Burnout (psychology)

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Burnout is a concept in industrial and organizational psychology for "an excessive stress reaction to one's occupational or professional environment. It is manifested by feelings of emotional and physical exhaustion coupled with a sense of frustration and failure".[1] Burnout has three dimensions[2]:

  • Emotional exhaustion
  • Depersonalization (cynicism)
  • Diminished personal accomplishment (inefficacy)

Subsequent research suggests the third dimension, personal accomplishment, better fits with the concept of professional engagement rather than with burnout.[3]

Workaholism more closely correlates with burnout than with engagement, although workaholism correlated with both (weakly negatively with engagement [via absorption])[4].

Engagement may not simply be the opposite of burnout. Engagement and burnout may be related more specifically[5]:

  • Emotional exhaustion may be the opposite of vigor
  • Cynicism may be the opposite of dedication

The distinction between burnout and depression is not clear[6].


The prevalence of burnout in the general, employed population of the United States, aged is (measured by MBI except where noted)[7][8][9]:

  • General, employed U.S. population
    • (2010): aged 31-47 30%[7], aged 29-65 29%[8]
    • (2014): aged 31-65 28%[9]
    • (2017): aged 29-65 28%[10]
    • (2021): during COVID epidemic in Japan: 31% (measured by Mini-Z)[11]
  • College graduates 2010: aged 31-47 36%[7]

Health care workers

As of 2017, 44% of physicians have have burnout[10] Previously, in 2014, as many as 50% of physicians in practice may have burnout.[9] General practitioners seem to have low job control and the highest proportion of burnout cases[12].

For physicians in training, rates of burnout (emotional exhaustion) for students, residents and fellows is about 50% while the rate is 36% in similarly aged college graduates.[7]


Burnout is due to loss of control at work, and also "burnout is mainly predicted by job demands but also by lack of job resources"[13].

Curiously, a study of physicians found, "High levels of personal accomplishment increased stress levels (beta=0 080), whereas depersonalisation lowered stress levels (beta=-0 105)"[14]

Different underlying factors may lead to varying phenotypes of burnout[15][16] One study found[15]:

  • Burnout (high on all three dimensions)
  • Engagement (low on all three)
  • Overextended (high on exhaustion only)
  • Disengaged (high on cynicism only). Also called depersonalization by Leiter[15] which may be the same as mental distance used by the World Health Organization[17].
  • Ineffective (high on inefficacy only)

Regarding the possible connection of burnout with autonomy, burnout is more common in[18]:

  • chaotic practices[18]
  • larger practices[18]
  • accountable care organizations[18]

Burnout in physicians in training is associated with perceived harassment[19]. In one survey of 24 American medical schools, harassment occurring at least one time was reported by 83% of students[19]. In this study, harassment was more commonly reported being perpetrated by residents[19]. The rates of burnout among students responding to the survey were[19]:

  • All students 34%
  • Those reporting recurrent harassment by faculty 57%
  • Those not reporting recurrent harassment by faculty 32%

Job demands-resources model of burnout

Several items, specifically workload, are reflected in the job demands-resources model of burnout[20].

These findings are reflected in the Demand-Control theory of job stress. [21]

Areas of Worklife Survey (AWS)

Leiter and Maslach found the following antecedents from the Areas of Worklife Survey (AWS) using factor analysis:[22]

  • Workload
  • Fairness
  • Control
  • Community
  • Values
  • Rewards

Of these causes, workload is the strongest correlate of emotional exhaustion[22] but loss of control may be the initial factor. Perceived control or autonomy and fairness correlate with cynicism.[22][23]

  • 16% of burnout is attributed to perceived control at the worksite.[24]

Leiter et al found that workload relates more to exhaustion while values incongruency relates more to cynicism[25].

Leadership quality

Leadership affects both burnout and work fulfillment. A study at the Mayo Clinic found that the "average leadership behaviour score of physicians’ work unit supervisor explained 11% of the variation in burnout and 47% of the variation in workplace satisfaction"[26].

In a second study across 11 healthcare organizations, the rates of burnout by tercile of leadership ratings of effectiveness by their direct reports[27]:

  • 18%
  • 35%
  • 47%

According to the yearly survey of recent medical school graduates by the Association of American Medical Colleges, the following are reported [28]:

  • Occasional public embarrassment 20%
  • Occasional public humiliation 8%

Burnout is now being studied in its reported antitheses, job satisfaction, job engagement and thriving. Thriving may protect against burnout[29][30]. Engagement is both negatively associated with burnout, but also unhealthy engagement may lead to burnout.[31]


Several burnout inventories are available including the Maslach, Copenhagen, and Oldenburg[32][33].

Maslach Burnout Inventory

The Maslach Burnout Inventory is a well-studied measurement of burnout that was first published in 1981. Maslach and her colleague Jackson first identified the construct "burnout" in the 1970s, and developed a measure that weighs the effects of on three scales[2]:

  • Emotional exhaustion (nine items)
  • Depersonalization (five items)
  • Personal accomplishment (eight items)

The Maslach Burnout Inventory (MBI) has several versions:

  • Human Services Survey (MBI-HSS) is 22-tems and for jobs such as 'clergy, police, therapists, social workers, medical'[34]
    • MBI-HSS without the Personal Accomplishment subscale is 14 items.
  • General Survey (MBI-GS) a 16-items for more general, non-social jobs as well[35]
    • MBI-GS without the Professional Efficacy subscale is 10 items.

