Predicting and preventing physician burnout: results from the United States and the Netherlands.

Burnout is a long-term stress reaction seen primarily in the human service professions. It is a “psychological syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment” (1). Over the past 20 years, many aspects of medical practice have changed: autonomy is declining, the status of physicians has diminished, and work pressures are increasing. Burnout is an unintended and adverse result of such changes. Burnout has been described among physicians in several countries and practice settings; in the Netherlands, physician disability insurance premiums have recently risen 20% to 30% owing to an increasing incidence of burnout and stress-related complaints (2). Paraphrasing Maslach, Wilters (3) describes burned out physicians as being angry, irritable, and impatient; “there is also an increase in absenteeism and job turnover. Decreasing productivity and practice revenue are byproducts of physician turnover.” Thus burnout can be associated with a deterioration in the physician-patient relationship and a decrease in both the quantity and quality of care. In a recent survey of health maintenance organization (HMO) physicians (4), burned out physicians were less satisfied, more likely to want to reduce their time seeing patients, more likely to order tests or procedures, and more interested in early retirement than other physicians. To better understand the interplay of the predictors of physician burnout and to develop strategies for prevention, we compared data from two large physician surveys, one in the United States (the Physician Worklife Study) and another in the Netherlands (the Dutch Study of Motivation among Medical Consultants). These data were used to construct and test a predictive model of physician burnout.