Original Article

Change in Physician Burnout between 2013 and 2020 in a Major Health System

Authors: Kathryn A. Martinez, PhD, MPH, Amy B. Sullivan, PsyD, Debra T. Linfield, MD, Victoria Shaker, BS, Pei-Chun Yu, MS, Michael B. Rothberg, MD, MPH


Objective: Assessing changes in physician burnout over time can offer insight into the causes of burnout. Existing studies are limited by using different samples of physicians at each time point. Our objective was to assess changes in burnout between 2013–2014 and 2019–2020 overall and within a cohort of physicians who took the survey twice.

Methods: This is a longitudinal cohort and cross-sectional study of physicians in a major health system. They were administered the Maslach Burnout Inventory in 2013–2014 and 2019–2020. We separately assessed differences in odds of burnout and its subscales in 2013–2014 and 2019–2020 by physician characteristics and clinical time. We then assessed differences in the odds of reporting burnout and its subscales in 2019–2020 compared with 2013–2014 overall and by physician sex, race, and change in clinical full-time employment.

Results: There were 1220 respondents in 2013–2014, 503 in 2019–2020, and 149 who responded at both time points. Burnout increased from 35% to 56%. Compared with 2013–2014, physicians had 2.39 higher odds (95% confidence interval [CI] 1.92–2.98) of burnout in 2019–2020, and this change in burnout was significantly more pronounced for female versus male physicians (odds ratio 1.80; 95% CI 1.57–1.80). Compared with White physicians, non-White physicians had significantly lower odds of burnout at both time points, but their odds increased significantly more over time (odds ratio 1.36; 95% CI 1.05–1.57).

Conclusions: We found a substantial increase in burnout over time, which was particularly pronounced for non-White and female physicians. Assessment over time is essential for understanding problematic trajectories of burnout that may be obscured by cross-sectional studies.

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1. Tawfik DS, Profit J, Morgenthaler TI, et al. Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors. Mayo Clin Proc 2018;93:1571–1580.
2. Menon NK, Shanafelt TD, Sinsky CA, et al. Association of physician burnout with suicidal ideation and medical errors. JAMA Netw Open 2020; 3:e2028780.
3. 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;172:1377.
4. West CP, Dyrbye LN, Erwin PJ, et al. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet 2016; 388:2272–2281.
5. Bakker AB, Schaufeli WB, Demerouti E, et al. Using equity theory to examine the difference between burnout and depression. Anxiety Stress Coping 2000;13:247–268.
6. Seo C, Corrado M, Fournier K, et al. Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review. BMC Med Educ 2021;21:80.
7. West CP, Dyrbye LN, Sinsky C, et al. Resilience and burnout among physicians and the general US working population. JAMA Netw Open 2020;3:e209385.
8. Shanafelt TD, Dyrbye LN, West CP. Addressing physician burnout: the way forward. JAMA 2017;317:901–902.
9. Shanafelt TD, Dyrbye LN, Sinsky C, et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc 2016;91:836–848.
10. Shanafelt TD, West CP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Mayo Clin Proc 2019;94:1681–1694.
11. Del Carmen MG, Herman J, Rao S, et al. Trends and factors associated with physician burnout at a multispecialty academic faculty practice organization. JAMA Netw Open 2019;2:e190554.
12. Windover AK, Martinez K, Mercer MB, et al. Correlates and outcomes of physician burnout within a large academic medical center. JAMA Intern Med 2018;178:856.
13. Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory Manual, 3rd ed. Mountain View, CA: Consulting Psychologists Press; 1996.
14. Shanafelt TD, Gradishar WJ, Kosty M, et al. Burnout and career satisfaction among US oncologists. J Clin Oncol 2014;32:678–686.
15. Marshall AL, Dyrbye LN, Shanafelt TD, et al. Disparities in burnout and satisfaction with work-life integration in U.S. physicians by gender and practice setting. Acad Med 2020;95:1435–1443.
16. Garcia LC, Shanafelt TD, West CP, et al. Burnout, depression, career satisfaction, and work-life integration by physician race/ethnicity. JAMA Netw Open 2020;3:e2012762.
17. Gupta K, Murray SG, Sarkar U, et al. Differences in ambulatory EHR use patterns for male vs. female physicians. https://catalyst.nejm.org/doi/full/10.1056/CAT.19.0690. Published November 13, 2019. Accessed December 28, 2020.
18. Gardner RL, Cooper E, Haskell J, et al. Physician stress and burnout: the impact of health information technology. J Am Med Informatics Assoc 2019;26:106–114.
19. McMurray JE, Linzer M, Konrad TR, et al. The work lives of women physicians. Results from the Physician Work Life Study. J Gen Intern Med 2000;15:372–380.
20. Linzer M, Harwood E. Gendered expectations: do they contribute to high burnout among female physicians? J Gen Intern Med 2018;33:963–965.
21. Jolly S, Griffith KA, DeCastro R, et al. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med 2014;160:344–353.
22. Deryugina T, Shurchkov O, Stearns J. COVID-19 disruptions disproportionately affect female academics. https://www.nber.org/papers/w28360. Published January 2021. Accessed June 6, 2022.
23. Squazzoni F, Bravo G, Grimaldo F, et al. Only second-class tickets for women in the COVID-19 race. A study on manuscript submissions and reviews in 2347 Elsevier journals during the pandemic. PLoS One 2021;16:e0257919.
24. Harry E, Sinsky C, Dyrbye LN, et al. Physician task load and the risk of burnout among US physicians in a national survey. Jt Comm J Qual Patient Saf 2021;47:76–85.
25. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med 2018;283:516–529.
26. Sheppard KG, Duncan CG. Relative value units in health care: friend, foe, or necessary evil? J Am Assoc Nurse Pract 2020;32:626–629.
27. Lagasse J. Physician pay increased in 2017 as demand grew, according to study, https://www.healthcarefinancenews.com/news/physician-pay-increased-2017-demand-grew-according-study. Published December 19, 2017. Accessed June 11, 2021.
28. Yan C, Rose S, Rothberg MB, et al. Physician, scribe, and patient perspectives on clinical scribes in primary care. J Gen Intern Med 2016;31:990–995.
29. Funk KA, Pestka DL, Roth MT, et al. Primary care providers believe that comprehensive medication management improves their work-life. J Am Board Fam Med 2019;32:462–473.
30. Murphy DR, Satterly T, Giardina TD, et al. Practicing clinicians’ recommendations to reduce burden from the electronic health record inbox: a mixed-methods study. J Gen Intern Med 2019;34:1825–1832.