Burnout is a hot topic right now. From magazine articles to academic conferences, podcasts to policy papers, the concept of ‘burnout’ is attracting attention like never before. Burnout isn’t a new idea, though. It first originated in the 1970s with Herbert Freudenberger, a US-based researcher. It then gathered more popularity in the 1980s when Christina Maslach introduced the ‘Maslach Burnout Inventory’, a questionnaire for measuring burnout. Since the turn of the century, the number of research studies into burnout has increased exponentially. In fact, more studies were published on burnout in 2020 alone than were published in the ten years between 2000 and 2010 combined (Figure 1). With so much popular interest, it can be easy to lose sight of the facts.
What is really happening with burnout?
To answer our opening question, yes: burnout is really increasing in healthcare professionals. The more surprising news is that burnout wasn’t increasing until the onset of the Covid-19 pandemic. Up until 2020, rates of burnout were stable. In the US, rates of burnout remained stable even after the onset of the pandemic, but that has since changed.
How do we know this?
There are only a small number of studies which have tracked burnout in a group of healthcare professionals over time. The first of these began in 2011 and measured burnout in US physicians. It has since gone back out to US physicians at four subsequent time points (2014, 2017, 2020 and 2021). As you can see from Figure 2, burnout fluctuated in the decade running up to the pandemic and even dipped a little at the start of the pandemic, but has since shot up to the highest rate recorded yet.
The best ongoing burnout survey is conducted by the UK General Medical Council (GMC). This survey has the largest number of respondents of any burnout survey in the world and also reports the best response rate. This means that the GMC survey results are more likely to reflect actual rates of burnout. The GMC first measured burnout in 2018, and they have since measured it annually. According to this survey, around 1 in 4 trainee doctors were reporting burnout when the survey was launched, and this remained stable until the onset of the pandemic. Increases were observed in the 2021 survey, and the 2022 survey results now suggest that 2 in 5 trainee doctors are experiencing burnout (Figure 3).
Should we be cautious?
There are two key problems with the datasets I have shared with you. The first is that they measure burnout differently. The GMC survey is particularly disappointing, as it uses a short questionnaire which only measures one aspect of burnout, emotional exhaustion. It entirely ignores depersonalisation, which is where clinicians began to detach and disengage from their patients. Depersonalisation is arguably the most concerning aspect of burnout, as our research has found that it is closely linked with poor patient care and bad career outcomes.
The second limitation is that these surveys are both in physicians. In fact, all the large and ongoing surveys of burnout I know of have been in physicians. This looks set to change now that the NHS Staff Survey has begun to include an item on burnout, but that survey will also suffer from the problem of using a poor measurement tool.
Where does this leave us?
Frankly, concerned. In many nations, austerity plans following the 2007/8 economic crash led to higher workloads and more challenging working conditions for healthcare professionals. This is the first time on recorded history, however, that we see burnout really increasing in a sustained manner. If there has ever been a time to actively invest in supporting staff, that time is now.