Top

Published in:

01-08-2019 | Burnout Syndrome

Physicians’ Perspectives About Burnout: a Systematic Review and Metasynthesis

Authors: Jordan Sibeoni, MD, PhD, Laura Bellon-Champel, PhD, Antoine Mousty, Msc, Emilie Manolios, Msc, Laurence Verneuil, MD, PhD, Anne Revah-Levy, MD, PhD

Published in: Journal of General Internal Medicine | Issue 8/2019

Abstract

Background

Doctors’ burnout is a major public health issue with important harmful effects on both the healthcare system and physicians’ mental health. Qualitative studies are relevant in this context, focusing as they do on the views of the physicians of how they live and understand burnout in their own professional field.

Objective

To explore physicians’ perspectives on burnout by applying a metasynthesis approach, including a systematic literature review and analysis of the qualitative studies.

Data Sources

Medline, PsycINFO, EMBASE, and SSCI from the earliest available date to June 2018

Review Methods

This metasynthesis follows thematic synthesis procedures. Four databases were systematically searched for qualitative studies reporting doctors’ perspectives on burnout. Article quality was assessed with the Critical Appraisal Skills Program. Thematic analysis was used to identify key themes and synthesize them.

Results

Thirty-three articles were included, covering data from more than 1589 medical doctors (68 residents and 1521 physicians). Two themes emerged from the analysis: (1) stress factors promoting burnout—ranked as organizational, then contextual and relational, and finally individual—factors and (2) protective factors, which were above all individual but also relational and organizational.

Conclusions

The individual and organizational levels are abundantly described in the literature, as risk factors and interventions. Our results show that doctors identify numerous organizational factors as originators of potential burnout, but envision protecting themselves individually. Relational factors, in a mediate position, should be addressed as an original axis of protection and intervention for battling doctors’ burnout.

Available only for authorised users

Maslach C, Leiter MP. The truth about burnout: How organizations cause personal stress and what to do about it. San Francisco, CA, US :Josey Bass ;1997, 200 p.

West CP, Shanafelt TD, Kolars JC. Quality of life, burnout,educational debt, and medical knowledge among internal medicine residents. JAMA. 2011;306(9):952–960. doi: https://doi.org/10.1001/jama.2011.1247 CrossRefPubMed

Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in Burnout and Satisfaction with Work-Life Balance in Physicians and the General US Working Population between 2011 and 2014. Mayo Clinic Proc. 2015;90(12):1600–1613. doi:https://doi.org/10.1016/j.mayocp.2015.08.023 CrossRef

Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: Prospective cohort study. BMJ. 2008;336:488–491. doi:https://doi.org/10.1136/bmj.39469.763218.BE CrossRefPubMedPubMedCentral

West CP, Dyrbye LN, Sloan JA, et al. Single Item Measures of Emotional Exhaustion and Depersonalization Are Useful for Assessing Burnout in Medical Professionals. J Gen Intern Med. 2009;24(12):1318–1321. doi:https://doi.org/10.1007/s11606-009-1129-z CrossRefPubMedPubMedCentral

Ariely D, Lanier WL. Disturbing Trends in Physician Burnout and Satisfaction with Work-Life Balance Dealing with Malady among the Nation’s Healers. Mayo Clinic Proceedings. 2015;90(12):1593–1596. doi:https://doi.org/10.1016/j.mayocp.2015.10.004 CrossRefPubMed

Dewa CS, Loong D, Bonato S, et al. How does burnout affect physician productivity? A systematic literature review. BMC Health Serv Res. 2014;14(325). doi:https://doi.org/10.1186/1472-6963-14-325

Shanafelt TD, Goh J, Sinsky C. The Business Case for Investing in Physician Well-being. JAMA Intern Med. 2017;177(12):1826–1832. doi:https://doi.org/10.1001/jamainternmed.2017.4340 CrossRefPubMed

Shanafelt TD, Balch CM, Dyrbye LN, et al. (2011). Special report: suicidal ideation among American surgeons. Arch Surg. 2011;146(1): 54–62. doi: https://doi.org/10.1001/archsurg.2010.292

10.

West CP, Tan AD, Shanafelt TD. Association of resident fatigue and distress with occupational blood and body fluid exposures and motor vehicle incidents. Mayo Clin Proc. 2012;87(12):1138–1144. doi: https://doi.org/10.1016/j.mayocp.2012.07.021 CrossRefPubMedPubMedCentral

11.

Lee RT, Seo B, Hladkyj S, et al. Correlates of physician burnout across regions and specialties: A meta-analysis. Hum Resour Health. 2013;28:11–48. doi:https://doi.org/10.1186/1478-4491-11-48 CrossRef

12.

Gazelle G, Liebschutz JM, Riess H. Physician Burnout: Coaching a Way Out. J Gen Intern Med, 2015;30(4):508–513. doi:https://doi.org/10.1007/s11606-014-3144-y

13.

West CP, Dyrbye LN, Erwin PJ, et al. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388(10057):2272–2281. doi:https://doi.org/10.1016/S0140-6736(16)31279-X CrossRefPubMed

14.

Noyes J, Lewin S. Chapter 6: Supplemental Guidance on Selecting a Method of Qualitative Evidence Synthesis, and Integrating Qualitative Evidence with Cochrane Intervention Reviews. In Supplementary Guidance for Inclusion of Qualitative Research. Cochrane Systematic Reviews of Interventions. 2011.

15.

Morton RL, Tong A, Howard K, et al. The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies. BMJ. 2010;340:c112.CrossRefPubMedPubMedCentral

16.

Bousquet G, Orri M, Winterman S, Brugiere C, Verneuil L, Revah-Levy A. Breaking Bad News in Oncology: A Metasynthesis. Journal of Clinical Oncology. 2015 Aug 1;33(22):2437–43.CrossRefPubMed

17.

Lachal J, Orri M, Speranza M, Falissard B, Lefevre H, QUALIGRAMH, et al. Qualitative studies among obese children and adolescents: a systematic review of the literature. Obes Rev. 2013 May;14(5):351–368.

18.

Lachal J, Orri M, Sibeoni J, Moro MR, Revah-Levy A. Metasynthesis of Youth Suicidal Behaviours: Perspectives of Youth, Parents, and Health Care Professionals. Dalal K, editor. PLOS ONE. 2015 May 22;10(5):e0127359.

19.

Sibeoni J, Orri M, Colin S, Valentin M, Pradère J, Revah-Levy A. The lived experience of anorexia nervosa in adolescence, comparison of the points of view of adolescents, parents, and professionals: A metasynthesis. International Journal of Nursing Studies. 2017 Jan;65:25–34.CrossRefPubMed

20.

Sibeoni J, Orri M, Valentin M, Podlipski M-A, Colin S, Pradere J, et al. Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals. PLoS ONE. 2017;12(1):e0169493.CrossRefPubMedPubMedCentral

21.

Atkins S, Lewin S, Smith H, et al. Conducting a meta-ethnography of qualitative literature: Lessons learnt. BMC Med Res Methodol. 2008;8(1). doi:https://doi.org/10.1186/1471-2288-8-21

22.

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8(45). doi:https://doi.org/10.1186/1471-2288-8-45

23.

Tong A, Flemming K, McInnes E, et al. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12(181). doi:https://doi.org/10.1186/1471-2288-12-181

24.

Chenail RJ. Learning to Appraise the Quality of Qualitative Research Articles: A Contextualized Learning Object for Constructing Knowledge. Qualitative Report 2011;16(1): 236–248.

25.

Franz CE, Barker JC, Kim K, et al. (2010). When help becomes a hindrance: Mental health referral systems as barriers to care for primary care physicians treating patients with alzheimer’s disease. Am J Geriatr Psychiatry. 2010;18(7):576–585. doi:https://doi.org/10.1097/JGP.0b013e3181a76df7

26.

Petek D, Gajsek T, Petek Ster M. Work-family balance by women GP specialist trainees in Slovenia: A qualitative study. BMC Med Educ. 2016;16(31):1–10. doi:https://doi.org/10.1186/s12909-016-0551-2 CrossRef

27.

Hasbrouck MA, Waddimba AC. The work-related stressors and coping strategies of group-employed rural health care practitioners: A qualitative study. Am J Ind Med. 2017;60(10):867–878. doi:https://doi.org/10.1002/ajim.22753 CrossRefPubMed

28.

Beng TS, Chin LE, Guan NC, et al. The Experiences of Stress of Palliative Care Providers in Malaysia: A Thematic Analysis. Am J Hosp Palliat Med. 2015;32(1):15–28. doi:https://doi.org/10.1177/1049909113503395 CrossRef

29.

Çiçeklioʇlu M, Öcek ZA, Turk M, et al. The influence of a market-oriented primary care reform on family physicians’ working conditions: A qualitative study in Turkey. Eur J Gen Pract. 2015;21(2):97–102. doi:https://doi.org/10.3109/13814788.2014.966075 CrossRef

30.

Flowerdew L, Brown R, Russ S, et al. Teams under pressure in the emergency department: An interview study. Emerg Med J. 2012;29(12):e2. doi:https://doi.org/10.1136/emermed-2011-200084 CrossRefPubMed

31.

Iversen L, Farmer JC, Hannaford PC. Workload pressures in rural general practice: a qualitative investigation. Scand J Prim Heal Care. 2002;20(3):139–144.CrossRef

32.

McGowan Y, Humphries N, Burke H, et al. Through doctors’ eyes: A qualitative study of hospital doctor perspectives on their working conditions. Br J Health Psychol. 2013;18(4):874–891. doi:https://doi.org/10.1111/bjhp.12037 CrossRefPubMed

33.

Picard J, Catu-Pinault A, Boujut E, et al. Burnout, empathy and their relationships: A qualitative study with residents in General Medicine. Psychol Heal and Med. 2016;21(3):354–361. doi:https://doi.org/10.1080/13548506.2015.1054407 CrossRef

34.

Turk M, Davas A, Tanik FA, et al. Organizational stressors, work-family interface and the role of gender in the hospital: Experiences from Turkey. Br J Health Psychol. 2014;19(2):442–458. doi:https://doi.org/10.1111/bjhp.12041 CrossRefPubMed

35.

Post DM, Weddington WH. Stress and coping of the African-American physician. J Natl Med Assoc. 2000;92(2):70–75.PubMedPubMedCentral

36.

Spinelli WM, Fernstrom KM, Britt H, et al. Seeing the patient is the joy:: A focus group analysis of burnout in outpatient providers. Fam Med. 2016;48(4):273–278. doi:https://doi.org/10.1007/s40596-017-0849-3 CrossRefPubMed

37.

Schneider S, Kingsolver K, Rosdahl J. Physician coaching to enhance well-being: A qualitative analysis of a pilot intervention. Explor J Sci Heal. 2014;10(6):372–379. doi:https://doi.org/10.1016/j.explore.2014.08.007 CrossRef

38.

Agana DF, Porter M, Hatch R, et al. Job satisfaction among academic family physicians. Fam Med. 2017 ; 49(8) :622–625.PubMed

39.

Kjeldmand D, Holmström I. Balint groups as a means to increase job satisfaction and prevent burnout among general practitioners. Ann Fam Med. 2008;6(2):138–145. doi:https://doi.org/10.1370/afm.813 CrossRefPubMedPubMedCentral

40.

