1932

Abstract

The prevalence of burnout among health workers is alarmingly high and worsening. Many factors across the domains of culture of wellness, efficiency of practice and work demands, and personal resilience place workers at risk for burnout. Intervention research has disproportionately studied individually focused interventions to strengthen personal resilience, demonstrating small benefit from such interventions. While coping strategies may have value, we stress the need to focus interventions on mitigating work conditions that breed burnout, such as inadequate levels of staffing, and to rigorously evaluate such interventions. A conceptual framework on burnout must include critical theory interrogating the broader economic, political, and structural forces shaping health care and the relative power of workers. The concept of moral injury may be more apt than burnout for describing the effects on workers’ well-being of accelerating health care consolidation by investor-owned organizations, government austerity policies, and the disempowered position of labor.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-publhealth-071823-122832
2025-04-04
2025-04-27
Loading full text...

Full text loading...

/deliver/fulltext/publhealth/46/1/annurev-publhealth-071823-122832.html?itemId=/content/journals/10.1146/annurev-publhealth-071823-122832&mimeType=html&fmt=ahah

Literature Cited

  1. 1.
    Adler-Milstein J, Zhao W, Willard-Grace R, Knox M, Grumbach K. 2020.. Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians. . J. Am. Med. Inf. Assoc. 27::53138
    [Crossref] [Google Scholar]
  2. 2.
    AFL-CIO. 2024.. Executive Paywatch. . AFL-CIO. https://aflcio.org/paywatch
    [Google Scholar]
  3. 3.
    Ahmed AM, Kadakia K, Ahmed A, Shultz B, Li X. 2022.. Trends in labor unionization among US health care workers, 2009–2021. . JAMA 328::240411
    [Crossref] [Google Scholar]
  4. 4.
    Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. 2002.. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. . JAMA 288::198793
    [Crossref] [Google Scholar]
  5. 5.
    Alarcon G, Eschleman KJ, Bowling NA. 2009.. Relationships between personality variables and burnout: a meta-analysis. . Work Stress 23::24463
    [Crossref] [Google Scholar]
  6. 6.
    Al Ma'mari Q, Sharour LA, Al Omari O. 2020.. Fatigue, burnout, work environment, workload and perceived patient safety culture among critical care nurses. . Br. J. Nurs. 29::2834
    [Crossref] [Google Scholar]
  7. 7.
    Altieri MS, Salles A, Bevilacqua LA, Brunt LM, Mellinger JD, et al. 2019.. Perceptions of surgery residents about parental leave during training. . JAMA Surg. 154::95258
    [Crossref] [Google Scholar]
  8. 8.
    Apathy NC, Hare AJ, Fendrich S, Cross DA. 2022.. Early changes in billing and notes after evaluation and management guideline change. . Ann. Intern. Med. 175::499504
    [Crossref] [Google Scholar]
  9. 9.
    Aronsson G, Theorell T, Grape T, Hammarström A, Hogstedt C, et al. 2017.. A systematic review including meta-analysis of work environment and burnout symptoms. . BMC Public Health 17::264
    [Crossref] [Google Scholar]
  10. 10.
    Awa WL, Plaumann M, Walter U. 2010.. Burnout prevention: a review of intervention programs. . Patient Educ. Couns. 78::18490
    [Crossref] [Google Scholar]
  11. 11.
    Balch CM, Shanafelt TD, Dyrbye L, Sloan JA, Russell TR, et al. 2010.. Surgeon distress as calibrated by hours worked and nights on call. . J. Am. Coll. Surg. 211::60919
    [Crossref] [Google Scholar]
  12. 12.
    Berwick DM. 2023.. Salve lucrum: the existential threat of greed in US health care. . JAMA 329::62930
    [Crossref] [Google Scholar]
  13. 13.
    Bodenheimer T, Sinsky C. 2014.. From triple to quadruple aim: care of the patient requires care of the provider. . Ann. Fam. Med. 12::57376
    [Crossref] [Google Scholar]
  14. 14.
    Bohman B, Dyrbye L, Sinsky CA, Linzer M, Olson K, et al. 2017.. Physician well-being: the reciprocity of practice efficiency, culture of wellness, and personal resilience. . NEJM Catal. 3:. https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0429
    [Google Scholar]
  15. 15.
    Brady KJ, Ni P, Carlasare L, Shanafelt TD, Sinsky CA, et al. 2022.. Establishing crosswalks between common measures of burnout in US physicians. . J. Gen. Intern. Med. 37::77784
    [Crossref] [Google Scholar]
  16. 16.
    Brajcich BC, Chung JW, Wood DE, Horvath KD, Tolley PD, et al. 2021.. National evaluation of the association between resident labor union participation and surgical resident well-being. . JAMA Netw. Open 4::e2123412
    [Google Scholar]
  17. 17.
    Brooks Carthon JM, Aponte R, Mason A, Nikpour J. 2023.. “ I had become fed up”: a qualitative study of Black nurse practitioners' experiences fighting against health inequity, racism, and burnout. . J. Am. Assoc. Nurse Pract. 35::70816
    [Google Scholar]
  18. 18.
    Byrne A, Tanesini A. 2015.. Instilling new habits: addressing implicit bias in healthcare professionals. . Adv. Health Sci. Educ. Theory Pract. 20::125562
    [Google Scholar]
  19. 19.
    Casalino LP, Li J, Peterson LE, Rittenhouse DR, Zhang M, et al. 2022.. Relationship between physician burnout and the quality and cost of care for Medicare beneficiaries is complex. . Health Aff. 41::54956
    [Google Scholar]
  20. 20.
    Castillo-Angeles M, Stucke RS, Rosenkranz KM, Smink DS, Rangel EL. 2022.. Paternity leave during surgical training: perspectives of male residents. . J. Surg. Educ. 79::e8591
    [Google Scholar]
  21. 21.
    Cimiotti JP, Aiken LH, Sloane DM, Wu ES. 2012.. Nurse staffing, burnout, and health care-associated infection. . Am. J. Infect. Control 40::48690
    [Google Scholar]
  22. 22.
    Cleary M, Kornhaber R, Thapa DK, West S, Visentin D. 2018.. The effectiveness of interventions to improve resilience among health professionals: a systematic review. . Nurse Educ. Today 71::24763
    [Google Scholar]
  23. 23.
    Coleman K, Wagner E, Schaefer J, Reid R, LeRoy L. 2016.. Redefining primary care for the 21st century. AHRQ Publ. 16(17)-0022-EF , Agency Healthc. Res. Qual., Rockville, MD:. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/workforce-financing/white_paper.pdf
    [Google Scholar]
  24. 24.
    Condon A. 2024.. HCA's CEO-to-worker pay ratio in 2023. . Becker's Hospital Review, March 26. https://www.beckershospitalreview.com/compensation-issues/hcas-ceo-to-worker-pay-ratio-in-2023
    [Google Scholar]
  25. 25.
    Cooley E, Yovanoff P. 1996.. Supporting professionals-at-risk: evaluating interventions to reduce burnout and improve retention of special educators. . Except. Child. 62::33655
    [Google Scholar]
  26. 26.
    Dahrouge S, Seale E, Hogg W, Russell G, Younger J, et al. 2016.. A comprehensive assessment of family physician gender and quality of care: a cross-sectional analysis in Ontario, Canada. . Med. Care 54::27786
    [Google Scholar]
  27. 27.
    Dai M, Willard-Grace R, Knox M, Larson SA, Magill MK, et al. 2020.. Team configurations, efficiency, and family physician burnout. . J. Am. Board Fam. Med. 33::36877
    [Google Scholar]
  28. 28.
    Dean W, Talbot S, Dean A. 2019.. Reframing clinician distress: moral injury not burnout. . Fed. Pract. 36::4002
    [Google Scholar]
  29. 29.
    DeChant PF, Acs A, Rhee KB, Boulanger TS, Snowdon JL, et al. 2019.. Effect of organization-directed workplace interventions on physician burnout: a systematic review. . Mayo Clinic Proc. Innovat. Qual. Outcomes 3::384408
    [Google Scholar]
  30. 30.
    De Marchis E, Knox M, Hessler D, Willard-Grace R, Olayiwola JN, et al. 2019.. Physician burnout and higher clinic capacity to address patients' social needs. . J. Am. Board Fam. Med. 32::6978
    [Google Scholar]
  31. 31.
    De Simone S, Vargas M, Servillo G. 2021.. Organizational strategies to reduce physician burnout: a systematic review and meta-analysis. . Aging Clin. Exp. Res. 33::88394
    [Crossref] [Google Scholar]
  32. 32.
    Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P. 2014.. How does burnout affect physician productivity? A systematic literature review. . BMC Health Serv. Res. 14::325
    [Crossref] [Google Scholar]
  33. 33.
    DiMatteo MR, Sherbourne CD, Hays RD, Ordway L, Kravitz RL, et al. 1993.. Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study. . Health Psychol. 12::93102
    [Crossref] [Google Scholar]
  34. 34.
    Douglas J, Haar J, Harris C. 2017.. Job insecurity and job burnout: Does union membership buffer the detrimental effects?. N. Z. J. Hum. Resourc. Manag. 17:(2)
    [Google Scholar]
  35. 35.
    Douglas M, Coman E, Eden AR, Abiola S, Grumbach K. 2021.. Lower likelihood of burnout among family physicians from underrepresented racial-ethnic groups. . Ann. Fam. Med. 19::34250
    [Crossref] [Google Scholar]
  36. 36.
    Dunn PM, Arnetz BB, Christensen JF, Homer L. 2007.. Meeting the imperative to improve physician well-being: assessment of an innovative program. . J. Gen. Intern. Med. 22::154452
    [Crossref] [Google Scholar]
  37. 37.
    Dyrbye L, Herrin J, West CP, Wittlin NM, Dovidio JF, et al. 2019.. Association of racial bias with burnout among resident physicians. . JAMA Netw. Open 2::e197457
    [Crossref] [Google Scholar]
  38. 38.
    Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Sloan J, Freischlag J. 2011.. Relationship between work-home conflicts and burnout among American surgeons: a comparison by sex. . Arch. Surg. 146::21117
    [Crossref] [Google Scholar]
  39. 39.
    Dyrbye LN, Thomas MR, Eacker A, Harper W, Massie FS Jr., et al. 2007.. Race, ethnicity, and medical student well-being in the United States. . Arch. Intern. Med. 167::21039
    [Crossref] [Google Scholar]
  40. 40.
    Dyrbye LN, Trockel M, Frank E, Olson K, Linzer M, et al. 2017.. Development of a research agenda to identify evidence-based strategies to improve physician wellness and reduce burnout. . Ann. Intern. Med. 166::74344
    [Crossref] [Google Scholar]
  41. 41.
    Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, et al. 2008.. Rates of medication errors among depressed and burnt out residents: prospective cohort study. . BMJ 336::48891
    [Crossref] [Google Scholar]
  42. 42.
    Firth-Cozens J. 2001.. Interventions to improve physicians’ well-being and patient care. . Soc. Sci. Med. 52::21522
    [Crossref] [Google Scholar]
  43. 43.
    Fleming P, Caffrey L, Van Belle S, Barry S, Burke S, et al. 2023.. How international health system austerity responses to the 2008 financial crisis impacted health system and workforce resilience—a realist review. . Int. J. Health Policy Manag. 12::7420
    [Google Scholar]
  44. 44.
    Furukawa MF, Machta RM, Barrett KA, Jones DJ, Shortell SM, et al. 2020.. Landscape of health systems in the United States. . Med. Care Res. Rev. 77::35766
    [Crossref] [Google Scholar]
  45. 45.
    Gaffney A, Woolhandler S, Himmelstein DU. 2023.. Century-long trends in the financing and ownership of American health care. . Milbank Q. 101::32548
    [Crossref] [Google Scholar]
  46. 46.
    Garcia LC, Shanafelt TD, West CP, Sinsky CA, Trockel MT, et al. 2020.. Burnout, depression, career satisfaction, and work-life integration by physician race/ethnicity. . JAMA Netw. Open 3::e2012762
    [Crossref] [Google Scholar]
  47. 47.
    Garman AN, Corrigan PW, Morris S. 2002.. Staff burnout and patient satisfaction: evidence of relationships at the care unit level. . J. Occup. Health Psychol. 7::23541
    [Crossref] [Google Scholar]
  48. 48.
    Ge M-W, Hu F-H, Jia Y-J, Tang W, Zhang W-Q, et al. 2023.. COVID-19 pandemic increases the occurrence of nursing burnout syndrome: an interrupted time-series analysis of preliminary data from 38 countries. . Nurse Educ. Pract. 69::103643
    [Crossref] [Google Scholar]
  49. 49.
    Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. 2005.. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. . Arch. Intern. Med. 165::26016
    [Crossref] [Google Scholar]
  50. 50.
    Goodair B, Reeves A. 2024.. The effect of health-care privatisation on the quality of care. . Lancet Public Health 9::e199206
    [Crossref] [Google Scholar]
  51. 51.
    Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. 2005.. Burnout and internal medicine resident work-hour restrictions. . Arch. Intern. Med. 165::2595600
    [Crossref] [Google Scholar]
  52. 52.
    Grol R, Mokkink H, Smits A, van Eijk J, Beek M, et al. 1985.. Work satisfaction of general practitioners and the quality of patient care. . Fam. Pract. 2::12835
    [Crossref] [Google Scholar]
  53. 53.
    Grumbach K, Knox M, Huang B, Hammer H, Kivlahan C, Willard-Grace R. 2019.. A longitudinal study of trends in burnout during primary care transformation. . Ann. Fam. Med. 17::S916
    [Crossref] [Google Scholar]
  54. 54.
    Guille C, Frank E, Zhao Z, Kalmbach DA, Nietert PJ, et al. 2017.. Work-family conflict and the sex difference in depression among training physicians. . JAMA Intern. Med. 177::176672
    [Crossref] [Google Scholar]
  55. 55.
    Halbesleben JRB, Rathert C. 2008.. Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. . Health Care Manag. Rev. 33::2939
    [Crossref] [Google Scholar]
  56. 56.
    Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, et al. 2015.. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. . Am. J. Public Health 105::e6076
    [Crossref] [Google Scholar]
  57. 57.
    Hamidi MS, Bohman B, Sandborg C, Smith-Coggins R, De Vries P, et al. 2018.. Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: a case study. . BMC Health Serv. Res. 18::851
    [Crossref] [Google Scholar]
  58. 58.
    Hazen KP, Carlson MW, Hatton-Bowers H, Fessinger MB, Cole-Mossman J, et al. 2020.. Evaluating the facilitating attuned interactions (FAN) approach: vicarious trauma, professional burnout, and reflective practice. . Child. Youth Serv. Rev. 112::104925
    [Crossref] [Google Scholar]
  59. 59.
    Helfrich CD, Simonetti JA, Clinton WL, Wood GB, Taylor L, et al. 2017.. The association of team-specific workload and staffing with odds of burnout among VA primary care team members. . J. Gen. Intern. Med. 32::76066
    [Crossref] [Google Scholar]
  60. 60.
    Hodkinson A, Zhou A, Johnson J, Geraghty K, Riley R, et al. 2022.. Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. . BMJ 378::e070442
    [Crossref] [Google Scholar]
  61. 61.
    Hung DY, Harrison MI, Truong Q, Du X. 2018.. Experiences of primary care physicians and staff following lean workflow redesign. . BMC Health Serv. Res. 18::274
    [Crossref] [Google Scholar]
  62. 62.
    Johnson KB, Neuss MJ, Detmer DE. 2021.. Electronic health records and clinician burnout: a story of three eras. . J. Am. Med. Inf. Assoc. 28::96773
    [Crossref] [Google Scholar]
  63. 63.
    Jun J, Ojemeni MM, Kalamani R, Tong J, Crecelius ML. 2021.. Relationship between nurse burnout, patient and organizational outcomes: systematic review. . Int. J. Nurs. Stud. 119::103933
    [Crossref] [Google Scholar]
  64. 64.
    Kim H, Wiedermann B. 2011.. Have Accreditation Council for Graduate Medical Education duty hour limits made a difference? A re-examination of resident sleep, mental health, education, and safety seven years later. Presented at the American Federation for Medical Research Eastern Regional Meeting , April 26–27 . J. Investig. Med. 59
    [Google Scholar]
  65. 65.
    Klatt M, Westrick A, Bawa R, Gabram O, Blake A, Emerson B. 2022.. Sustained resiliency building and burnout reduction for healthcare professionals via organizational sponsored mindfulness programming. . Explore 18::17986
    [Crossref] [Google Scholar]
  66. 66.
    Knox M, Willard-Grace R, Huang B, Grumbach K. 2018.. Maslach burnout inventory and a self-defined, single-item burnout measure produce different clinician and staff burnout estimates. . J. Gen. Intern. Med. 33::134451
    [Crossref] [Google Scholar]
  67. 67.
    Kushnir T, Greenberg D, Madjar N, Hadari I, Yermiahu Y, Bachner YG. 2014.. Is burnout associated with referral rates among primary care physicians in community clinics?. Fam. Pract. 31::4450
    [Crossref] [Google Scholar]
  68. 68.
    Kushnir T, Kushnir J, Sarel A, Cohen AH. 2011.. Exploring physician perceptions of the impact of emotions on behaviour during interactions with patients. . Fam. Pract. 28::7581
    [Crossref] [Google Scholar]
  69. 69.
    Lafreniere JP, Rios R, Packer H, Ghazarian S, Wright SM, Levine RB. 2016.. Burned out at the bedside: patient perceptions of physician burnout in an internal medicine resident continuity clinic. . J. Gen. Intern. Med. 31::2038
    [Crossref] [Google Scholar]
  70. 70.
    Landrigan CP, Fahrenkopf AM, Lewin D, Sharek PJ, Barger LK, et al. 2008.. Effects of the accreditation council for graduate medical education duty hour limits on sleep, work hours, and safety. . Pediatrics 122::25058
    [Crossref] [Google Scholar]
  71. 71.
    Langelaan S, Bakker AB, van Doornen LJ, Schaufeli WB. 2006.. Burnout and work engagement: Do individual differences make a difference?. Personal. Individ. Differ. 40::52132
    [Crossref] [Google Scholar]
  72. 72.
    Lawrence JA, Davis BA, Corbette T, Hill EV, Williams DR, Reede JY. 2022.. Racial/ethnic differences in burnout: a systematic review. . J. Racial Ethn. Health Disparities 9::25769
    [Crossref] [Google Scholar]
  73. 73.
    Lee M, Cha C. 2023.. Interventions to reduce burnout among clinical nurses: systematic review and meta-analysis. . Sci. Rep. 13::10971
    [Crossref] [Google Scholar]
  74. 74.
    Leiter MP. 1991.. Coping patterns as predictors of burnout: the function of control and escapist coping patterns. . J. Organ. Behav. 12::12344
    [Crossref] [Google Scholar]
  75. 75.
    Leiter MP, Harvie P, Frizzell C. 1998.. The correspondence of patient satisfaction and nurse burnout. . Soc. Sci. Med. 47::161117
    [Crossref] [Google Scholar]
  76. 76.
    Linzer M, Jin JO, Shah P, Stillman M, Brown R, et al. 2022.. Trends in clinician burnout with associated mitigating and aggravating factors during the COVID-19 pandemic. . JAMA Health Forum 3::e224163
    [Crossref] [Google Scholar]
  77. 77.
    Linzer M, Manwell LB, Williams ES, Bobula JA, Brown RL, et al. 2009.. Working conditions in primary care: physician reactions and care quality. . Ann. Intern. Med. 151::2836
    [Crossref] [Google Scholar]
  78. 78.
    Linzer M, Poplau S, Babbott S, Collins T, Guzman-Corrales L, et al. 2016.. Worklife and wellness in academic general internal medicine: results from a national survey. . J. Gen. Intern. Med. 31::100410
    [Crossref] [Google Scholar]
  79. 79.
    Linzer M, Poplau S, Brown R, Grossman E, Varkey A, et al. 2017.. Do work condition interventions affect quality and errors in primary care? Results from the Healthy Work Place Study. . J. Gen. Intern. Med. 32::5661
    [Crossref] [Google Scholar]
  80. 80.
    Linzer M, Poplau S, Grossman E, Varkey A, Yale S, et al. 2015.. A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) study. . J. Gen. Intern. Med. 30::110511
    [Crossref] [Google Scholar]
  81. 81.
    Loerbroks A, Glaser J, Vu-Eickmann P, Angerer P. 2017.. Physician burnout, work engagement and the quality of patient care. . Occup. Med. 67::35662
    [Crossref] [Google Scholar]
  82. 82.
    Maisel N, Thombley R, Overhage JM, Blake K, Sinsky CA, Adler-Milstein J. 2023.. Physician electronic health record use after changes in US Centers for Medicare & Medicaid Services documentation requirements. . JAMA Health Forum 4::e230984
    [Crossref] [Google Scholar]
  83. 83.
    Martin-Kerry J, McLean J, Hopkins T, Morgan A, Dunn L, et al. 2023.. Characterizing asset-based studies in public health: development of a framework. . Health Promot. Int. 38::daad015
    [Crossref] [Google Scholar]
  84. 84.
    Martini S, Arfken CL, Balon R. 2006.. Comparison of burnout among medical residents before and after the implementation of work hours limits. . Acad. Psychiatry 30::35255
    [Crossref] [Google Scholar]
  85. 85.
    Martins AE, Davenport MC, Del Valle MP, Di Lalla S, Domínguez P, et al. 2011.. Impact of a brief intervention on the burnout levels of pediatric residents. . J. Pediatr. 87::49398
    [Crossref] [Google Scholar]
  86. 86.
    Maslach C, Jackson SE, Leiter MP. 1996.. Maslach Burnout Inventory Manual. Palo Alto, CA:: Consult. Psychol. , 3rd ed..
    [Google Scholar]
  87. 87.
    Maslach C, Leiter MP. 2017.. New insights into burnout and health care: strategies for improving civility and alleviating burnout. . Med. Teach. 39::16063
    [Crossref] [Google Scholar]
  88. 88.
    Melville A. 1980.. Job satisfaction in general practice: implications for prescribing. . Soc. Sci. Med. Med. Psychol. Med. Sociol. 14A::49599
    [Google Scholar]
  89. 89.
    Moffatt-Bruce SD, Nguyen MC, Steinberg B, Holliday S, Klatt M. 2019.. Interventions to reduce burnout and improve resilience: impact on a health system's outcomes. . Clin. Obstet. Gynecol. 62::43243
    [Crossref] [Google Scholar]
  90. 90.
    Montori V. 2020.. Why We Revolt: A Patient Revolution for Careful and Kind Care. New York:: Rosetta Books. , 2nd ed..
    [Google Scholar]
  91. 91.
    Mulder L, Garcia E, Sirintrapun SJ, Kundu I, Soles R. 2024.. Examining the role of diversity, equity, and inclusion in mitigating workforce burnout in laboratory medicine. . Am. J. Clin. Pathol. 161::13039
    [Crossref] [Google Scholar]
  92. 92.
    Natl. Acad. Med. 2024.. Action Collaborative on Clinician Well-Being and Resilience. . National Academy of Medicine. https://nam.edu/initiatives/clinician-resilience-and-well-being/
    [Google Scholar]
  93. 93.
    Nigam JAS, Barker RM, Cunningham TR, Swanson NG, Chosewood LC. 2023.. Vital Signs: Health worker–perceived working conditions and symptoms of poor mental health—quality of worklife survey, United States, 2018–2022. . MMWR 72::1197205
    [Google Scholar]
  94. 94.
    Off. US Surg. Gen. 2022.. Addressing health worker burnout: the US Surgeon General's advisory on building a thriving health workforce. Rep. , Off. US Surg. Gen., Washington, DC:. https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf
    [Google Scholar]
  95. 95.
    Panagioti M, Panagopoulou E, Bower P, Lewith G, Kontopantelis E, et al. 2017.. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. . JAMA Intern. Med. 177::195205
    [Crossref] [Google Scholar]
  96. 96.
    Pastores SM, Kvetan V, Coopersmith CM, Farmer JC, Sessler C, et al. 2019.. Workforce, workload, and burnout among intensivists and advanced practice providers: a narrative review. . Crit. Care Med. 47::55057
    [Crossref] [Google Scholar]
  97. 97.
    Profit J, Adair KC, Cui X, Mitchell B, Brandon D, et al. 2021.. Randomized controlled trial of the “WISER” intervention to reduce healthcare worker burnout. . J. Perinatol. 41::222534
    [Crossref] [Google Scholar]
  98. 98.
    Rabatin J, Williams E, Baier Manwell L, Schwartz MD, Brown RL, Linzer M. 2016.. Predictors and outcomes of burnout in primary care physicians. . J. Prim. Care Community Health 7::4143
    [Crossref] [Google Scholar]
  99. 99.
    Rabinowitz S, Kushnir T, Ribak J. 1996.. Preventing burnout: increasing professional self efficacy in primary care nurses in a Balint Group. . Aaohn J. 44::2832
    [Crossref] [Google Scholar]
  100. 100.
    Rathert C, Williams ES, Linhart H. 2018.. Evidence for the quadruple aim: a systematic review of the literature on physician burnout and patient outcomes. . Med. Care 56::97684
    [Crossref] [Google Scholar]
  101. 101.
    Reed K, Cochran KL, Edelblute A, Manzanares D, Sinn H, et al. 2020.. Creative arts therapy as a potential intervention to prevent burnout and build resilience in health care professionals. . AACN Adv. Crit. Care 31::17990
    [Crossref] [Google Scholar]
  102. 102.
    Regehr C, Glancy D, Pitts A, LeBlanc VR. 2014.. Interventions to reduce the consequences of stress in physicians: a review and meta-analysis. . J. Nerv. Ment. Dis. 202::35359
    [Crossref] [Google Scholar]
  103. 103.
    Rehder K, Adair KC, Sexton JB. 2021.. The science of health care worker burnout: Assessing and improving health care worker well-being. . Arch. Pathol. Lab. Med. 145::1095109
    [Crossref] [Google Scholar]
  104. 104.
    Rehder KJ, Adair KC, Hadley A, McKittrick K, Frankel A, et al. 2020.. Associations between a new disruptive behaviors scale and teamwork, patient safety, work-life balance, burnout, and depression. . Jt. Comm. J. Qual. Patient Saf. 46::1826
    [Google Scholar]
  105. 105.
    Reid RJ, Coleman K, Johnson EA, Fishman PA, Hsu C, et al. 2010.. The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. . Health Aff. 29::83543
    [Crossref] [Google Scholar]
  106. 106.
    Reinhart E. 2023.. Doctors aren't burned out from overwork. We're demoralized by our health system. . New York Times, Feb. 5. https://www.nytimes.com/2023/02/05/opinion/doctors-universal-health-care.html
    [Google Scholar]
  107. 107.
    Rittenhouse DR, Mertz E, Keane D, Grumbach K. 2004.. No exit: an evaluation of measures of physician attrition. . Health Serv. Res. 39::157188
    [Crossref] [Google Scholar]
  108. 108.
    Rotenstein L, Wang H, West CP, Dyrbye LN, Trockel M, et al. 2024.. Teamwork climate, safety climate, and physician burnout: a national, cross-sectional study. . Jt. Comm. J. Qual. Patient Saf. 50::45862
    [Google Scholar]
  109. 109.
    Rotenstein LS, Brown R, Sinsky C, Linzer M. 2023.. The association of work overload with burnout and intent to leave the job across the healthcare workforce during COVID-19. . J. Gen. Intern. Med. 38::192027
    [Crossref] [Google Scholar]
  110. 110.
    Rotenstein LS, Cohen DJ, Marino M, Bates DW, Edwards ST. 2023.. Association of clinician practice ownership with ability of primary care practices to improve quality without increasing burnout. . JAMA Health Forum 4::e230299
    [Crossref] [Google Scholar]
  111. 111.
    Rotenstein LS, Fong AS, Jeffery MM, Sinsky CA, Goldstein R, et al. 2022.. Gender differences in time spent on documentation and the electronic health record in a large ambulatory network. . JAMA Netw. Open 5::e223935
    [Crossref] [Google Scholar]
  112. 112.
    Rule A, Shafer CM, Micek MA, Baltus JJ, Sinsky CA, Arndt BG. 2023.. Gender differences in primary care physicians’ electronic health record use over time: an observational study. . J. Gen. Intern. Med. 38::157072
    [Crossref] [Google Scholar]
  113. 113.
    Sabety A. 2023.. The value of relationships in healthcare. . J. Public Econ. 225::104927
    [Crossref] [Google Scholar]
  114. 114.
    Scheffler RM, Alexander L, Fulton BD, Arnold DR, Abdelhadi OA. 2023.. Monetizing medicine: private equity and competition in physician practice markets. Rep. , Am. Antitrust Inst. https://www.antitrustinstitute.org/wp-content/uploads/2023/07/AAI-UCB-EG_Private-Equity-I-Physician-Practice-Report_FINAL.pdf
    [Google Scholar]
  115. 115.
    Schwartz SP, Adair KC, Bae J, Rehder KJ, Shanafelt TD, et al. 2019.. Work-life balance behaviours cluster in work settings and relate to burnout and safety culture: a cross-sectional survey analysis. . BMJ Qual. Saf. 28::14250
    [Crossref] [Google Scholar]
  116. 116.
    Serratt T, Harrington C, Spetz J, Blegen M. 2011.. Staffing changes before and after mandated nurse-to-patient ratios in California's hospitals. . Policy Politics Nurs. Pract. 12::13340
    [Crossref] [Google Scholar]
  117. 117.
    Sexton JB, Adair KC, Leonard MW, Frankel TC, Proulx J, et al. 2018.. Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout. . BMJ Qual. Saf. 27::26170
    [Crossref] [Google Scholar]
  118. 118.
    Shanafelt T, Goh J, Sinsky C. 2017.. The business case for investing in physician well-being. . JAMA Intern. Med. 177::182632
    [Crossref] [Google Scholar]
  119. 119.
    Shanafelt TD, Bradley KA, Wipf JE, Back AL. 2002.. Burnout and self-reported patient care in an internal medicine residency program. . Ann. Intern. Med. 136::35867
    [Crossref] [Google Scholar]
  120. 120.
    Shanafelt TD, Mungo M, Schmitgen J, Storz KA, Reeves D, et al. 2016.. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. . Mayo Clin. Proc. 91::42231
    [Crossref] [Google Scholar]
  121. 121.
    Shanafelt TD, West CP, Dyrbye LN, Trockel M, Tutty M, et al. 2022.. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. . Mayo Clin. Proc. 12::224858
    [Crossref] [Google Scholar]
  122. 122.
    Sharma N, Chakrabarti S, Grover S. 2016.. Gender differences in caregiving among family-caregivers of people with mental illnesses. . World J. Psychiatry 6::717
    [Crossref] [Google Scholar]
  123. 123.
    Skerrett P. 2022.. Burnout at the bedside is causing a crisis in nursing. . STAT First Opin. Podcast, Jan. 26. https://www.statnews.com/2022/01/26/nurse-burnout-continues-pandemic/
    [Google Scholar]
  124. 124.
    Spataro BM, Tilstra SA, Rubio DM, McNeil MA. 2016.. The toxicity of self-blame: sex differences in burnout and coping in internal medicine trainees. . J. Women's Health 25::114752
    [Crossref] [Google Scholar]
  125. 125.
    Stewart MT, Reed S, Reese J, Galligan MM, Mahan JD. 2019.. Conceptual models for understanding physician burnout, professional fulfillment, and well-being. . Curr. Probl. Pediatr. Adolesc. Health Care 49::100658
    [Google Scholar]
  126. 126.
    Tai-Seale M, Dillon EC, Yang Y, Nordgren R, Steinberg RL, et al. 2019.. Physicians’ well-being linked to in-basket messages generated by algorithms in electronic health records. . Health Aff. 38::107378
    [Crossref] [Google Scholar]
  127. 127.
    Talbot SG, Dean W. 2018.. Physicians aren't ‘burning out.’ They're suffering from moral injury. . STAT, July 26. https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/
    [Google Scholar]
  128. 128.
