Volume: 7 Issue: 1
Year: 2019, Page: 3-9,
Introduction: Medical professionals are passing through turbulent times. Doctors today face many challenges. Fierce competition to get into medical school and subsequently into postgraduate courses, financial burden due to high cost of medical education, keeping abreast with technological advances, pressure for specialization and super-specialization, long working hours, poor diet and recreation make doctors particularly in their formative years highly vulnerable to burnout. This paper deals with the problem of burnout among doctors. For this review medical database such as PubMed, Scopus, and Google Scholar were searched using keywords, “burnout,” “burnout syndrome,” and “doctors.” Besides relevant newspaper and media reports were included. The review has brought out that burnout is an important issue among doctors. Doctors in various situations face different occupational environments predisposing to prolonged stress and burnout. In government hospitals and health centres, doctors are overworked due to high patient load and limited resources. In the private sector there is increasing corporatization leading to pressure from management to resort to questionable practices to increase profit. Doctors in teaching institutions face the stress of frequent surprise inspections. Burnout can adversely affect health and well being – in extreme cases leading to suicidal ideation. On the professional front it can lead to medical errors. Prevention and coping skills for burnout include leadership and resilience training, stress management skills, and organizational measures. However, evidence of efficacy of most measures is modest. There is much scope for interdisciplinary research to resolve these issues.
Keywords: Burnout; burnout syndrome; doctors; perspectives; determinants; coping.
1. Sharma S. India’s public health system in crises: Too many patients, not enough doctors. Hindustan Times, New Delhi, Aug 29, 2017. Available at: https:// www.hindustantimes.com/india-news/public-healthsystem-in-crisis-too-many-patients-not-enough-doctors/ story-39XAtFSWGfO0e4qRKcd8fO.html (last accessed 14 June 2018)
2. Kay M. The unethical revenue targets that India’s corporate hospitals set their doctors. BMJ 2015; 351: h4312 doi: https://doi.org/10.1136/bmj.h4312
3. Nagpal N. Goodbye clinics and nursing homes, welcome corporate hospitals. March 30, 2014. Available at: http:/ /www.indiamedicaltimes.com/2014/03/30/good-byeclinics-nursing-homes-welcome-corporate-hospitals/ (Last accessed 15 – 06 – 2018).
4. Jacob S. Physician autonomy is under siege and morale is declining. Healthcare. 30 June 2014. Available at: http:/ /healthcare.dmagazine.com/2014/06/30/physicianautonomy-is-under-siege-and-morale-is-declining/ (last accessed 16 – 06 – 2018).
5. Lemaire J B, Wallace J E, Burnout among doctors. BMJ 2017;358:j3360. doi: https://doi.org/10.1136/bmj.j3360
6. Scheuch K, Haufe E, Seibt R. Teachers’ Health. Dtsch Arztebl Int 2015; 112: 347–56. DOI: 10.3238/ arztebl.2015.0347. Available at: https:// www.aerzteblatt.de/int/archive/article/170603 (accessed 16 - 06 -2018)
7. Desai S N. Coaching classes: cause or effect? Youth Ki Awaaz. April 25, 2011. Available at: https:// www.youthkiawaaz.com/2011/04/coaching-classes-causeor-effect/ (last accessed 15 – 06 – 2018).
8. Maslach C, Leiter MP. The Truth about Burnout. San Francisco, CA: Jossey-Bass Publishers; 1997.
9. Moss M, Good V S, Gozal D, Kleinpell R, Sessler C N. An official critical care societies collaborative statement: Burnout syndrome in Critical Care Health Care Professionals. A call for action. American Journal of Critical Care 2016; 25: 4: 368 – 376.
10. Edelwich J, Brodsky A. Burn-out: Stages of Disillusionment in the Helping Professions. New York, NY: Human Sciences Press; 1980.
11. Maslach C, Jackson SE. MBI: Maslach Burnout Inventory; Manual Research Edition. Palo Alto, CA: Consulting Psychologists Press; 1986
12. Kristensen T S, Borritz M, Villadsen E, Christensen K B. The Copenhagen Burnout Inventory: A new tool for assessment of burnout. Work & Stress 2007; 19: 3: 192 – 207. DOI: 10.1080/02678370500297720
13. Copenhagen Burnout Inventory (English Version) used in the PUMA study. Available at: http:// www.arbejdsmiljoforskning.dk/upload/cbi-scales.pdf (last accessed 16 - 06 – 2018).
14. Bianchi R, Schonfeld I S, Laurent E. Is it time to consider the “burnout syndrome” a distinct illness? Front. Public Health 08 June 2015; https://doi.org/10.3389/ fpubh.2015.00158 (last accessed 22 July 2018).
15. Langade D, Modi P D, Sidhwa Y F, et al. (September 08, 2016) Burnout Syndrome Among Medical Practitioners Across India: A Questionnaire-Based Survey. Cureus 8(9): e771. DOI 10.7759/cureus.771
16. Lo D, Wu F, Chan M, Chu R, Li D. A systematic review of burnout among doctors in China: a cultural perspective. Asia Pac Fam Med 2018; 17: 3. https://doi.org/10.1186/ s12930-018-0040-3 (last accessed 22 - 07 – 2018).
17. Shanafelt TD, Sonja B, Litjen T, Dyrbye LN, Sotile W, Daniel S, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. JAMA Intern Med. 2012; 172: 137785.
18. Dyrbye LN, Massie FS Jr, Eacker A, Harper W, Power D, Durning SJ, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010; 304: 117380.
19. Shanafelt TD. Enhancing meaning in work: a prescription for preventing physician burnout and promoting patientcentered care. JAMA 2009; 302: 133840.
20. Cohen JS, Leung Y, Fahey M, Hoyt L, Sinha R, Cailler L, et al. The happy docs study: a Canadian Association of Internes and Residents well-being survey examining resident physician health and satisfaction within and outside of residency training in Canada. BMC Res Notes 2008; 1: 105.
21. Legassie J, Zibrowski E, Goldszmidt M. Measuring resident well-being: impostorism and burnout syndrome in residency. J Gen Intern Med. 2008; 23: 10904.
22. Ashkar K, Romani M, Musharra?eh U, Shaaya M. Prevalence of burnout syndrome among medical residents: experience of a developing country. Postgrad Med. 2010; 86: 26671.
23. McCray L W, Cronholm P F, Bogner H R, Gallo J J, Neill R A. Resident Physician Burnout: Is there hope? Fam Med 2008; 40: 9: 626 – 632.
24. Raj K S. Well being in Residency: A Systematic Review. Journal of Graduate Medical Education 2016; 8: 675 – 684.
25. Bakker A. B., & Demerouti, E. The job demands-resources model: State of the art. Journal of Managerial Psychology 2007; 22: 309–328.
26. Demerouti E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. The job demands-resources model of burnout. Journal of Applied Psychology 2001; 86: 499–512.
27. Fernet C Austin S, Trepanier S, Dussault M. How do job characteristics contribute to burnout? Exploring the distinct mediating roles of perceived autonomy, competence and relatedness. European Journal of Work and Organizational Psychology 2013; 22: 2: 123 – 127.
28. Deci, E. L., & Ryan R. M. Intrinsic motivation and self determination in human behavior. New York, NY: Platinum Press. 1985.
29. Ryan, R. M., & Deci E. L. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. The American Psychologist 2000; 55; 1: 68– 78.
30. DeCharms R. Personal causation; the internal affective determinants of behavior. New York, NY: Academic Press. 1968.
31. White R. W. Motivation reconsidered: The concept of competence. Psychological Review 1959; 66: 5, 297–333.
32. Baumeister R. & Leary M. R. The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin 1995; 117: 3: 497–529.
33. Bajpai V “The Challenges Confronting Public Hospitals in India, Their Origins, and Possible Solutions,” Advances in Public Health, vol. 2014, Article ID 898502, 27 pages, 2014. https://doi.org/10.1155/2014/898502. Accessible at https://www.hindawi.com/journals/aph/2014/898502/ (last accessed 20 June 2018)
34. Gadre A, Shukla A. Health Care becomes an industry: the Growing influence of Corporate and Multi-speciality Hospitals. In: Dissenting Diagnosis. Gurgaon. Random House Publishers India Pvt. Ltd. 2016; 44 – 59.
