LEARNING OBJECTIVES
After reading this article you will be able to:
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• understand the concept of burnout
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• recognise its symptoms and signs and associated risk factors
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• describe strategies to prevent and manage burnout in clinicians.
Burnout is a psychological condition involving sustained physical and emotional exhaustion due to ongoing high levels of occupational stress, particularly in roles involving frequent interpersonal interactions (Maslach Reference Maslach, Leiter and Fink2016). The concept, first introduced in 1971, described fatigue experienced by US air traffic controllers working long hours under intense pressure (Calabrese Reference Calabrese1971). It was later expanded by psychologist Herbert Freudenberger (Reference Freudenberger1974) to encompass the negative impact of emotionally demanding work that requires sustained compassion.
Understanding burnout in healthcare
Although healthcare professionals often find their work deeply meaningful and rewarding, they are also particularly vulnerable to burnout. The pressures brought on by crises such as the COVID-19 pandemic heighten this risk, as highlighted by a survey of UK doctors early in the pandemic (British Medical Association 2020). Burnout not only affects the well-being of healthcare workers, but also has serious consequences for patient care and organisational performance. Therefore, it is crucial to adopt evidence-based strategies to both prevent and manage burnout. Since burnout stems from workplace stress, effective interventions must address both organisational systems and individual coping mechanisms.
Today, burnout is widely recognised through the framework developed by Christina Maslach (Maslach Reference Maslach and Jackson1981), who defined it as a phenomenon consisting of three core dimensions: emotional exhaustion, depersonalisation and reduced personal accomplishment (Box 1).
The three core dimensions of burnout
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• Emotional exhaustion: a state involving physical as well as mental fatigue, portrayed as feeling overwhelmed or drained by work demands.
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• Depersonalisation: cynicism and the propensity to distance/detach oneself emotionally from those encountered in the workplace, e.g. patients or colleagues, and associated with negativity and indifferent attitude.
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• Reduced personal accomplishment: a reduced feeling of achievement and professional efficacy, resulting in perceived or actual decline in effectiveness and a loss of purpose.
(Maslach & Jackson Reference Maslach and Jackson1981)
Burnout has significant implications for practitioners’ health and well-being, the level of care delivered and the overall functioning of healthcare organisations. Recognising and addressing burnout is essential to maintaining a resilient and effective workforce. ICD-11 (World Health Organization 2018) identifies burnout as a syndrome caused by persistent, unmanaged stress in the workplace, rather than classifying it as a formal medical diagnosis. Although burnout is not itself a medical diagnosis, those affected are at notably higher risk of developing diagnosable mental health conditions, including depressive disorder, anxiety disorders and substance misuse (van Dam Reference van Dam2021).
Measurement of burnout
Levels of burnout among health and social care professionals are measured using recognised assessment scales such as the Maslach Burnout Inventory (MBI) (Maslach Reference Maslach, Jackson, Leiter, Zalaquett and Wood1997). The MBI contains 22 statements assessed on a scale ranging from ‘never’ to ‘daily’, covering the three core domains – emotional exhaustion, depersonalisation (emotional detachment/cynicism) and personal accomplishment. Results can be contrasted with normative data to identify both severity and prevalence of burnout within a workforce. A shorter version of the MBI has been developed that contains nine items covering the three domains (Schaufeli Reference Schaufeli, Leiter, Maslach, Maslach, Jackson and Leiter1996). However, this abbreviated scale could increase likelihood of false positives, resulting in an overestimation of burnout levels (Lim Reference Lim, Ong and Ong2019). Emotional exhaustion is a common concern in healthcare settings, making it an important focus for both assessment and intervention (Houdmont Reference Houdmont, Daliya and Adiamah2022).
Clinical features
Although it is not classified as a medical diagnosis, recognising the early signs and symptoms of burnout is essential for timely intervention and support. Symptoms can manifest across several domains, five of which have been highlighted by Kinman et al (Reference Kinman, Dovey and Teoh2023): the emotional, cognitive, physical, social and behavioural (Box 2).
Common symptoms of burnout
Emotional symptoms
Individuals may experience increased irritability, frustration, anxiety or panic. Common feelings include self-doubt, helplessness, emotional numbness and a loss of enthusiasm or purpose. A sense of being undervalued and a decline in job satisfaction are also frequently reported.
Cognitive symptoms
Burnout can impair concentration, lead to procrastination and make decision-making more difficult. It may also result in increased cynicism, overcritical thinking, repetitive thinking focused on minor stressors, and persistent feelings of professional inadequacy.
Physical symptoms
These include chronic fatigue, poor sleep, headaches, gastrointestinal problems and a weakened immune response, making individuals more susceptible to illness.
Social symptoms
Affected individuals often feel isolated, disconnected or alienated from colleagues, friends and even family, contributing to a sense of being alone.
Behavioural symptoms
Burnout may lead to withdrawal from social and professional interactions, a lost sense of humour, irritability and reduced empathy. Some may turn to unhealthy coping mechanisms, such as overeating, alcohol or substance use, and may begin to neglect personal needs.
(After Kinman et al, Reference Kinman, Dovey and Teoh2023)
The burnout trajectory
Burnout is a gradual process and can follow a recognisable pattern (Selye Reference Selye1956), as also noted by Edelwich & Brodsky (Reference Edelwich and Brodsky1980) in their five-stage model (enthusiasm, stagnation, frustration, apathy and intervention). From the work of subsequent scholars, these might be recast as the following: high expectations and idealism; pessimism and early job dissatisfaction; withdrawal and isolation; disengagement from work; and irreversible detachment and health breakdown ( Box 3). Box 4 presents fictitious case vignettes of clinicians along the burnout trajectory.
