Who experiences burnout? That depends on how it's defined

Burnout is a common topic in healthcare, but what, exactly, defines “burnout”? How should it be measured to assess chronic occupational stress on physicians?

A systematic review published Sept. 18 in JAMA found substantial variability in estimating rates of burnout. Researchers also differed on defining the condition and assessing its impact.

“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,” wrote the authors, led by Lisa Rotenstein, MD, MBA, with Brigham and Women’s Hospital in Boston.

The researchers examined 182 studies that were conducted between 1991 and 2018. Data were collected from 109,628 individuals from 45 countries. Common topics included overall burnout (67 percent of studies), emotional exhaustion (72 percent), depersonalization (68.1 percent) and low personal achievement (63.2 percent).

“This wide range reflected the marked heterogeneity in the criteria used to define and measure burnout in the literature, with at least 142 unique definitions for meeting overall burnout or burnout subscale criteria identified,” Rotenstein et al. wrote.

The authors noted that various media outlets cite 50 percent for burnout, but the problems discovered by this retrospective analysis call into question the validity of such a figure. 

Prevalence of burnout and burnout-related conditions widely varied from study to study. Overall burnout ranged from 0 to 80.5 percent, with similar results for emotional exhaustion (0 to 86.2 percent), depersonalization (0 to 89.9 percent) and low personal accomplishment (0 to 87.1 percent).

“Research on burnout among physicians has increased awareness of physician mental health and well-being as an important issue, and U.S. national organizations have recently called for all healthcare systems to assess their physicians on measures of well-being, often with a focus on burnout,” Rotenstein et al. wrote. “This review indicates that a more consistent definition of burnout and improved assessment tools may be necessary if these policy measures are to successfully improve the physician work environment.”