By Ellen Feldman, MD
It is Friday afternoon — again. The clinic finally is quieting down and staff members are wrapping up for the weekend. “Have a great weekend,” Patrick calls as he heads out the door. “See you Monday, bright and early!” adds Jett, cheerfully waving goodbye.
The provider sits quietly, nodding at each colleague while mentally juggling unfinished tasks. Seventeen incomplete charts (or is it 18 — how could it be that many?), lab results to review, and aren’t there some inbox messages? Then, a pop-up on the calendar: Marc’s soapbox derby is in 40 minutes.
“I suppose another Saturday will be spent catching up,” the provider sighs, wondering if this is still worth it.
Primary care providers (PCPs) have long embraced the intrinsic rewards of patient care: offering vital services that make a profound difference in their communities. Medicine always has been demanding, both emotionally and intellectually. Yet, providers have historically found deep purpose in their work, which, for many, balanced the long hours and frustrations of practice.1
However, the modern practice of medicine brings new challenges. While many providers continue to find fulfillment, mounting pressures — such as administrative burdens, financial strain, and large patient loads — have reshaped the field, contributing to widespread burnout.1,2
This paper examines burnout in the PCP and its related consequences, including the far-reaching effect on the medical workforce, patient outcomes, and comorbid conditions. After a brief overview of burnout and its historic precedents, review of the latest available statistics, and exploration of suspected causes, the core of the discussion focuses on practical strategies for supporting provider well-being, illustrated through the experiences of several providers.
What Is Burnout Anyway? Is it a Diagnosis or a Catch-All Term?
Images of people with substance use disorders sitting in group sessions with blank expressions, staring at cigarettes slowly burning out prompted psychologist Herbert Freudenberg to coin the term “burnout” in the 1970s. He borrowed this phrase from drug slang where “burnout” was used casually to describe functional decline in peers. Freudenberg used the term in his research and writings to describe a phenomenon he observed among colleagues and patients — and experienced himself. Characterized by a steady decline in energy, motivation, and commitment to the job, as well as emotional depletion over time, Freudenberg noted that burnout most often occurred in professionals with jobs requiring empathy and personal involvement.3,4
Researchers Maslach and Johnson extended Freudenberg’s work on burnout, and in the 1980s developed the Maslach Burnout Inventory (MBI), still in use today as one of the few validated research tools to measure the degree and effect of this state. The team was the first to describe burnout as an all-encompassing condition involving emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment stemming from the weight of professional stressors and responsibilities.5,6
Although burnout as a defined syndrome was not recognized in the scientific literature until the 1970s, evidence suggests its existence long before that time. The term “burnout” may have first been used metaphorically as early as 1599, in poem VII of The Passionate Pilgrim, a poetry collection attributed to Shakespeare: “She burn’d with love, … She burn’d out love, as soon as straw outburneth.”7 By the turn of the 20th century, burnout was depicted in popular literature. Thomas Mann’s 1901 Buddenbrooks (later adapted into a 2008 movie) portrays a protagonist grappling with progressive mental exhaustion, disillusionment, and loss of drive.8 In medical literature, an early hint of burnout emerged in 1952, with a published case study of a psychiatric nurse diagnosed with “exhaustion reaction.” In hindsight, viewing this case with “2024” vision, the symptoms clearly align with what we now identify as burnout.9
The works of Freudenberg and Maslach in the 1970s marked a turning point, sparking global interest and research into the effects of burnout on the workforce. Despite inconsistent findings from these investigations, burnout underwent a pivotal reclassification in 2015, transitioning from an amorphous concept to a mental “state” in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).10
In 2019, the World Health Organization (WHO) introduced further nuance by reclassifying burnout to an occupational syndrome in the ICD-11. This change stirred controversy and prompted a clarification from WHO that burnout is not yet considered a medical diagnosis, per se.11 However, the triad of symptoms identified in the 1970s remains central to its definition. The ICD-11 outlines burnout across three dimensions:12
- feelings of energy depletion or emotional exhaustion;
- increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job;
- reduced professional efficacy.
Even with WHO recognition, there remains difficulty pinpointing a universal definition of burnout and each of its components. (For example, what exactly is “emotional exhaustion”?)
Despite this problem, studies consistently note negative consequences from this syndrome.13 Healthcare providers, and particularly physicians, are at high risk for developing burnout; a nuanced understanding of this condition gives the PCP tools to self-monitor as well as care for patients who may present with signs of burnout.