Five stages of burnout in healthcare professionals
Stage 1 High expectations and idealism: entry into the profession with enthusiasm, motivation and a strong desire to make a difference.
Stage 2 Pessimism and early job dissatisfaction: initial signs of disillusionment, frustration and emotional fatigue begin to surface.
Stage 3 Withdrawal and isolation: reduced engagement with colleagues and patients, increased emotional distance and detachment.
Stage 4 Disengagement from work: a marked decline in motivation, productivity and interest in professional responsibilities.
Stage 5 Irreversible detachment and health breakdown: persistent burnout may have long-term psychological and physical health consequences, including serious mental health conditions. In the differential diagnosis of burnout, the likelihood that an independent psychiatric disorder, such as a mood or anxiety disorder or substance misuse, explains the presentation must be considered.
Case vignettes: clinicians along the burnout trajectory
Vignette 1
A 55-year-old emergency department consultant presents with a mixture of mood and anxiety-related complaints to his general practitioner. She has been working as a locum for many years and over the past few years has faced disciplinary proceedings by multiple employers. Typically, after a recurrent pattern of conflict with colleagues, she would allege mistreatment. Concerns were also raised about errors at work. She was treated with antidepressants and accessed counselling, but struggled to make progress and was signed off from work.
Vignette 2
A 30-year-old newly appointed consultant in paediatrics presents to a general practitioner with low mood, fatigue and poor sleep. He started in his new post with considerable enthusiasm, aiming to change the work culture in a department short on morale and resources. His ideas for change were seen by colleagues as impractical, leaving him frustrated. He began to struggle to fulfil routine responsibilities and finally sought time off from work.
Vignette 3
A 26-year-old core trainee in psychiatry presents to a general practitioner with increasing stress-related concerns. She chose the specialty after having seen first-hand the impact of enduring mental illness in a family member and wanting to contribute to improving outcomes in mental illness. The death of a patient on a ward and a formal complaint following an unrelated incident added to her anxieties. She felt unsupported by her supervisor and the wider team and in time she became disillusioned by work.
Epidemiology
National Health Service staff
Healthcare professionals are at increased risk of experiencing burnout. The prevalence rates vary significantly across studies, owing to differences in how burnout is defined and measured across various cultural and organisational contexts. In the National Health Serivce staff survey of 2025 (NHS England 2026), completed by 71 000 doctors, 61% of doctors in training and 41% of trainers were reported to be at moderate risk of burnout.
Doctors: UK and international studies
A systematic review of 14 studies exploring the mental health of doctors in the UK found that 31–54% reported emotional exhaustion, 17–45% experienced depersonalisation and 6–40% perceived low personal accomplishment (Kinman Reference Kinman and Teoh2018). Higher rates were reported in a systematic review of 182 studies from 45 countries: 72% for emotional exhaustion, 68% for depersonalisation and 63% for low personal accomplishment (Rotenstein Reference Rotenstein, Torre and Ramos2018).
General practitioners (GPs) appear to be especially at risk. A systematic review and meta-analysis of 60 studies across 29 countries concluded that GPs worldwide are at moderate to high risk of burnout (Karuna Reference Karuna, Palmer and Scott2022).
Particularly concerning are findings from the General Medical Council’s (GMC) National Training Surveys. The 2022 survey reported that 63% of trainees and 52% of trainers were at moderate or high risk of burnout (GMC 2022). These findings reflect increases since the 2021 survey and the highest rate recorded since the questions were introduced (GMC 2022). Vicarious trauma is a major concern for psychiatry trainees, who are regularly exposed to patients’ accounts of trauma. Such exposure can result in psychological distress, manifesting as post-traumatic stress disorder (PTSD)-like symptoms, emotional detachment and professional burnout (Darod Reference Darod2025).
Psychodynamic perspective on burnout
From a psychodynamic standpoint, burnout is understood as the outcome of unresolved internal conflicts, unrealistic self-expectations and excessive emotional investment in one’s work. Rather than viewing burnout solely as a response to external job stressors, this perspective emphasises the role of unconscious drives and ego dynamics in shaping vulnerability to exhaustion and disengagement. Freudenberger (Reference Freudenberger1974, Reference Freudenberger1980) described burnout as a clinical syndrome rooted in overcommitment and the need for self-validation through professional achievement. Similarly, Edelwich & Brodsky (Reference Edelwich and Brodsky1980) conceived of it as a gradual loss of idealism resulting from the clash between personal aspirations and organisational realities. Cherniss (Reference Cherniss1980, Reference Cherniss, Schaufeli, Maslach and Marek1993) highlighted burnout as a defence against threats to self-concept, while Pines & Aronson (Reference Pines and Aronson1988) framed it as an existential crisis involving the loss of meaning in work. Collectively, psychodynamic models portray burnout as a deeply personal process of disillusionment, identity erosion and emotional depletion.
Risk factors
Organisational risk factors
Research highlights organisational conditions as the most significant contributors to burnout among healthcare professionals. Key organisational risk factors are outlined in Box 5.
Organisational risk factors for burnout in healthcare professionals
Key factors
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• Excessive workload: high caseloads, intensified duties and pressure to meet performance outcomes.
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• Demanding work schedules: long hours, shift work, frequent overtime, limited control over shift patterns and insufficient breaks.
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• Emotional demands of care: the psychological toll of continuous compassionate engagement.
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• