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Cited by 1,904Healthcare professionals’ stress and burnoutOccupational Health and BurnoutStress and Burnout Research

Prevalence of Burnout Among Physicians: A Systematic Review

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Rotenstein, Lisa S., Torre, Matthew, Ramos, Marco A., Rosales, Rachael C., Guille, Constance, Sen, Srijan, Mata, Douglas A.·2018·JAMA
DOI 10.1001/jama.2018.12777PMC PMC6233645
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Abstract

Importance: Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown. Objective: To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout. Data Sources and Study Selection: Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018. Data Extraction and Synthesis: Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively. Main Outcomes and Measures: Point or period prevalence of burnout assessed by questionnaire. Results: Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined. Conclusions and Relevance: In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.

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  • The 94% prevalence estimate may overstate burnout because the study used a sensitive definition requiring only one subscale to reach its critical boundary.

    “This may be an overestimation for the reason that the authors utilized a sensitive approach in defining burnout—at least one alteration reaching the critical boundary in any of the three subscales [5, 16].”

    From Burnout among neurology residents during the COVID-19 pandemic: a national cross-sectional study (2022) · cites this paper as [5]

    The Qualitative Synthesis reports that permissive definitions requiring a cutoff on either emotional exhaustion or depersonalization produced higher prevalence estimates than definitions requiring all three subscales to meet cutoffs. The Discussion also cautions that some cutoffs may capture symptoms rather than clinically meaningful burnout. The paper does not evaluate the citing study’s 94% estimate or establish that its rule was a cutoff on any one of all three subscales. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Wellness was the second-highest reported type of coaching program in the analysis.

    “Considering the high prevalence of burnout in academic medical centres [166–168], it is not surprising that wellness was the second-highest reported type of coaching program in our analysis.”

    From Coaching in undergraduate and graduate medical education: a scoping review of success factors, barriers, and outcomes (2026) · cites this paper as [168]

    The cited paper reports burnout among practicing physicians, with prevalence estimates ranging from 0% to 80.5% (Prevalence of Overall Burnout Among Physicians). Its Discussion cautions that variation in definitions makes any single prevalence estimate difficult to interpret; it does not establish high prevalence specifically in academic medical centres. The statement that wellness was the second-highest coaching-program type is a finding of the citing authors’ own analysis, not a claim attributed to this source. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Approximately half of physicians and nurses in the US report significant burnout symptoms in the form of high emotional exhaustion, high depersonalization, and/or a low sense of personal accomplishment.

    “According to most recent studies, approximately half of physicians and nurses in the US report significant burnout symptoms in the form of high emotional exhaustion, high depersonalization, and/or a low sense of personal accomplishment.3-5”

    From What do we really know about addressing burnout among healthcare workers? Maybe less than we think (2026) · cites this paper as [5]

    The Qualitative Synthesis (page unavailable) reports a US physician study in which burnout symptoms rose from 45.5% in 2011 to 54.4% in 2014, and the paper describes the three named burnout components. It does not establish an approximately 50% prevalence among US nurses. The Discussion (page unavailable) also cautions that differing definitions make a single physician-burnout prevalence estimate difficult to interpret. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Burnout, depression, and moral injury overlap but are not identical.

    “burnout, depression, and moral injury overlap but are not identical”

    From Individual-Focused Interventions for Physician Burnout: A Meta-Analysis of Mindfulness, Coaching, and Peer Support (2025) · cites this paper as [13]

    The Qualitative Synthesis reports overlap between burnout and depression in physicians. The Discussion considers burnout a distinct entity but also notes an argument for treating it as a form of depression; it does not establish a definitive distinction. Neither passage addresses moral injury, so the three-way claim is not fully supported. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • A minimum sample of 55 participants was required for the prevalence estimate, assuming 95% confidence, 10% error, prevalence up to 80.5%, and a population of 136.

    “a minimum of 55 participants should be enrolled assuming 95% confidence and an error rate of 10% in the prevalence estimate, and assuming a prevalence rate of up to 80.5% [5] and a total population of 136”

    From Burnout among neurology residents during the COVID-19 pandemic: a national cross-sectional study (2022) · cites this paper as [5]

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Cites

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Flagged first, then by citations

Research works printed but not linked: 7

  1. [14]14. Marôco J, Marôco AL, Leite E, Bastos C, Vazão MJ, Campos J. Burnout in Portuguese healthcare professionals: an analysis at the national level [in Portuguese]. Acta Med Port. 2016;29(1):24-30.
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  3. [39]39. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385. doi:10 .1001/archinternmed.2012.3199
  4. [53]53. Aguirre Roldán AM, Quijano Barriga AM. Burnout syndrome, family and work related variables on general practitioners in Bogota: a strategy of work quality [in Spanish]. Rev Colomb Psiquiatr. 2015;44(4):198-205. doi:10.1016/j.rcp .2015.05.017 · DOI
  5. [76]76. Das S, Barman S, Datta S, et al. Degree of burnout among emergency healthcare workers and factors influencing level of burnout: a pilot study. Delhi Psychiatry J. 2016;19(1):36-47.
  6. [91]91. Frutos-Llanes R, Jiménez-Blanco S, Blanco-Montagut LE. Burnout syndrome in general practitioners of Avila [in Spanish]. Semergen. 2014;40(7):357-365. doi:10.1016/j.semerg.2014.02 .008 · DOI
  7. [131]131. Tironi MOS, Nascimento Sobrinho CL, Barros D de S, et al. Professional burnout syndrome of intensive care physicians from Salvador, Bahia, Brazil [in Portuguese]. Rev Assoc Med Bras (1992). 2009;55(6):656-662. doi:10.1590/S0104- 42302009000600009 176. · DOI

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Authors
Rotenstein, L. S., Torre, M., Ramos, M. A., Rosales, R. C., Guille, C., Sen, S., & Mata, D. A.
Affiliations
  • Brigham and Women's Hospital (US)
  • Yale University (US)
  • Medical University of South Carolina (US)
  • University of Michigan (US)
Corresponding author
Mata, Douglas A.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2018-09-18
Volume
320
Issue
11
Pages
1131
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2018.12777
PMC
PMC6233645
OpenAlex
W2890627641
Cited by
1,904
References
232
Citations by year
2026: 228 · 2025: 267 · 2024: 250 · 2023: 250 · 2022: 271 · 2021: 288 · 2020: 236 · 2019: 106 · 2018: 7 · 2017: 1
FWCI
28.95
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • JAMA (publishedVersion, public-domain)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute of Mental Health (R01MH101459)
Topics
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
  • Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
Keywords
physician burnout, burnout prevalence, emotional exhaustion, depersonalization, low personal accomplishment, Maslach Burnout Inventory, burnout definition, cut-off values, physician well-being, occupational stress in medicine
MeSH terms
Compassion Fatigue, Burnout, Professional, Depersonalization, Humans, Job Satisfaction, Physicians, Surveys and Questionnaires, Prevalence

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