Burnout in physicians is associated with an increased risk of medical errors, decreased quality of care, and reduced patient satisfaction. Without intervention, physicians with burnout are at increased risk of both developing health complications and of leaving the profession.13,14
Although wellness initiatives likely contribute to mitigating burnout, research consistently shows that they are not a standalone solution. This is not surprising, since recent investigations have highlighted a strong connection between burnout and specific workplace factors rather than individual traits or even job type. The evidence points to the combination of robust organizational support and personal wellness efforts as the most effective approach.14,15 To this point, Dr. Tait Shanafelt, a leading expert on burnout in healthcare and chief wellness officer at Stanford Medicine since 2017, emphasizes that healthcare organizations must take proactive measures to prevent provider burnout.16
That said, the individual provider still plays a vital role in addressing burnout. Recognizing early signs, staying mindful of burnout risks, and practicing self-care and wellness techniques are essential steps. As Shanafelt observes, “Physicians must acknowledge that they are subject to normal human limitations and attend to rest, breaks, sleep, personal relationships, and individual needs.”15,16
Regardless of classification or precise definition, the term burnout deeply resonates with many medical providers who experience its hallmark symptoms: emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment — all stemming from chronic, work-related stress and responsibilities. Presentation can vary widely, and overlapping symptoms with other conditions often complicate recognition and treatment.13-16
The two clinical scenarios presented here illustrate typical manifestations of burnout in medical providers and explore potential strategies for resolution.
Meet Dr. P.
Dr. P, 55 years of age with 20 years in a busy, urban family practice, sits in his small, cluttered office, staring blankly at his computer screen. A patient message notification pings, but he does not move to open it. Outside his door, the hum of activity in the clinic continues — phones ringing, nurses bustling between exam rooms — but Dr. P. seems insulated, as if separated from the world he had once thrived in.
“If I had more energy,” he muses, “I would feel ashamed.” During morning meeting, his frustration had boiled over again. When the clinic director mentioned a new initiative to improve documentation compliance, Dr. P. let out a dry laugh. “Another metric to measure how little time we actually have with patients,” he said in a voice tinged with sarcasm. As he spoke, the room grew quiet. A few colleagues exchanged glances, some with sympathy and others with visible discomfort.
Later that day, Jett, his medical assistant, approaches him hesitantly. “Dr. P., I just wanted to remind you about your inbox and medication refills. There are several patients who are calling now to ask about the delay.”
“I will get to it,” he replies curtly, without looking up. Jett pauses, as if weighing whether to press further, but then walks away. Dr. P. sighs and rubs his temples. He feels angry, but quickly realizes he is not angry with Jett but at himself. He used to be meticulous about things like this. Patients never had to call more than once. But lately, even small tasks feel insurmountable.
He noticed this first in the examination room with patients, where the differences between now and the past were stark. Dr. P. still asked the necessary questions and prescribed the correct medication, but something was missing. Patient visits felt empty and unsatisfying. He rarely smiled, and the warm, empathetic tone that had come naturally and provided reassurance to patients was gone — he just could not muster the energy. Instead, detached efficiency predominated. “We’ll adjust your medication,” he says to a patient that afternoon, barely making eye contact. “Follow up in three months.” The patient nods, but her confusion lingers behind as she gathers her belongings and leaves.
Back in his office, Dr. P. slumps in his chair, scrolling absentmindedly through an inbox full of unanswered messages. He had thought about retirement more in the last few months than in the past 20 years combined. It is not just the exhaustion; it is the creeping sense that his work no longer matters. The system is broken, and he cannot fix it.
Is This Burnout, Depression, or Both?
The relationship between burnout, depression, and anxiety remains a topic of ongoing debate in the literature. Some studies suggest these conditions share common neuroendocrine changes and that their clinical presentations often overlap, especially when looking at emotional exhaustion — a core component of burnout. This has led some researchers to propose that, in fact, burnout may represent a dimension of depression or that burnout may act as a risk factor for its development.17
Conversely, other experts emphasize that it is critical to distinguish burnout from depression and anxiety. They argue that burnout is specifically tied to work and situational stressors, whereas depression is pervasive and independent of context. This distinction is important, since the treatment approaches for these conditions differ significantly.18
A large 2019 meta-analysis provided additional clarity by examining studies that used the MBI — a widely accepted tool for measuring burnout. It found that studies employing the MBI were more effective at differentiating burnout from depression and anxiety than those using fewer specific measures. Based on these findings, it appears that depression, anxiety, and burnout are distinct conditions, although they do share some common characteristics, and they may develop in tandem.19 Likewise, burnout has an association with other medical comorbidities, such as development of headaches, insomnia, gastrointestinal distress, and musculoskeletal discomfort.19,20
A 2020 study published in the Journal of the American Medical Association (JAMA) highlighted the critical importance of distinguishing between burnout and depression in medical professionals. The findings revealed that while depression in physicians is directly related to suicidal ideation, burnout does not show a direct association with this serious symptom. On the other hand, burnout was found to have a stronger connection to the risk of medical errors compared to depression among healthcare providers.21
Back to Dr. P.
