Physicians' Total Burden of Occupational Stressors: More than Threefold Increased Odds of Burnout

Abstract

Objectives: To assess the relation between total job stressor burden and physician burnout, identifying potentially contributory modifiable stressors, using a comprehensive, theory-based instrument created for physicians by physicians.

Methods: From 2018 to 2019, we conducted a cross-sectional study in a public teaching hospital in India. Of 305 clinically active physicians, 293 were reached and 42.7% participated. Job stressors were assessed via the physician-specific Occupational Stressor Index (OSI) and burnout by the Copenhagen Burnout Index (CBI).

Results: The 76 fully participating physicians were 68% male, 84% residents, and 70% age 30 or younger, from various specialties. Mean scores for total OSI: 87 ± 7.8; personal burnout: 46.6 ± 18.2; work-related burnout: 41.4 ± 20.7; and patient-related burnout: 31.7 ± 22.4. Total OSI scores were significantly associated with personal and work-related burnout, adjusting for working-years as physicians and sex. Total OSI scores >88 showed adjusted odds ratios (±95% confidence intervals): 3.99 (1.31, 12.1) and 6.50 (1.85, 22.8) for personal and work-related burnout, respectively. The high demands aspect of the OSI showed significant multivariate relations to personal, work-related, and patient-related burnout. Patient-related burnout was significantly more likely among male physicians in these multivariate analyses. Physicians outside preventive/diagnostic areas, with heavier burdens and more emergency cases were less likely to fully participate.

Conclusions: The total burden of job stressors is powerfully associated with personal and work-related burnout. The clinically defined total OSI cutpoint >88 warranting urgent intervention is corroborated by >3-fold odds of personal and work-related burnout. Lowering total OSI scores is an immediate priority, starting with potentially modifiable stressors that are already maximum/near-maximum (inadequate rest breaks, nightshifts, work hours, insufficient work-free vacation time, and infection hazards). These issues affect patient care.