35. Ogresta J, Rusac S, Zurec L. Relationship between Burnout Syndrome and Job Satisfaction among mental health workers. Croat Med J 2008; 49: 3: 364 – 374.
36. Khamisa N, Oldenburg B, Peltzer K, Ilic D. Work related stress, burnout, job satisfaction and general health of nurses. Int J Environ Res Public Health 2015; 12: 1: 652 – 666.
37. Friganovic A, Kovacevic I Ilic B, Zulec M, Krisic V Bile C G. Healthy settings in hospitals – how to prevent burnout syndrome in nurses: literature review. Acta Clin Croat 2017; 56: 292 – 298.
38. Tijdink J K, Vergouwen A C M, Smulders Y M. Emotional exhaustion and burnout among medical professors: a nationwide survey. BMC Medical Education 2014; 14: 183. http://www.biomedcentral.com/1472-6920/14/183 (last accessed 23 - 07 – 2018).
39. Saleh KJ, Quick JC, Conaway M, Sime WE, Martin W, Hurwitz S, Einhorn TA: The prevalence and severity of burnout among academic orthopaedic departmental leaders. J Bone Joint Surg Am 2007, 89(4):896–903.
40. Gabbe SG, Melville J, Mandel L, Walker E: Burnout in chairs of obstetrics and gynecology: diagnosis, treatment, and prevention. Am J Obstet Gynecol 2002, 186(4):601–612
41. Cruz OA, Pole CJ, Thomas SM: Burnout in chairs of academic departments of ophthalmology. Ophthalmology 2007, 114(12):2350–2355.
42. Smith R. Why doctors are so unhappy? BMJ 2001; 322: 1073 – 4.
43. Bhatia M S, Saha R. Burnout in medical residents: A growing concern. J Postgrad Med 2018;64:136-7
44. Imo U O. Burnout and psychiatric morbidity among doctors in the UK: a systematic literature review of prevalence and associated factors. BJPsy Bulletin 2017; 41: 197 – 204.
45. Shanefelt T Burnout and self reported patient care in an internal medicine residency program. Ann Int Med 2002; 136: 358.
46. Shanefelt T, Balch C, Bechamps G, Russell T, dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg 2010; 251: 995 – 1000.
47. Salanova M, Llorens S: Current state of research on burnout and future challenges . Papeles del psicólogo. 2008, 29:59–67.
48. Mishra S. Our intellectuals have failed us – system of a Down. Indian Heart J 2017; 69: 133 – 135.
49. Mishra S. What ails the practice of medicine: the Atlas has shrugged. Indian Heart J 2015; 67: 1: 1 – 7.
50. Melamed S, Kushnir T, Shirom A: Burnout and risk factors for cardiovascular diseases. Behav Med. 1992, 18:53–60. 10.1080/08964289.1992.9935172
51. Danhof-Pont M, van Veen T, Zitman FG. Biomarkers in burnout: a systematic review. J Psychosom Res. 2011; 70: 50524.
52. Henkens K. Leenders M. Burnout and older workers’ intention to retire. Int J Manpow 2010; 31: 3: 306 – 321.
53. Soler J K, Yaman H, Esteva M, Dobbs F, Asenova R S, Katic M, et al. Burnout in European Family Doctors: the EGPRN study. Fam Pract 2008; 25: 4: 245 – 265.
54. Zhang Y, Feng X. The relationship between job satisfaction, burnout and turnover intention among physicians from urban state state-owned medical institutions in Hubei China: a cross sectional study. BMC Health Serv Res 2011; 11: 235.
55. Dewa C S, Loong D, Bonato S, Thanh N X, Jacobs P. How does burnout affect physician productivity? A systematic literature review. BMC Health Services Research 2014; 14: 325. Doi 10.1186/1472-6963-14-325.
56. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among US medical students. Ann Intern Med. 2008;149(5):334-341.
57. Montgomery A J. The relationship between leadership and physician well being: A scoping review. Journal of Healthcare Leadership 2016; 8: 71 – 80.
58. Association of American Medical Colleges. Recommendations for Clinical Skills Curricula for Undergraduate Medical Education. Task Force on the Clinical Skills Education of Medical Students. Washington DC: Association of American Medical Colleges; 2008. Available from: https://www.aamc.org/download/130608/ data/clinicalskills_oct09.qxd. pdf. Accessed July 24, 2018.