Dr. P. looks up in response to a light knock on his door. “Do you have time to talk?” says Dr. E., the office director, closing the door behind her as Dr. P. nods hesitantly. “I gather you were unhappy about what I said this morning, and I have noticed you have seemed different lately. You have been with this clinic for years, and your dedication has always been inspiring. I can see you are struggling. How are you really doing?”
For a moment, Dr. P. does not answer. He considers brushing it off, saying he was just tired, but something in her tone invites honesty. “I don’t know,” he admits, his voice heavy. “I’m exhausted. I feel like I’m failing my patients, my team, and even my family — everyone. The system is broken, and I don’t think I can keep up anymore. I’ve seen patients with depression, and maybe that is what is wrong with me — but somehow, that diagnosis does not seem to fit how I feel. When I take time off, I feel reinvested and energized, but that seems to slip away when I come back.”
Dr. E. nods, letting his words settle. “I hear you,” she says. “Maybe you are describing burnout. Burnout isn’t just feeling tired; it’s what happens when we’ve given everything we have without getting what we need in return. You are not alone in this, and you don’t have to navigate it alone.”
“Burnout,” echoes Dr. P. “Really? I know primary care doctors are at risk, but somehow I never thought I was at risk, especially not at my age and with my years of experience. Plus, didn’t I read the latest statistics showing a decrease in burnout among PCPs? “
Screening Tools for Burnout
Notably, burnout is not a formal medical diagnosis but is assessed primarily through self-reported data gathered via screening tools. This reliance on subjective reporting can make accurate measurement challenging. In response, the medical field is working toward establishing a consensus definition of burnout and standardizing measurement tools. These features should help physicians better understand prevalence moving forward.22
Although newer tools have been introduced and are being tested, the MBI, developed and introduced in the 1980s with some modifications over the years, remains the most common tool to measure burnout in the United States. Currently, there are multiple forms of this questionnaire, including one geared specifically toward healthcare professionals.5,6,23
There is a self-administered format of the MBI that, as is typical of this tool, involves responding to questions on a gradient regarding frequency. The questions pertain to each of the three main elements of burnout: exhaustion/fatigue, depersonalization or loss of empathy, and a diminished sense of personal achievement. For example, the questionnaire asks to quantify a feeling of being emotionally drained, sensitivity toward patients, and self-assessment of professional effectiveness.24
Measurements of burnout in medical providers stem back to the midpoint of the 20th century when articles describing “doctor discontent” and low morale began to point to a growth of burnout in the medical profession. Notably, measurements of physician satisfaction declined from 1986 to 1997. Studies at the time pointed to the growth of managed care, loss of physician autonomy, and increasing popularity of employed provider models as likely culprits.25 In response, in 2001, The Joint Commission mandated that all hospitals have a policy to address well-being of physicians (distinct from disciplinary processes).26
Since 2011, the American Medical Association (AMA), Mayo Clinic, and Stanford Medicine have collaborated on triennial surveys to measure burnout among U.S. medical providers.27 More recently, the AMA, recognizing the profound effect of provider burnout on healthcare organizations — including reduced efficiency, financial strain, and poorer patient outcomes — introduced a new initiative: the “Organizational Biopsy.” This tool offers a holistic approach to assessing burnout and improving organizational health across key areas such as administrative culture, efficiency, self-care, and employee retention.28
According to the AMA data, the percentage of physicians endorsing at least one symptom of burnout dropped to 48.2% in 2023. This marks the first time since the COVID-19 pandemic that the rate has fallen below 50%.29 Similarly, a recent Medscape survey reflected this downward trend, albeit with different percentages.30 Despite these variations, the data consistently highlight that a substantial proportion of physicians continue to experience burnout symptoms.
Among physicians who reported at least one symptom of burnout in the Medscape survey, 83% attributed their symptoms to job-related factors. Although female physicians were more likely to report signs of burnout than their male counterparts (56% to 44%, respectively), this gender gap appears to be narrowing compared to previous years.30
As in prior surveys, doctors singled out bureaucratic tasks as the leading contributor to burnout, with almost two-thirds of respondents citing administrative work as the primary stressor. Additional factors contributing to burnout included excessive working hours, lack of respect from administrators and colleagues, and inadequate compensation.30
Importantly, nearly one-half of the surveyed providers felt their employers failed to acknowledge or recognize issues with burnout, while another 29% said they were unsure.30 The significance of this metric cannot be overstated, since research increasingly emphasizes that addressing burnout requires systemic changes on an organizational level rather than relying solely on individual coping strategies.2,13,15,16,22
For examples of systemic changes on an organizational level that can address burnout, see Table 1.
