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  • What is the primary cause of reduced physician wellness?

  • How prevalent is burnout among physicians, particularly among those working in inpatient settings?

  • What can be done to mitigate the effects of burnout?

  • How can shift work disorder (SWD) and the resulting sleep disturbances affect burnout?

  • What are strategies to alleviate SWD?

Physician burnout is an increasingly common condition with far-reaching consequences. Burnout is a syndrome related to chronic workplace stressors, and it is characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. In 1981, Christina Maslach, a psychologist based at the University of California Berkeley, created and standardized the Maslach Burnout Inventory (MBI) to quantify the syndrome. A four-item questionnaire, it assesses the severity and frequency of these three symptoms as well as an optional fourth factor assessing involvement.1

Emotional exhaustion (EE) refers to the feeling of being drained or fatigued and loss of enthusiasm for one's work.2 EE is the primary quality and the clearest symptom of burnout,3 and a necessary, but not sufficient, criterion for burnout diagnosis.3 The second symptom is depersonalization (DP), which is characterized by cynicism and lack of interest in and empathy for patients. The third is a low sense of personal accomplishment (PA) that manifests as the feeling of ineffectiveness and the sense that one's work loses its meaningfulness.3

Burnout is the primary reason for diminishing physician wellness. Wellness is a state of being that includes the interdependent aspects of absence of physical illness, good mental health, and positive social relationships. Wellness allows for prosperity in both professional and personal domains as well as a sense of professional fulfillment. The latter is key to physician wellness and consists of the basic elements of job satisfaction, self-esteem, feeling effective at work, and overall happiness.46

Of the many professional roles that physicians assume, patient care and the easing of misery appear to be the most fundamental and satisfying one. Other rewarding aspects of being a physician include scholarly activities (research, teaching, writing, etc) and individual interactions with coworkers and patients.2,7 A physician, therefore, can feel fulfilled through a number of avenues including educational pursuits, productivity, and innovative personal advancement.2

In this chapter, we will discuss the prevalence of burnout, its consequences and potential causes, and methods to prevent it and enhance physician wellness.


Burnout affects physicians at all levels of their education and career. In a large cohort study (n = 4287), 49.6% [95% confidence interval (CI), 47.5%–51.8%] of students from seven medical schools reported experiencing burnout. Suicidal ideation (SI) within the previous year was reported by 11.2% (CI, 9.9%–12.6%) of the surveyed cohort.8 With intervention, burnout improved in 26% of responders. Improvement in burnout was associated with significant reduction in SI.8


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