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Key Points

Question  How is burnout assessed among physicians and what is the prevalence of burnout among physicians?

Findings  In this systematic review, there was substantial variability in prevalence estimates of burnout among physicians, ranging from 0% to 80.5%, and marked variation in burnout definitions, assessment methods, and study quality. Associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined.

Meaning  These findings preclude definitive conclusions about the prevalence of burnout among physicians and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.

Abstract

Importance  Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown.

Objective  To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout.

Data Sources and Study Selection  Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018.

Data Extraction and Synthesis  Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively.

Main Outcomes and Measures  Point or period prevalence of burnout assessed by questionnaire.

Results  Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined.

Conclusions and Relevance  In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.

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Article Information

Corresponding Author: Douglas A. Mata, MD, MPH, Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, Brigham Education Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115-6106 (dmata@bwh.harvard.edu)

Accepted for Publication: August 9, 2018.

Author Contributions: Dr Mata had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Rotenstein, Mata.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Rotenstein, Ramos, Mata.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Mata.

Obtained funding: Guille, Sen, Mata.

Administrative, technical, or material support: Guille, Sen, Mata.

Supervision: Guille, Sen, Mata.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Funding/Support: This study received funding from the National Institutes of Health (grant R01MH101459 to Dr Sen).

Role of the Funder/Sponsor: The study funder had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Disclaimer: The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources.

Data Sharing Statement: See Supplement 2.

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