Table 1. Organizational Level Changes to Address Burnout2,13,15,16,22 |
|
To address Dr. P.’s comment on age and experience, a 2021 Medscape survey revealed that burnout affects physicians across all age groups, with the highest prevalence among Generation X (born between 1965 and 1980) at 48%. Slightly lower rates were reported among baby boomers (born between 1946 and 1964) at 38% and millennials or Generation Y (born between 1981 and 1996) at 39%. Predictably, physicians of the baby boomer generation were the most likely to attribute burnout to the increasing role of technology in medical care.31
Data on burnout in Generation Z (born between 1997 and 2012) is more limited because this cohort is just beginning to enter training and the healthcare workforce.31
Back to Dr. P.
The medical director leans forward, her tone practical yet empathic. “Burnout can hit any of us. Here’s what I would like to suggest. First, let’s adjust your schedule. You have been taking on one of the heaviest patient loads — let’s reduce that for now so you have some breathing room. Second, I’d like to connect you to a coach we’ve partnered with. They specialize in helping physicians manage burnout and rediscover their sense of purpose. It is part of your benefit package. And, finally, let’s talk about system-level changes. You are not wrong that the system is flawed. Your insights could help us advocate for better workflows and support for the whole team.”
“Hmm,” Dr. P. clears his throat and blinks rapidly, feeling surprised. He had expected criticism, maybe even a formal warning, but not understanding or even a potential solution. “That sounds … helpful,” he begins cautiously. “But will the rest of the team be OK with me scaling back — it just shifts more of the burden onto them, doesn’t it?”
Dr. E. looks thoughtful. “They want you to succeed as much as I do — and several are worried about you. We will make it work. But this is not just about scaling back. At the core, this is about finding a way forward that works for you. Burnout often leads to early retirement. I don’t want to see you go in that direction — not without trying a new approach first. You’ve given so much to this clinic over the years, let us give something back to you.”
Over the next few months, the changes begin to take effect. With a lighter schedule, Dr. P. finds he can focus more on the patients he sees, rather than feeling overwhelmed by the sheer volume. It was in the exam room where he first noticed he was starting to enjoy seeing patients again, feeling more satisfied and less burdened.
The sessions with the coach are a revelation. Although he approaches the first meeting with deep skepticism, the opportunity to reflect on why he had gone into medicine in the first place propels a reconnection with a sense of purpose and meaning.
At morning meeting a few months later, Dr. P. speaks up again — but this time it is not with frustration. He proposes a new way to streamline administrative tasks, an idea that sparks a productive discussion among his colleagues. Dr. E., listening from the sidelines, catches his eye and smiles, and for the first time in a long while, he smiles back.
What Is a Physician Coach?
It turns out, coaching is not just for athletes. Although business coaching has been around since the early 1900s, the profession became more standardized toward the end of the 20th century with the establishment of the International Coach Federation (ICF). The ICF introduced formal training criteria and credentialing, elevating coaching to a recognized profession.32
Physician coaching is a specialized and growing area within this field. Many physician coaches are healthcare providers themselves, but this is not a requirement. Recent studies suggest that physician coaching can be a promising intervention for addressing burnout.33 However, experts agree that individual-level changes achieved through coaching must be paired with systemic organizational efforts for long-term success.15,16,22
As mentioned earlier, one notable initiative in addressing burnout on an organizational level is the AMA’s Organizational Biopsy, which gathered feedback from more than 12,000 physicians across 81 health systems in 31 states.34 Although this initiative provides valuable insight into the factors contributing to burnout and potential solutions, it represents only a fraction of the broader healthcare landscape.
For context, the American Hospital Association reports there currently are 407 health systems in the United States, and the Association of American Medical Colleges estimates nearly 1 million active physicians nationwide.35,36 This gap underscores the limitations of current programs in reaching the majority of providers. Although the AMA’s efforts to address burnout are laudable and set a strong foundation for systemic change, the limited scope highlights the need for broader, scalable interventions to support the providers and health systems that remain untouched by these initiatives. Expanding access to resources and increasing collaboration with additional health systems are critical next steps in tackling this widespread crisis.
Meet Dr. M.
Dr. M., 42 years of age and a family practice doctor in a rural area, working in two local clinics for a regional healthcare system, sits in her car in the gravel parking lot of the main rural health clinic where she has worked for the past 10 years. Beyond the clinic, fields stretch to the horizon, the early evening sunlight casting long shadows over the two-lane highway. She should have been home by now, but she cannot bring herself to leave. The idea of facing her family — the unfinished homework, the dinner conversations, the endless bedtime rituals — feels overwhelming. She stares down at her hands on the steering wheel, gripping it as if it might anchor her to something solid.