Miyasaki JM, Rheaume C, Gulya L, et al. Qualitative study of burnout, career satisfaction, and well-being among US neorologists in 2016. Neurology. 2017;89:1730–1738. doi:https://doi.org/10.1212/WNL.0000000000004526 CrossRefPubMed

41.

Orri M, Revah-Lévy A, Farges O. Surgeons’ emotional experience of their everyday practice - A qualitative study. PLoS One, 2015;10(11):1–15. doi:https://doi.org/10.1371/journal.pone.0143763 CrossRef

42.

Sturman N, Tan Z, Turner J. “a steep learning curve”: Junior doctor perspectives on the transition from medical student to the health-care workplace. BMC Med Educ. 2017;17(1):1–7. doi:https://doi.org/10.1186/s12909-017-0931-2 CrossRef

43.

Loukas A, Zucker RA, Fitzgerald HE, et al. Developmental trajectories of disruptive behavior problems among sons of alcoholics: effects of parent psychopathology, family conflict, and child undercontrol. J Abnorm Psychol. 2003;112(1):119–131. doi:https://doi.org/10.1037/0021-843X.112.1.119 CrossRefPubMed

44.

Verdonk P, Räntzsch V, De Vries R, et al. Show what you know and deal with stress yourself: A qualitative interview study of medical interns’ perceptions of stress and gender. BMC Med Educ. 2014;14(96). doi:https://doi.org/10.1186/1472-6920-14-96

45.

Wainwright E, Fox F, Breffni T, et al. Coming back from the edge: A qualitative study of a professional support unit for junior doctors. BMC Med Educ. 2017;17(142). doi:https://doi.org/10.1186/s12909-017-0978-0

46.

Riley R, Spiers J, Buszewicz M, et al. What are the sources of stress and distress for general practitioners working in England? A qualitative study. BMJ Open. 2018;8(1):1–7. doi:https://doi.org/10.1136/bmjopen-2017-017361 CrossRef

47.

Granek L, Bartels U, Scheinemann K, et al. Grief Reactions and Impact of Patient Death on Pediatric Oncologists. Pediatr Blood Cancer. 2015;62(1):134–142. doi: https://doi.org/10.1002/pbc.25228 CrossRefPubMed

48.

Menezes MA, Hodgson JM, Sahhar M, et al. “Taking Its Toll”: The Challenges of Working in Fetal Medicine. Birth. 2013;40(1),52–60. doi:https://doi.org/10.1111/birt.12029 CrossRefPubMed

49.

Dzeng E, Colaianni A, Roland M, et al. Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study. J Gen Intern Med. 2016;31(1):93–99. doi:https://doi.org/10.1007/s11606-015-3505-1 CrossRefPubMed

50.

Zambrano SC, Chur-Hansen A, Crawford GB. The experiences, coping mechanisms, and impact of death and dying on palliative medicine specialists. Palliative and Supportive Care. 2014;12(4):309–316. doi:https://doi.org/10.1017/S1478951513000138 CrossRefPubMed

51.

Gwala-Ngozo J, Taylor M, Aldous C. Understanding the experiences of doctors who undertake elective surgery on HIV/AIDS patients in an area of high incidence in South Africa. African J AIDS Res. 2010;9(1),11–16. doi:https://doi.org/10.2989/16085906.2010.484536 CrossRef

52.

Fitzgerald K, Yates P, Benger J, et al. The psychological health and well-being of emergency medicine consultants in the UK. Emerg Med J. 2017;34(7):430–435. doi:https://doi.org/10.1136/emermed-2015-205246 CrossRefPubMed

53.

Verhoef LM, Weenink JW, Winters S, et al. The disciplined healthcare professional: a qualitative interview study on the impact of the disciplinary process and imposed measures in the Netherlands. BMJ Open. 2015;5(11). doi:https://doi.org/10.1136/bmjopen-2015-009275

54.

Cheshire A, Ridge D, Hughes J, et al. Influences on GP coping and resilience: A qualitative study in primary care. Br J Gen Pract. 2017;67(659):428–436. doi:https://doi.org/10.3399/bjgp17X690893 CrossRef

55.

