Relationship Between Burnout, Professional Behaviors, and Cost-Conscious Attitudes Among US Physicians

  • Liselotte N. DyrbyeEmail author
  • Colin P. West
  • Andrea Leep Hunderfund
  • Christine A. Sinsky
  • Mickey Trockel
  • Michael Tutty
  • Lindsey Carlasare
  • Daniel Satele
  • Tait Shanafelt
Original Research



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.

Key Results

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 Words

professional 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.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Liselotte N. Dyrbye
    • 1
    Email author
  • Colin P. West
    • 1
  • Andrea Leep Hunderfund
    • 1
  • Christine A. Sinsky
    • 2
  • Mickey Trockel
    • 3
  • Michael Tutty
    • 2
  • Lindsey Carlasare
    • 2
  • Daniel Satele
    • 4
  • Tait Shanafelt
    • 3
  1. 1.Mayo ClinicRochesterUSA
  2. 2.American Medical AssociationChicagoUSA
  3. 3.Stanford School of MedicineStanfordUSA
  4. 4.Department of Health Sciences ResearchMayo ClinicRochesterUSA

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