Inside the clinic that day, the pressure had been relentless. Patients had trickled in steadily, many of them presenting with complex medical and social needs: an older farmer struggling to manage his diabetes after losing his wife, a young woman concerned about her child’s persistent cough but unable to afford a specialist referral, and a woman battling chronic pain and despair after years of opioid use. For Dr. M., every encounter felt like a reminder of her limitations — not as a physician, but as someone trying to patch together solutions in a system with few resources.
In the breakroom earlier that afternoon, she had overheard the receptionist chatting with the nurse about the latest staffing changes. “Dr. M. has been quieter than usual,” she heard the receptionist comment, her voice dropping to a whisper. “You think she is OK?”
“She’s just busy,” she heard the nurse reply. “We all are.”
They were not wrong — she is busy. Too busy to eat lunch most days, too busy to notice how much weight she had lost recently, and too busy to dwell on the knot of anxiety that seemed permanently lodged in her chest. But when she caught her reflection in the mirror after washing her hands, the dark circles under her eyes and the pallor of her skin reminded her that there was a problem. That she has a problem.
That night, after finally making it home, she finds herself sitting at the kitchen table long after her husband has gone to sleep. She had missed her son’s school concert and bedtime for both kids. She looks at the note with the supper leftovers and feels … nothing. Blank. The thoughts that had been simmering below the surface for months now bubbled up: What is wrong with me? Why can’t I handle this anymore? The hopelessness she feels about her own patients’ situations is starting to bleed into her own life.
Her once-steady and capable hands now tremble slightly when she tries to hold a pen, and her mind feels like it is swimming through molasses whenever she tries to focus on charting. This is not the way she had envisioned life as a family doctor.
The hardest part, she reflects, is the isolation. In this rural area, she is the only physician for miles. Several advanced practice nurses have come and gone during her tenure, all lured by better pay and more amenities in highly populated areas. She has never felt that way; having grown up in a nearby town, she deeply appreciates her upbringing and wants the same for her children. “Ironic, isn’t it,” she muses, “that I don’t have the time to enjoy the experience with them.”
The clinic administrators are sympathetic but more focused on keeping the doors open than on supporting staff well-being. When she had hinted at feeling overwhelmed during a monthly call with the regional director, the response was brisk: “We all have to pull through. Our patients depend on us.”
She knows that is true — her patients do depend on her. But Dr. M. is beginning to realize that she is facing a choice — she is going to have to find a way to care for herself or she will not be able to care for her patients — or her family.
Physician Mental Health
In March 2022, the Lorna Breen Health Care Provider Protection Act was signed into law. The intent of the law is to eliminate barriers and break down the stigma for mental healthcare among medical providers. The legislation is named after Dr. Lorna Breen, a New York City emergency room physician who died by suicide in the spring of 2020, during the COVID-19 pandemic.37
The law allocates funds for healthcare students and providers to be trained in evidence-based methods to “reduce and prevent suicide, burnout, mental health conditions, and substance use disorders” in healthcare providers.37,38
Dr. M. clears her schedule for the morning. Sitting in the comfort of her home, she hesitates briefly before clicking the “Join Meeting” button on her laptop. As the telemedicine session connects, a video window opens and a calm, professional voice greets her. “Hi, Dr. M. I am Dr. C. It is good to meet you.”
For a moment, Dr. M. feels a wave of self-consciousness. Her finger hovers near the track pad, tempted to exit the call. Instead, she takes a deep breath, adjusts the camera, and reminds herself why she is here. Sitting on this side of the screen is unfamiliar territory, but after weeks of feeling overwhelmed and helpless, she finally has taken a friend’s advice.
A former medical school classmate had encouraged her to reach out. “If it doesn’t feel right, you can always end the call,” her friend had said. “But maybe it will help. At the very least you’ll get another perspective.” Dr. M. had decided to schedule a telemedicine appointment with a physician outside her clinic, hoping to find some clarity — or relief.
The session begins with light, casual conversation, but soon Dr. C. gently guides it toward how Dr. M. has been feeling. As Dr. M. opens up, the words begin to flow, and with them, an outpouring of emotion. She speaks of her unrelenting fatigue, the sleepless nights spent obsessively replaying patient interactions, and the heavy guilt that comes with feeling she is falling short — not only as a doctor but as a parent and partner. Voice trembling, she admits that some mornings she dreads stepping into the clinic, knowing she cannot possibly meet the demands of the day.
Dr. C., listening carefully, asks targeted questions. “Have you noticed changes in your appetite or concentration?” Yes. “Have you had thoughts of quitting medicine or feeling like you can’t go on like this?” Also yes. “Has it gotten so difficult that you contemplated hurting yourself or ending your life?” Never.
By the end of the session, Dr. C. gently and clearly shares her assessment. “What you’re describing aligns with both burnout and clinical depression. Burnout often stems from external and occupational stressors — workload, lack of resources, systemic barriers — while depression is more internal, affecting your mood, energy, and your outlook on life. They overlap and they feed into each other, but the good news is that both are treatable.”
