cortisol levels are associated with burnout<ref name="pmid28434435">{{cite journal| author=Fernández-Sánchez JC, Pérez-Mármol JM, Blásquez A, Santos-Ruiz AM, Peralta-Ramírez MI| title=Association between burnout and cortisol secretion, perceived stress, and psychopathology in palliative care unit health professionals. | journal=Palliat Support Care | year= 2018 | volume= 16 | issue= 3 | pages= 286-297 | pmid=28434435 | doi=10.1017/S1478951517000244 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28434435  }} </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>
* 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>
* [[Electronic health record]]s<ref>https://www.mayoclinicproceedings.org/article/S0025-6196(19)30836-5/fulltext</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>.
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.
<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 ===
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>
 
===Leadership===
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>
 
 
===Electronic health records===
 
[[Electronic health record]]s (EHRs) contribute to burnout. This is especially among physicians in ambulatory care<ref name="pmid27138425">{{cite journal| author=Linzer M, Poplau S, Babbott S, Collins T, Guzman-Corrales L, Menk J | display-authors=etal| 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> and women. EHR usage after hours is especially problematic for [[internal medicine]] physicians<ref name="pmid31073856">{{cite journal| author=Saag HS, Shah K, Jones SA, Testa PA, Horwitz LI| title=Pajama Time: Working After Work in the Electronic Health Record. | journal=J Gen Intern Med | year= 2019 | volume= 34 | issue= 9 | pages= 1695-1696 | pmid=31073856 | doi=10.1007/s11606-019-05055-x | pmc=6712097 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31073856  }} </ref>
 
EHR usability can be measured with the System Usability Scale<ref name="pmid31735343">{{cite journal| author=Melnick ER, Dyrbye LN, Sinsky CA, Trockel M, West CP, Nedelec L | display-authors=etal| title=The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians. | journal=Mayo Clin Proc | year= 2020 | volume= 95 | issue= 3 | pages= 476-487 | pmid=31735343 | doi=10.1016/j.mayocp.2019.09.024 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31735343  }} </ref><ref name="pmid33289493">{{cite journal| author=Melnick ER, Harry E, Sinsky CA, Dyrbye LN, Wang H, Trockel MT | display-authors=etal| title=Perceived Electronic Health Record Usability as a Predictor of Task Load and Burnout Among US Physicians: Mediation Analysis. | journal=J Med Internet Res | year= 2020 | volume= 22 | issue= 12 | pages= e23382 | pmid=33289493 | doi=10.2196/23382 | pmc=7785404 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33289493  }} </ref>.
 
===Pandemic related burnout===
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>.
 
==Consequences==
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>.
 
 
===Clinical outcomes===
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===
 
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 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>.
 
==Prevention==
 
Thriving<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> and engagement<ref name="pmid24895952">{{cite journal| author=Mason VM, Leslie G, Clark K, Lyons P, Walke E, Butler C et al.| title=Compassion fatigue, moral distress, and work engagement in surgical intensive care unit trauma nurses: a pilot study. | journal=Dimens Crit Care Nurs | year= 2014 | volume= 33 | issue= 4 | pages= 215-25 | pmid=24895952 | doi=10.1097/DCC.0000000000000056 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24895952  }} </ref><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> are negatively correlated with, and thus may be protective, against burnout. However, 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>
 
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 ===
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===
{{See also|Industrial and organizational psychology}}
 
==Treatment==
===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>:
* 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====
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>.
 
Calling can be measured with:
* 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>.
 
===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>:
* 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>.
 
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>.
 
== See also ==
* [[Job satisfaction]]
* [[Stress (medicine)]]
* [[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."
 
== References ==
<references/>
 
*”Sources of Management of Excessive Job Stress and Burnout”, In P. Warr (Ed.), ''Psychology at Work'' Fourth Edition. Penguin.
* “Tailoring treatment strategies for different types of burnout” Farber, B. A. (1998). Paper presented at the ''Annual Convention of the American Psychological Association'', 106th, San Francisco California, August 14-18. ED 424 517
* “Staff burnout”, Freudenberger, H. J. (1974). ''Journal of Social Issues'', 30(1), 159-165.
* “Authentic leaders creating healthy work environments for nursing practice”, Shirey MR. ''American Journal of Critical Care'' May 2006. Vol. 15, Iss. 3; p. 256
* “Taming burnout's flame”, Krista Gregoria Lussier, ''Nursing Management'' Chicago: Apr 2006. Vol. 37, Iss. 4; p. 14
*  “A Scientific Solution To Librarian Burnout”, Craig S. Shaw  ''New Library World Year'' 1992 Volume: 93 Number: 5
*  ''Stress and Burnout in Library Service'', Caputo, Janette S. Phoenix, AZ: Oryx Press, 1991.
* ''An assessment of burnout in academic librarians in America using the Maslach Burnout Inventor'' (the MBI) Ray, Bernice, Ph.D., Rutgers University - New Brunswick, 2002, 90 pages; AAT 3066762
 
[[Category:Psychological conditions]]
[[Category:sociology]]
[[Category:Psychological stress]]
 
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Template:Otheruses4 Template:DiseaseDisorder infobox 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". According to the World Health Organization (WHO), "Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition." [1]

Burnout has three dimensions:

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

The WHO describes the three dimensions as[1]:

  • Feelings of energy depletion or exhaustion;
  • Increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and
  • Reduced professional efficacy

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

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".

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

Engagement may not simply be the opposite of burnout.

Prevalence

The prevalence of burnout in the general, employed population of the United States, aged is:

  • General, employed U.S. population
    • (2010): aged 31-47 30%
  1. 1.0 1.1 World Health Organization. Burn-Out an “Occupational Phenomenon”: International Classification of Diseases. Available online: https://www.who.int/mental_health/evidence/burn-out/en/