Eckleberry-Hunt in 2017 raised the question that burnout is being over-reported by deeming burnout present if either emotional exhaustion or depersonalization are present.[36]

2-item Maslach Burnout Inventory

In this survey, abnormal is defined as symptoms weekly or more on either item.[37][38][39]

1. I feel burned out from my work[39] or How often do you feel burned out from your work?[38]

  • Never
  • A few times a year or less
  • Once a month
  • A few times a month
  • Once a week
  • A few times a week
  • Every day

This item correlates with emotional exhaustion subscale of the Maslach Burnout Inventory (minus the single item being tested)[37]:

  • 0.76 to 0.83 across the four samples[37]

2. I have become more callous toward people since I took this job[39] or How often do you feel you’ve become more callous toward people since you started your residency?[38]

  • Never
  • A few times a year or less
  • Once a month
  • A few times a month
  • Once a week
  • A few times a week
  • Every day

This item correlates with depersonalization subscale of the Maslach Burnout Inventory (minus the single item being tested)[37]:

  • 0.61 to 0.72 across the four samples[37]

The two-item score correlates with the overall MBI with a correlation of 0.65[40] which is under the threshold recommended for group crrelations[41]

The two-item format has been used in national surveys in 2011[8] and its follow-up survey in 2014[9].

Mini Z

The 10‑item Zero Burnout Program survey, or called the Mini Z[42], was adapted from the earlier Northwest Permanente (NWP) and Ohio Permanente Medical Group (OPMG) by Freeborn[43] and Schmoldt[44]. The SIBOQ was then used by the Physician Worklife Survey[45]. The SIBOQ was first validated against the MBI by Rohland in 2004[46]. The SIBOQ was later used by the Minimizing Error, Maximizing Outcomes (MEMO)[47] studies used the self-definition format.

The Mini Z is a single item (burnout is defined as answers c, d, or e) that correlates with the emotional exhaustion scale of the Maslach[46]:

  • The Northwest Permanente (NWP) and Ohio Permanente Medical Group (OPMG) by Schmoldt, Freeborn and Klevit[43][44] stated[44] that the NWP also used the self-diagnosis item of Veninga that started in 1991 used the format:
    • The tedium index of Pines[48]
    • The self-diagnosis of burnout item of Veninga[49]


1. Using your own definition of “burnout,” please circle one of the answers below: a. I enjoy my work. I have no symptoms of burnout. b. I am under stress, and don’t always have as much energy as I did, but I don’t feel burned out. c. I am definitely burning out and have one or more symptoms of burnout, e.g., emotional exhaustion. d. The symptoms of burnout that I am experiencing won’t go away. I think about work frustrations a lot. e. I feel completely burned out. I am at the point where I may need to seek help.

2. The Mini-Z also contains the relevant dimensions:

  • Workload
    • My control over my workload is...
    • Sufficiency of time for documentation is...
    • The amount of time I spend on the electronic health record (EHR) at home is...
  • Cynicism:
    • My professional values are well aligned with those of my department leaders...

The Mini Z is promoted by the American Medical Association's Steps Forward campaign.[50]

The Mini Z may report lower prevalence of burnout than when measured by the full Maslach Burnout Inventory (MBI).[51]

Burnout Assessment Tool

A newer survey is the Burnout Assessment Tool (BAT)[52] developed by Schaufeli and others[53]. The BAT has four subscales:

  • Exhaustion
  • Mental distance
  • Emotional impairment
  • Cognitive impairment

The BAT versions are:

  • Full version with 23 items
  • Short version with 12 items[54]

Copenhagen Burnout Inventory

The Copenhagen Burnout Inventory has 19 items and was developed in 2005.[55]

Oldenburg Burnout Inventory

The Oldenburg Burnout Inventory has 16 items and was developed by Demerouti and others and has two scales[56][57]:

  • Disengagement scale. The highest loading item is "I find my work to be a positive challenge" and the second highest loading item is "I always find new and interesting aspects in my work"[58].
  • Exhaustion scale. The highest loading item is "After my work, I usually feel worn out and weary"[58].

Professional Fulfillment Index (PFI) (Stanford)

The PFI contains relevant dimensions including interpersonal disengagement[59]:

  • "Less empathetic with my patients"
  • "Less empathetic with my colleagues"

Physician Well-Being Index (PWBI)

The PWBI contains 7 items, one of which queries burnout in a yes/no response format. Its development[60] and application[61] have been reported.

Scales include disengagement:

  • "Have you worried that your work is hardening you emotionally?"

Professional Quality of Life (ProQOL)

The ProQOL has 30 items over three scales[62]:

  • Compassion satisfaction (CS)
  • Burnout (BO)
  • Compassion fatigue (CF)

The ProQOL does not include depersonalization.

The ProQO moderately correlates with the single-item burnout question from the Mini-Z[63].

The ProQOL is available at https://proqol.org/.


Thriving[29][30] and engagement[64][3] are negatively correlated with, and thus may be protective, against burnout. However, unhealthy engagement may lead to burnout.[31]

Perceived control or autonomy and fairness correlate with cynicism.[22][23]

Successful teamwork may be important[65][66].


Burnout is associated with many clinical outcomes and personnel outcomes, but the relationships have much statistical heterogeneity[67].

Burnout may be associated with operating margins[68].


Institutional and individual strategies to reduce burnout have been reviewed[69].

Physicians may not be aware that they are burned out and providing awareness may increase engagement with addressing burnout[70].

Meditation and Dhyana

Trauma-informed yoga may help[71].

Transcendental Meditation may help[72].

Art therapy

Randomized controlled trials of art therapy yield mixed and heterogeneous results[73][74].

See also


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