Dr. M. nods, relieved but still apprehensive. Dr. Chen outlines a plan: a trial of an antidepressant to help lift the fog of depression, ongoing teletherapy sessions, and practical strategies for managing burnout. “It is important to focus on what is in your control,” Dr. C. adds. “You’ve spent so long advocating for your patients. Consider that now is the time to advocate for yourself — and perhaps your colleagues, too.”
As noted previously, although there is an overlap between some of the symptoms of depression and the signs of burnout, these are distinct entities and require distinct and targeted treatment. Antidepressants are not indicated for burnout. However, some psychotherapies may be appropriate for either or both conditions. Mind-body interventions such as meditation or yoga can be used as adjunctive interventions in both as well, although research is mixed regarding strength of response.18,19
Although symptoms of depression are pervasive and not related to a specific situation, signs of burnout are related to work; thus, interventions to ameliorate burnout need to address organizational-level factors.2,22,25,26 Without administrative support or intervention, a provider with burnout may need to push the limits of the system to see if change is possible, to advocate for provider needs, and/or to set clear boundaries regarding work conditions that are healthy and acceptable.
Back to Dr. M.
As the weeks pass, the fog begins to lift. The antidepressant seems to help her regain clarity and energy, while therapy provides tools to process her emotions and set boundaries. For the first time in her career, Dr. M. permits herself to take time away from the office — initially for the appointments, but eventually for other personal time. As she feels stronger emotionally, she welcomes back a sense of agency.
One day, during a conversation with a colleague at the regional health office, Dr. M. brings up her struggles. “We need to talk about burnout,” she says, surprising herself with the strength in her voice. “We are all feeling it, but no one is addressing it. We don’t even have a basic system for peer support.” Her colleague nods. “You are right. But what can we do with the resources we have?”
That question ignites something in Dr. M. Over the next few months, she begins working on small, actionable changes. She helps organize monthly virtual check-ins for rural providers to share challenges and solutions, facilitated through telehealth platforms. She collaborates with a nearby community college to explore ways to increase support staffing for rural clinics. And she starts advocating for change at the regional level, writing a letter to the health system’s leadership about the need for wellness initiatives and burnout education.
Her work begins to ripple outward. Other rural providers join her efforts, and the small changes start making a difference. While the larger systemic issues remains daunting, Dr. M. no longer feels powerless. By prioritizing her own mental health and using her experience to spark change, she finds renewed purpose — not just as a healthcare provider, but as a leader and advocate for her community.
A Word About Suicide, Burnout, and Depression
In response to a 2018 survey of more than 5,000 physicians, one in 15 (6.5%) of the respondents endorsed having had suicidal thoughts during the year prior to the survey, putting physicians at significantly higher risk of such thoughts than the general population. Female physicians appear at higher risk than male physicians, and the suicide rate for physicians exceeds the rate in the general population.39
As noted earlier in this paper, a 2020 cross-sectional study involving more than 1,200 physicians found that depression, but not physician burnout, was directly related to suicidal ideation in this population.21
Yet, with the close ties between the two conditions, it is useful to closely evaluate or self-evaluate for both burnout and depression when either is present. Burnout, as illustrated in the earlier vignettes, often creates a fertile ground for depression to develop. Although burnout itself may not directly lead to suicidal ideation, it can contribute to feelings of hopelessness, isolation, and professional dissatisfaction that increase vulnerability to depression — and, consequently, to suicidal thinking.40-42
For the PCP, who often faces the pressures of demanding workloads, complex patient needs, and systemic inefficiencies, this overlap is especially concerning. It is crucial to recognize the warning signs of burnout and depression, both in oneself and in colleagues. Symptoms such as energy loss, persistent sadness, withdrawal from professional duties or personal activities, or a decline in focus should not be dismissed as “just” overload or stress.39,40-42
The American Foundation for Suicide Prevention provides extensive information and resources (including a toolkit and confidential hotline) for suicide prevention in healthcare providers: https://afsp.org/suicide-prevention-for-healthcare-professionals/.43
A Word About Technology and Burnout
Recent advancements in artificial intelligence (AI) have introduced tools designed to assist PCPs in managing patient communications, potentially alleviating burnout. AI-driven systems can generate draft responses to patient messages, streamlining the communication process and reducing the administrative burden on clinicians.44
A study published in JAMA Network Open evaluated the implementation of a large language model used to draft patient messages in the electronic inbox. The model generated draft responses within seconds, allowing clinicians to review, edit, and send the final response back to the patient seamlessly. These integrations aimed to reduce the time clinicians spend on administrative tasks, thereby addressing factors contributing to burnout. The findings suggested that the use of AI-generated draft replies was associated with improvement in clinician well-being, indicating the potential for these tools for quick adaptation and usability in clinical workflows.45
Although these AI tools show promise in enhancing efficiency and reducing workload, it is essential to implement them thoughtfully. Ensuring that AI-generated messages maintain the quality and empathy expected in patient communications is crucial. Ongoing research and careful integration into clinical workflows are necessary to maximize the benefits of AI in reducing PCP burnout.45,47
Another exciting use of technology in medicine is the development of AI-powered medical scribes that “listen” to patient interactions and generate clinical notes automatically.46 Although the potential of this type of technology to reduce the burden of documentation is significant, it is essential to ensure that these systems accurately capture the nuances of patient encounters and maintain patient confidentiality. Proper training and oversight are necessary to integrate AI scribes effectively into clinical practice, ensuring that they enhance rather than hinder the provider-patient relationship.46,47
Take-Home Message
- Hallmark signs of burnout include emotional exhaustion, depersonalization or cynicism about work, and a sense of reduced personal efficacy.