59. Accreditation Council for Graduate Medical Education, American Board of Emergency Medicine. The Emergency Medicine Milestone Project. 2012. Available from: https:/ /www.acgme.org/Portals/0/PDFs/ Milestones/ PediatricEmergencyMedicineMilestones.pdf. Accessed July 24, 2018.
60. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114: 6: 513–519.
61. Hlubocky F J, Rose M, Epstein R M. Mastering Resilience in Oncology: Learn to Thrive in the Face of Burnout. Am Soc Clin Oncol Educ Book 2017; 37: 771 – 781. doi 14694/ EDBK_173874.
62. Epstein RM. Attending: Medicine, Mindfulness, and Humanity. Delran, NJ: Simon & Schuster; 2016.
63. Nedrow A, Steckler NA, Hardman J. Physician resilience and burnout: can you make the switch? Fam Pract Manag. 2013;20:25-30.
64. Antonovsky A. The sense of coherence: An historical and future perspective. In McCubbin HI, Thompson EA, Thompson AI, et al (eds). Stress, coping, and health in families: Sense of Coherence and resiliency. Thousand Oaks, CA: Sage; 1998a;3-20.
65. Southwick SM, Pietrzak RH, Tsai J, et al. Resilience: an update. PTSD Research Quarterly. 2015;25:1-10. 43. Garmezy N. Resiliency and vulnerability to adverse developmental outcomes associated with poverty. Am Behav Scientist. 1991;34:416-430.
66. Luthar SS, Cicchetti D, Becker B. The construct of resilience: a critical evaluation and guidelines for future work. Child Dev. 2000;71:543-562.
67. VanBreda AD. Resilience Theory: A Literature Review. Pretoria, South Africa: South African Military Health Service; 2001.
68. Bonanno GA. Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol. 2004;59:20-28.
69. Southwick SM, Bonanno GA, Masten AS, et al. Resilience definitions, theory, and challenges: interdisciplinary perspectives. Eur J Psychotraumatol. 2014;5:1-14.
70. Pietrzak RH, Southwick SM. Psychological resilience in OEFOIF Veterans: application of a novel classification approach and examination of demographic and psychological correlates. J Affect Disord. 2011;133:560-568.
71. Aburn G, Gott M, Hoare K. What is resilience? An integrative review of the empirical literature. J Adv Nurs. 2016;72:980-1000.
72. Chun CA, Moos RH, Cronkite RC. Culture: a fundamental context for the stress and coping paradigm. Wong PT, Wong LC, editors. Handbook of Multicultural Perspectives on Stress and Coping. New York: Springer, 2006;29-53.
73. Hamou-Jennings FA, Dong C. Resilience training for healthcare providers: an Asian perspective. mHealth 2016;2:25.
74. Jones JW, Barge BN, Steffy BD, et al. Stress and medical malpractice: organizational risk assessment and intervention. J Appl Psychol 1988;73:727-35.
75. Huang T, Larsen KT, Ried-Larsen M, et al. The effects of physical activity and exercise on brain-derived neurotrophic factor in healthy humans: A review. Scand J Med Sci Sports 2014;24:1-10.
76. Deuster PA, Silverman MN. Physical fitness: a pathway to health and resilience. US Army Med Dep J 2013:24-35.
77. Romani M, Ashkar K. Burnout among physicians. Libyan Journal of Medicine 2014; 9: 23556 – http://dx.doi/ 10.3402/ljm.v9.23556
78. Van der Klink JJ, Blonk RWB, Schene AH, van Dijk FJH. The bene?ts of interventions for work-related stress. Am J Public Health. 2001; 91: 2706.
79. Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well-being: assessment of an innovative program. J Gen Intern Med. 2007; 22: 154452.
80. Awa W, Plaumann M, Walter U. Burnout prevention: a review of intervention programs. Patient Educ Couns. 2010; 78: 18490.
81. Marine A, Ruotsalainen J, Serra C, Verbeek J. Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev. 2006: CD002892.
Banerjee A. Physician Heal Thyself: Perspectives on Burnout among Doctors. Perspectives in Medical Research 2019; 7(1):3-9.