Burnout is reaching epidemic proportions. Although it’s important to identify burnout and understand the causes, we have to stop blaming doctors for becoming burned out and recognize it as a systems issue. There is a growing trend among health systems and other employers of physicians to adopt both individual and system-level interventions and develop a model of shared responsibility.


KEY WORDS: burnout, physicians, systems approach, scope, drivers, consequences, prevention, joy


Burnout appears to have become a mass phenomenon, receiving a high degree of media attention. This is probably for a good reason — we are measuring burnout in physician populations more now and finding concerning results. Some studies report that close to one in two physicians is suffering from burnout.1 Burnout is an epidemic hiding in plain sight! We need to understand it better, so that we can best decide how to address and manage it effectively.


What is burnout?

Burnout is a psychological term that refers to long-term exhaustion and diminished interest in work. The term was first coined in the 1970s by the American psychologist, Herbert Freudenberger, who used it to describe the consequences of severe stress and high ideals experienced by people working in “helping” professions.2

Burnout is a state of chronic stress, characterized by a triad of symptoms of mental exhaustion and physical fatigue, detachment from work, and feelings of diminished competence. The Maslach burnout inventory (MBI) has been recognized for more than a decade as the leading measure of burnout, incorporating the extensive research that has been conducted in the more than 25 years since its initial publication.3 MBI surveys use three general scales to assess the main symptoms:


  • Emotional exhaustion scale — measures feelings of emotional overextension and exhaustion from one’s work
  • Depersonalization scale — measures an unfeeling and impersonal response toward recipients of one’s service, care, treatment, or instruction
  • Personal accomplishment scale — measures feelings of competence and achievement in one’s work


What is the scope of the problem?

In 2006, two surveys4 were conducted in Canada to examine the prevalence and severity of burnout in physicians. In the first, Alberta physicians responded to a series of demographic questions and four burnout measures, including a modified MBI. In the second survey, Canadian physicians completed the Boudreau burnout questionnaire as part of the Canadian Medical Association Physician Resource Questionnaire. Overall, 45.7% of Canadian physicians and 48.6–55.5% of Alberta physicians were classified as being in the advanced phases of burnout.


In 2008, a survey of Canadian physicians showed lower rates of burnout, but confirmed that in addition to workload, value congruence also contributed to predicting burnout among physicians.5


The 2017 CMA survey results are pending. In May 2017, Doctors Nova Scotia partnered with Michael Leiter and the Centre for Organizational Research and Development at Acadia University to conduct a survey studying the work–life issues facing Nova Scotia’s physicians and found burnout to be a serious problem.6


In the United States, a 2011 Medscape report revealed burnout in 45.5% of physicians. In 2014, it was present in 54.5% of physicians.7 Top









Looking at physician satisfaction and burnout at different career stages, Drybye8 found that early-career physicians (0–10 years out of residency) had the lowest satisfaction with career choice and highest frequency of at-home conflicts. Mid-career physicians (11–20 years out of residency) worked more hours, took more overnight call, had the lowest level of satisfaction with specialty choice, and the highest rate of burnout.


An examination of the burnout literature reveals that it is prevalent in medical students (28%–45%) and residents (27%–75%, depending on specialty), as well as practising physicians.9 A 2017 Canadian Federation of Medical Students survey sent to medical students across the country showed that around 37% met the criteria for burnout.10


The highest rate of burnout has been reported among the “frontline” specialties: family medicine, general internal medicine, and emergency medicine.1,11


What are the drivers of burnout?

The causes of burnout can be intrinsic, extrinsic, and related to the culture of medicine.


  • Intrinsic drivers include the typical personality traits of physicians, which reveal us to be perfectionistic, responsible, conscientious professionals who have high expectations of ourselves.
  • Extrinsic factors are related to the practice of medicine, such as long hours, frequent call, and frustration with administrative burden; feeling undervalued; frustrations with referral networks; difficult patients; medicolegal issues; and challenges in finding work–life balance. There is often a marked sense of lack of control.12 One study showed that the highest burnout rate was associated with spending less than 20% of one’s time doing the aspect of work that was most enjoyed.13
  • Finally, the culture of medicine reinforces highly perfectionistic and responsible behaviour as ideal. It strives for perfection and encourages self-denial. The patient must come first, and the physician must be strong and invincible and never show weakness.


The American Medical Association has defined seven drivers of burnout: workload and job demands, efficiency and resources, meaning in work, culture and values, control and flexibility, social support and community at work, and work–life integration.14


What are the consequences of burnout?

Although burnout is not a psychiatric diagnosis, it can lead to serious consequences, with impacts on the physician, patients, and the system.


The physician

  • Although appearing similar to depression, burnout differs in that it primarily impacts a person’s relation to their work. However, some of these effects can affect one’s personal life too.
  • Physicians can develop serious chronic physical problems, problems with relationships, and psychiatric problems including anxiety, depression, and substance abuse, which can lead to suicide.


The patient

  • In terms of level of care, burnout can lead to increased rates of medical errors, riskier prescribing patterns, and lesser patient adherence to chronic disease management plans.15,16
  • In terms of level of caring, it can negatively affect communication, reduce empathy, and lead to lower patient satisfaction. Top


The system

  • Dissatisfaction makes physicians more likely to leave clinical practice or retire early.
  • Physicians’ ability or interest in leading changes in practice or the health care system may decline. This is of concern, as we need to increase physicians’ interest and competencies in leadership roles.


How can we prevent burnout?

Historically, most programs to address burnout have focused on treatment of individual physicians, offering stress management, resiliency training, mindfulness meditation training, and encouraging doctors to take care of their own health and have their own family doctor.17 Studies have found that self-awareness and mindfulness training can reduce physician burnout and increase both physician well-being and patient-centred qualities. Training physicians to enhance their personal resilience using the 5Cs framework (control/confidence, commitment, connections, calming, care for self) has been successful.18 This is important as it helps physicians maintain a sense of control.


However, the results have been limited, as physicians may become healthier but still have to return to work in an unhealthy medical workplace. We have to stop blaming doctors for becoming burned out and recognize it as a systems issue.


There is a growing trend among health systems and other employers of physicians to adopt both individual and system-level interventions and develop a model of shared responsibility.19 In such a model, we would need to create processes to:


  • Trust physicians again. Eliminate intrusive regulations and metrics without clear value.
  • Develop practice models that preserve the decision-making autonomy of physicians.
  • Adopt realistic work expectations.
  • Allow physician autonomy, the ability to influence work environment and schedule control.
  • Provide adequate support services: nursing, secretarial, administrative, social work, ancillary services.
  • Let doctors do the doctoring. Identify, reduce, and delegate clerical work to others, e.g., use of medical scribes.
  • Create a collegial work environment, healthy relationships, and common goals.
  • Be value oriented; include medical profession core values as part of the mission.
  • Minimize work–home interference by providing flexibility in child care and scheduling.
  • Promote work–life balance, ensuring vacation time, limiting overtime, establishing mentoring, considering periodic sabbaticals.
  • Measure, track, and benchmark physician satisfaction and well-being as a key institutional success metric. What gets measured gets done.
  • Coordinate with medical schools, regulatory bodies, physician health programs, health care organizations, insurers, and government to create a healthy medical culture. Top


From burnout to joy

In 2000, Myers conducted a review of 115 years of medical literature and illustrated a clear dichotomy with regard to publications focused on “physician distress” versus “physician wellness.” There were 70 000 articles on depression and 57 000 on anxiety; but only 5700 focused on life satisfaction, 2958 on happiness, and 851 on joy. What if we focused on creating more of the positive?


The Institute for Healthcare Improvement recently published a white paper on improving joy in the workplace for all health care professionals.20 They suggest that instead of framing the challenge as “reducing burnout,” we should focus on “enhancing joy.” “Joy, not burnout, ought to rule the day.” I couldn’t agree more.



1.Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172(18):1377-85. DOI: 10.1001/archinternmed.2012.3199

2.Freudenberger HJ, Richelson G. Burnout: the high cost of high achievement. Toronto: Anchor; 1980.

3.Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory (3rd ed.). Palo Alto, Calif.: Consulting Psychologists Press; 1996.

4.Boudreau RA, Grieco RL, Cahoon SL, Robertson RC, Wedel RJ. The pandemic from within: two surveys of physician burnout in Canada. Can J Community Mental Health 2006;25:71-88. https://doi.org/10.7870/cjcmh-2006-0014

5.Leiter M, Frank E, Matheson TJ. Demands, values, and burnout: relevance for physicians. Can Fam Physician 2009;55(12):1224-5. Available:


6.Leiter MP. Survey report. Halifax: Doctors Nova Scotia; 2017. Available: https://tinyurl.com/yd6hvxxk

7.Health, wealth, weed, burnout: physician lifestyle report 2015. New York: Medscape; 2015.

8.Dyrbye LN, Varkey P, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician satisfaction and burnout at different career stages. Mayo Clin Proc 88(12):1358-67. doi: 10.1016/j.mayocp.2013.07.016

9.Waguih WI, Lederer S, Mandili C, Nikravesh R, Seligman L, Vasa M, et al. J Burnout during residency training: a literature review. J Grad Med Educ 2009;1(2):236-42. doi: 10.4300/JGME-D-09-00054.1

10.Glauser W. Medical schools addressing student anxiety, burnout and depression. CMAJ 2017;189(50):E1569-70. DOI:

https://doi.org/10.1503/cmaj.109-5516. Available:  https://tinyurl.com/ya79dbdo

11.Peckham C. Physician burnout: it just keeps getting worse. New York: Medscape; 2015. Available: https://tinyurl.com/ya6onpr4

12.Koven S. Is burnout a real problem? Boston Globe 2014;26 May.

13.Shanafelt TD, West CP, Sloan JA, Novotny PJ, Poland GA, Menaker R, et al. Career fit and burnout among academic faculty. Arch Intern Med 2009;169(10):990-5. doi: 10.1001/archinternmed.2009.70

14.Shanafelt TD, Noseworthy JH. Drivers of burnout and engagement in physicians. In Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2017;92(1):129-46. Available:  https://tinyurl.com/y9rj9tec

15.Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136(5):358-67.

16.Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg 2010;251(6):995-1000. doi: 10.1097/SLA.0b013e3181bfdab3

17.Gautam M. Irondoc: practical stress management tools for physicians (2nd ed). Ottawa: Book Coach Press; 2011.

18.Gautam M. The 5 Cs of physician resilience. Can J Physician Leadersh 2015;1(3):24-7.

19.Shanafelt T, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2017;92(1):129-46.

20.Perlo J, Balik B, Swensen S, Kabcenell A, Lansman J, Feeley D. IHI framework for improving joy in work. White paper. Cambridge, Mass.: Institute for Healthcare Improvement; 2017. Available: https://tinyurl.com/yaf7zm87



Mamta Gautam, MD, MBA, FRCPC, CPDC, CCPE — a psychiatrist with over 25 years of experience treating physicians and physician leaders — is also a coach, author, and president of Peak MD, Ottawa, Ontario.


Correspondence to: mgautam@rogers.com


This article has been peer reviewed.


Join Dr. Gautam at her workshop for seasoned physician leaders, Sustaining Joy as Experienced Leaders, at the 2018 Canadian Conference on Physician Leadership, April 20–21, 2018, in Vancouver. Learn to identify and address the challenges faced by experienced leaders and then focus on the joy in medicine, recall our passion, and inspire other physicians to take on leadership roles. Top


What is burnout?

However, the results have been limited, as physicians may become healthier but still have to return to work in an unhealthy medical workplace. We have to stop blaming doctors for becoming burned out and recognize it as a systems issue.

From burnout to joy