- Although measures of burnout in PCPs remain imprecise, recent surveys show that burnout continues to be a highly prevalent and potentially dangerous occupational syndrome affecting healthcare systems.
- Addressing burnout requires recognition followed by both individual and system intervention.
- Distinguishing burnout from depression allows delivery of targeted and effective treatment.
- Looking ahead, thoughtfully applied technological advances, centered on patient care, may play a pivotal role in combating burnout among medical providers.
Ellen Feldman, MD, is with Altru Health System, Grand Forks, ND.
References
1. Rampton V, Böhmer M, Winkler A. Medical technologies past and present: How history helps to understand the digital era. J Med Humanit. 2022;43(2):343-364.
2. Sinskey JL, Margolis RD, Vinson AE. The wicked problem of physician well-being. Anesthesiol Clin. 2022;40(2):213-223.
3. King N. When a psychologist succumbed to stress, he coined the term ‘burnout.’ NPR. Published Dec. 8, 2016. https://www.npr.org/2016/12/08/504864961/when-a-psychologist-succumbed-to-stress-he-coined-the-term-burnout
4. Freudenberger HJ. Staff burn-out. J Soc Issues. 1974;30:159-165.
5. Maslach C, Leiter MP. Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103-111.
6. Maslach C, Jackson SE. The measurement of experienced burnout. J Organiz Behav. 1981;2(2):99-113.
7. Open Source Shakespeare. Speeches (lines) for Shakespeare in “Passionate Pilgrim.” https://www.opensourceshakespeare.org/views/plays/characters/charlines.php?CharID=Shakespeare&WorkID=passionatepilgrim
8. EditorEric.com. Buddenbrooks. http://www.editoreric.com/greatlit/books/Buddenbrooks.html
9. Schwartz MS, Will GT. Low morale and mutual withdrawal on a mental hospital ward. Psychiatry. 1953;16(4):337-353.
10. ICD10Data.com. 2025 ICD-10-CM Diagnosis Code Z73.0. http://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z69-Z76/Z73-/Z73.0
11. Brooks M. Burnout inclusion in ICD-11: Media got it wrong, WHO says. Published June 7, 2019. Medscape. https://www.medscape.com/viewarticle/914077
12. ICD-11 for Mortality and Morbidity Statistics. QD85 Burnout. World Health Organization. https://icd.who.int/browse/2024-01/mms/en#129180281
13. Rahaman MS, Ali Reza S, Rahman M. Burnout in the human service sector: Causes, consequences and sustainable remedial measures. International Journal of Public Sector Performance Management. 2024;13(1):129-148.
14. Agency for Healthcare Research and Quality. Physician burnout. https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html
15. Razai MS, Kooner P, Majeed A. Strategies and interventions to improve healthcare professionals’ well-being and reduce burnout. J Prim Care Community Health. 2023;14:21501319231178641.
16. Shanafelt TD. Physician well-being 2.0: Where are we and where are we going? Mayo Clin Proc. 2021;96(10):2682-2693.
17. Schonfeld IS, Bianchi R. From burnout to occupational depression: Recent developments in research on job-related distress and occupational health. Front Public Health. 2021;9:796401.
18. Parker G, Tavella G. Distinguishing burnout from clinical depression: A theoretical differentiation template. J Affect Disord. 2021;281:168-173.
19. Koutsimani P, Montgomery A, Georganta K. The relationship between burnout, depression, and anxiety: A systematic review and meta-analysis. Front Psychol. 2019;10:284.
20. Hammarström P, Rosendahl S, Gruber M, Nordin S. Somatic symptoms in burnout in a general adult population. J Psychosom Res. 2023;168:111217.