Lindfors S, Boman J, Alexanderson K. Strategies used to handle stress by academic physicians at a university hospital. Work. 2012;43(2):183–193. doi:https://doi.org/10.3233/WOR-2012-1364 CrossRefPubMed

56.

Swetz KM, Harrington SE, Matsuyama RK, et al. Strategies for Avoiding Burnout in Hospice and Palliative Medicine: Peer Advice for Physicians on Achieving Longevity and Fulfillment. J Palliat Med. 2009;12(9):773–777. doi:https://doi.org/10.1089/jpm.2009.0050 CrossRefPubMed

57.

Woolhouse S, Brown JB, Thind A. “Building through the Grief”: Vicarious Trauma in a Group of Inner-City Family Physicians. J Am Board Fam Med, 2012;25(6):840–846. doi:https://doi.org/10.3122/jabfm.2012.06.120066 CrossRefPubMed

58.

Zwack J, Schweitzer J. If every fifth physician is affected by burnout, what about the other four? resilience strategies of experienced physicians. Acad Med. 2013;88(3):382–389. doi:https://doi.org/10.1097/ACM.0b013e318281696b CrossRefPubMed

59.

Bruchon-Schweitzer M, Boujut E. (2014). Psychologie de la Santé Concepts, Méthodes et modèles. Paris: Dunod ;2014, 542 p.

60.

Southwick FS, Southwick SM. The Loss of a Sense of Control as a Major Contributor to Physician Burnout: A Neuropsychiatric Pathway to Prevention and Recovery. JAMA Psychiatry. 2018;75(7):665–666. doi:https://doi.org/10.1001/jamapsychiatry.2018.0566 CrossRefPubMed

61.

Furnham A. (2012). The psychology of behaviour at work: The individual in the organization. London:Psychology Press;1997,722p.

62.

Bianchi R, Schonfeld IS, Laurent E. Burnout-depression overlap: a review. Clin Psychol Rev. 2015;36:28–41. doi: https://doi.org/10.1016/j.cpr.2015.T01.004 CrossRefPubMed

63.

Leiter MP, Durup J. The discriminant validity of burnout and depression: a confirmatory factor analytic study. Anxiety Stress Coping. 1994;7:357–373. doi:https://doi.org/10.1080/10615809408249357 CrossRef

64.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6 (6): e1000097. doi:https://doi.org/10.1371/journal.pmed10000 CrossRefPubMedPubMedCentral

Title: Physicians’ Perspectives About Burnout: a Systematic Review and Metasynthesis
Authors: Jordan Sibeoni, MD, PhD
Laura Bellon-Champel, PhD
Antoine Mousty, Msc
Emilie Manolios, Msc
Laurence Verneuil, MD, PhD
Anne Revah-Levy, MD, PhD
Publication date: 01-08-2019
Publisher: Springer US
Keyword: Burnout Syndrome
Published in: Journal of General Internal Medicine / Issue 8/2019
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-019-05062-y

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Physicians’ Perspectives About Burnout: a Systematic Review and Metasynthesis

Abstract

Background

Objective

Data Sources

Review Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Data Sources

Review Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2019

Implementing an Opt-in eConsult Program at Seven Academic Medical Centers: a Qualitative Analysis of Primary Care Provider Experiences

Assessing Clinical Reasoning: Targeting the Higher Levels of the Pyramid

The Patient Care Ownership Scale: Development of an Instrument to Measure Patient Care Ownership Among Internal Medicine Trainees

The Impact of Breast Density Notification Laws on Supplemental Breast Imaging and Breast Biopsy

A Systematic Review of the Impact of Patient–Physician Non-English Language Concordance on Quality of Care and Outcomes

High-Need Patients’ Goals and Goal Progress in a Veterans Affairs Intensive Outpatient Care Program

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page