Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Aug 3;3(8):e2013761.
doi: 10.1001/jamanetworkopen.2020.13761.

Factors Associated With Burnout and Stress in Trainee Physicians: A Systematic Review and Meta-analysis

Anli Yue Zhou  1 , Maria Panagioti  2 , Aneez Esmail  2 , Raymond Agius  1 , Martie Van Tongeren  1 , Peter Bower  2
Affiliations
Meta-Analysis

Factors Associated With Burnout and Stress in Trainee Physicians: A Systematic Review and Meta-analysis

Anli Yue Zhou et al. JAMA Netw Open. .

Abstract

Importance: Evidence suggests that physicians experience high levels of burnout and stress and that trainee physicians are a particularly high-risk group. Multiple workplace- and non-workplace-related factors have been identified in trainee physicians, but it is unclear which factors are most important in association with burnout and stress. Better understanding of the most critical factors could help inform the development of targeted interventions to reduce burnout and stress.

Objective: To estimate the association between different stressors and burnout/stress among physicians engaged in standard postgraduate training (ie, trainee physicians).

Data sources: Medline, Embase, PsycINFO, and Cochrane Database of Systematic reviews from inception until April 30, 2019. Search terms included trainee, foundation year, registrar, resident, and intern.

Study selection: Studies that reported associations between stressors and burnout/stress in trainee physicians.

Data extraction and synthesis: Two independent reviewers extracted the data and assessed the quality of the evidence. The main meta-analysis was followed by sensitivity analyses. All analyses were performed using random-effects models, and heterogeneity was quantified using the I2 statistic.

Main outcome and measures: The main outcome was the association between burnout/stress and workplace- or non-workplace-related factors reported as odds ratios (ORs) and their 95% CIs.

Results: Forty-eight studies were included in the meta-analysis (n = 36 266, median age, 29 years [range, 24.6-35.7 years]). One study did not specify participants' sex; of the total population, 18 781 participants (52%) were men. In particular, work demands of a trainee physician were associated with a nearly 3-fold increased odds for burnout/stress (OR, 2.84; 95% CI, 2.26-3.59), followed by concerns about patient care (OR, 2.35; 95% CI, 1.58-3.50), poor work environment (OR, 2.06; 95% CI, 1.57-2.70), and poor work-life balance (OR, 1.93; 95% CI, 1.53-2.44). Perceived/reported poor mental or physical health (OR, 2.41; 95% CI, 1.76-3.31), female sex (OR, 1.34; 95% CI, 1.20-1.50), financial worries (OR, 1.35; 95% CI, 1.07-1.72), and low self-efficacy (OR, 2.13; 95% CI, 1.31-3.46) were associated with increased odds for burnout/stress, whereas younger age and a more junior grade were not significantly associated.

Conclusions and relevance: The findings of this study suggest that the odds ratios for burnout and stress in trainee physicians are higher than those for work-related factors compared with nonmodifiable and non-work-related factors, such as age and grade. These findings support the need for organizational interventions to mitigate burnout in trainee physicians.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Zhou reported receiving grants from British Medical Association Foundation and National Institute for Health Research (NIHR) during the conduct of the study. Dr Agius reported receiving grants from the NIHR during the conduct of the study. Dr Bower reported receiving grants from the NIHR during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Studies Included in the Review
Figure 2.
Figure 2.. Meta-analysis of Each Work-Related Factor and Its Association With Burnout/Stress
Each line represents 1 factor. Weights are from random-effects model. OR indicates odds ratio.
Figure 3.
Figure 3.. Meta-analysis of Each Non–Work-Related Factor and Its Association With Burnout/Stress
Each line represents 1 factor. Weights are from random-effects model. OR indicates odds ratio.
See this image and copyright information in PMC

Comment in

References

    1. The British Medical Association Doctors' titles: explained. 2017. Accessed July 21, 2019. https://www.bma.org.uk/advice-and-support/international-doctors/life-and...
    1. 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 - DOI - PubMed
    1. Peisah C, Latif E, Wilhelm K, Williams B. Secrets to psychological success: why older doctors might have lower psychological distress and burnout than younger doctors. Aging Ment Health. 2009;13(2):300-307. doi: 10.1080/13607860802459831 - DOI - PubMed
    1. Stucky ER, Dresselhaus TR, Dollarhide A, et al. Intern to attending: assessing stress among physicians. Acad Med. 2009;84(2):251-257. doi: 10.1097/ACM.0b013e3181938aad - DOI - PubMed
    1. Dyrbye LN, West CP, Satele D, et al. Burnout among US medical students, residents, and early career physicians relative to the general US population. Acad Med. 2014;89(3):443-451. doi: 10.1097/ACM.0000000000000134 - DOI - PubMed

Publication types