21. Menon NK, Shanafelt TD, Sinsky CA, et al. Association of physician burnout with suicidal ideation and medical errors. JAMA Netw Open. 2020;3(12):e2028780.
22. Underdahl L, Ditri M, Duthely LM. Physician burnout: Evidence-based roadmaps to prioritizing and supporting personal wellbeing. J Healthc Leadersh. 2024;16:15-27.
23. National Academy of Medicine. Valid and reliable survey instruments to measure burnout, well-being, and other work-related dimensions. https://nam.edu/valid-reliable-survey-instruments-measure-burnout-well-work-related-dimensions/
24. Mind Garden. Maslach Burnout Inventory (MBI). https://www.mindgarden.com/117-maslach-burnout-inventory-mbi
25. Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction: Results from the physician worklife study. J Gen Intern Med. 2000;15(7):441-450.
26. Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well-being: Assessment of an innovative program. J Gen Intern Med. 2007;22:1544-1552.
27. 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 and 2017. Mayo Clin Proc. 2019;94(9):1681-1694.
28. American Medical Association. Organizational well-being assessment. https://www.ama-assn.org/system/files/org-well-being-assessment.pdf
29. Berg S. Physician burnout rate drops below 50% for first time in 4 years. American Medical Association. Published July 2, 2024. https://www.ama-assn.org/practice-management/physician-health/physician-burnout-rate-drops-below-50-first-time-4-years
30. Medscape. Medscape Physcian Lifestyle & Happiness Report 2024. https://www.medscape.com/sites/public/lifestyle/2024
31. Symplr. Provider burnout by generation. Published Sept. 24, 2021. https://www.symplr.com/blog/physician-burnout-generational-issue
32. International Coaching Federation. Credentials and standards. https://coachingfederation.org/credentials-and-standards
33. Boet S, Etherington C, Dion PM, et al. Impact of coaching on physician wellness: A systematic review. PLoS One. 2023;18(2):e0281406.
34. American Medical Association. Joy in Medicine: Recognized Organizations 2024. https://www.ama-assn.org/system/files/joy-in-medicine-2024.pdf
35. American Hospital Association. https://www.aha.org
36. Association of American Medical Colleges. 2022 physician specialty data report. https://www.aamc.org/data-reports/data/2022-physician-specialty-data-report-executive-summary
37. Dr. Lorna Breen Heroes’ Foundation. President Biden signs Dr. Lorna Breen Heroes’ Foundation signature bill into law. Published March 18, 2022. https://drlornabreen.org/president-biden-signs-bill-into-law/
38. Dr. Lorna Breen Heroes’ Foundation. Dr. Lorna Breen Heroes’ Foundation hails Senate passage of legislation protecting healthcare workers’ mental health. Published Feb. 17, 2022. https://drlornabreen.org/we-did-it/
39. Shanafelt TD, Dyrbye LN, West CP, et al. Suicidal ideation and attitudes regarding help seeking in US physicians relative to the US working population. Mayo Clin Proc. 2021;96(8):2067-2080.
40. Ji YD, Robertson FC, Patel NA, et al. Assessment of risk factors for suicide among US health care professionals. JAMA Surg. 2020;155(8):713-721.
41. Harvey SB, Epstein RM, Glozier N, et al. Mental illness and suicide among physicians. Lancet. 2021;398(10303):920-930.
42. American Medical Association. Preventing physician suicide. Updated Sept. 16, 2024. https://www.ama-assn.org/practice-management/physician-health/preventing-physician-suicide
43. American Foundation for Suicide Prevention. Suicide prevention for healthcare professionals. https://afsp.org/suicide-prevention-for-healthcare-professionals/
44. James TA. How artificial intelligence is disrupting medicine and what it means for physicians. Harvard Medical School. Published April 13, 2023. https://postgraduateeducation.hms.harvard.edu/trends-medicine/how-artificial-intelligence-disrupting-medicine-what-means-physicians
45. Garcia P, Ma SP, Shah S, et al. Artificial intelligence-generated draft replies to patient inbox messages. JAMA Netw Open. 2024;7(3):e243201.
46. Agarwal P, Lall R, Girdhari R. Artificial intelligence scribes in primary care. CMAJ. 2024;196(30):E1042.
47. Pavuluri S, Sangal R, Sather J, Taylor RA. Balancing act: The complex role of artificial intelligence in addressing burnout and healthcare workforce dynamics. BMJ Health Care Inform. 2024;31(1):e101120.
Medicine always has been demanding, both emotionally and intellectually. Yet, primary care providers have found deep purpose in their work. However, the modern practice of medicine brings new challenges, such as administrative burdens, financial strain, and large patient loads, contributing to widespread burnout. This paper examines burnout in the primary care provider and its related consequences and offers practical strategies for supporting provider well-being.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content