    Tawfik DS, Scheid A, Profit J, Shanafelt T, Trockel M, et al. 2019.. Evidence relating health care provider burnout and quality of care: a systematic review and meta-analysis. . Ann. Intern. Med. 171::55567
    [Crossref] [Google Scholar]
  129. 129.
    Thomas Craig KJ, Willis VC, Gruen D, Rhee K, Jackson GP. 2021.. The burden of the digital environment: a systematic review on organization-directed workplace interventions to mitigate physician burnout. . J. Am. Med. Inf. Assoc. 28::98597
    [Crossref] [Google Scholar]
  130. 130.
    Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D. 2004.. Nurse burnout and patient satisfaction. . Med. Care 42::II5766
    [Crossref] [Google Scholar]
  131. 131.
    Venegas CL, Nkangu MN, Duffy MC, Fergusson DA, Spilg EG. 2019.. Interventions to improve resilience in physicians who have completed training: a systematic review. . PLOS ONE 14::e0210512
    [Crossref] [Google Scholar]
  132. 132.
    Waldman JD, Kelly F, Aurora S, Smith HL. 2004.. The shocking cost of turnover in health care. . Health Care Manag. Rev. 29::27
    [Crossref] [Google Scholar]
  133. 133.
    Weisman CS, Nathanson CA. 1985.. Professional satisfaction and client outcomes. A comparative organizational analysis. . Med. Care 23::117992
    [Crossref] [Google Scholar]
  134. 134.
    Welp A, Meier LL, Manser T. 2015.. Emotional exhaustion and workload predict clinician-rated and objective patient safety. . Front. Psychol. 5::111843
    [Crossref] [Google Scholar]
  135. 135.
    West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. 2016.. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. . Lancet 388::227281
    [Crossref] [Google Scholar]
  136. 136.
    West CP, Dyrbye LN, Satele DV, Shanafelt TD. 2021.. Colleagues Meeting to Promote and Sustain Satisfaction (COMPASS) groups for physician well-being: a randomized clinical trial. . Mayo Clin. Proc. 96::260614
    [Crossref] [Google Scholar]
  137. 137.
    West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. 2009.. Association of resident fatigue and distress with perceived medical errors. . JAMA 302::1294300
    [Crossref] [Google Scholar]
  138. 138.
    WHO (World Health Organ.) Eur. Reg. 2023.. Bucharest Declaration on the health and care workforce: high-level regional meeting on health and care workforce in Europe: time to act, 22–23 March 2023, Bucharest, Rom. Rep. , WHO, Copenhagen:. https://iris.who.int/bitstream/handle/10665/366519/Bucharest-decl-2023-eng.pdf
    [Google Scholar]
  139. 139.
    Willard-Grace R, Hessler D, Rogers E, Dubé K, Bodenheimer T, Grumbach K. 2014.. Team structure and culture are associated with lower burnout in primary care. . J. Am. Board Fam. Med. 27::22938
    [Crossref] [Google Scholar]
  140. 140.
    Willard-Grace R, Knox M, Huang B, Hammer H, Kivlahan C, Grumbach K. 2019.. Burnout and health care workforce turnover. . Ann. Fam. Med. 17::3641
    [Crossref] [Google Scholar]
  141. 141.
    Willard-Grace R, Knox M, Huang B, Hammer H, Kivlahan C, Grumbach K. 2021.. Primary care clinician burnout and engagement association with clinical quality and patient experience. . J. Am. Board Fam. Med. 34::54252
    [Crossref] [Google Scholar]
  142. 142.
    Williams ES, Rathert C, Buttigieg SC. 2020.. The personal and professional consequences of physician burnout: a systematic review of the literature. . Med. Care Res. Rev. 77::37186
    [Crossref] [Google Scholar]
  143. 143.
    Williams ES, Skinner AC. 2003.. Outcomes of physician job satisfaction: a narrative review, implications, and directions for future research. . Health Care Manag. Rev. 28::11939
    [Crossref] [Google Scholar]
  144. 144.
    Yan Q, Jiang Z, Harbin Z, Tolbert PH, Davies MG. 2021.. Exploring the relationship between electronic health records and provider burnout: a systematic review. . J. Am. Med. Inf. Assoc. 28::100921
    [Crossref] [Google Scholar]
  145. 145.
    Yeun Y-R, Han J-W. 2016.. Effect of nurses’ organizational culture, workplace bullying and work burnout on turnover intention. . Int. J. Bio-Sci. Bio-Technol. 8::37280
    [Crossref] [Google Scholar]
/content/journals/10.1146/annurev-publhealth-071823-122832
Loading
/content/journals/10.1146/annurev-publhealth-071823-122832
Loading

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error