Relationship Between Burnout, Professional Behaviors, and Cost-Conscious Attitudes Among US Physicians
Despite the importance of professionalism, little is known about how burnout relates to professionalism among practicing physicians.
To evaluate the relationship between burnout and professional behaviors and cost-conscious attitudes.
Design and Participants
Cross-sectional study in a national sample of physicians of whom a fourth received a sub-survey with items exploring professional behaviors and cost-conscious attitudes. Responders who were not in practice or in select specialties were excluded.
Maslach Burnout Inventory and items on professional behaviors and cost-conscious attitudes.
Among those who received the sub-survey 1008/1224 (82.3%) responded, and 801 were eligible for inclusion. Up to one third of participants reported engaging in unprofessional behaviors related to administrative aspects of patient care in the last year, such as documenting something they did not do to close an encounter in the medical record (243/759, 32.0%). Fewer physicians reported other dishonest behavior (e.g., claiming unearned continuing medical education credit; 40/815, 4.9%). Most physicians endorsed cost-conscious attitudes with over 75% (618/821) agreeing physicians have a responsibility to try to control health-care costs and 62.9% (512/814) agreeing that cost to society is important in their care decisions regarding use of an intervention. On multivariable analysis adjusting for personal and professional characteristics, burnout was independently associated with reporting 1 or more unprofessional behaviors (OR 2.01, 95%CI 1.47–2.73, p < 0.0001) and having less favorable cost-conscious attitudes (difference on 6–24 scale − 0.90, 95%CI − 1.44 to − 0.35, p = 0.001).
Professional burnout is associated with self-reported unprofessional behaviors and less favorable cost-conscious attitudes among physicians.
Key Wordsprofessional burnout physicians professionalism health care costs
Electronic health records
American Medical Association
Maslach Burnout Inventory
Funding for this study was provided by the Mayo Clinic Department of Medicine Program on Physician Well-Being, the Stanford WellMD Center, and the American Medical Association. Funding sources had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 4.West CP, Shanafelt TD. The influence of personal and environment factors on professionalism in medical education. BMC Med Educ 2007 30;7:29 https://www.ncbi.nlm.nih.gov/pubmed/17760986
- 10.Dyrbye LN, Massie FS, Jr., Eacker A, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010;304:1173-80.Google Scholar
- 13.Melville A. Job satisfaction in general practice: implications for prescribing. Soc Sci Med. 1980;14A:495-9.Google Scholar
- 16.Shanafelt T, West CP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011-2017. Mayo Clin Proc In press (ePub available).Google Scholar
- 17.(AAPOR): Aafpor. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. 2011.Google Scholar
- 18.Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto: Consulting Psychologists Press; 1996.Google Scholar
- 22.Maslach C. Maslach Burnout Inventory Manual. Palo Alto: Consulting Psychologists Press; 1986.Google Scholar
- 26.Code of Medical Ethics. at https://www.ama-assn.org/delivering-care/ethics/code-medical-ethics-overview. accessed 6 Nov 2019
- 27.American Medical Association. AMA Code of Medical Ethics. Opinion 9.031. Reporting Impaired, Incompetent, or Unethical Colleagues. Accessed at https://www.ama-assn.org/delivering-care/ethics/reporting-incompetent-or-unethical-behaviors-colleagues. accessed 6 Nov 2019
- 34.Kirchhoff AC, Hart G, Campbell EG. Rural and urban primary care physician professional beliefs and quality improvement behaviors. The Journal of Rural Health : official journal of the American Rural Health Association and the National Rural Health Care Association 2014;30:235-43.CrossRefGoogle Scholar
- 36.National Alliance for Physician Competence. Guide to good medical practice-USA. 2008: available at http://www.ama-assn.org/ama1/pub/upload/mm/377/ggmp-usa.pdf, accessed 2/27/2014.
- 37.Gunderman R. For the young doctor about to burnout out. The Atlantic 2014.Google Scholar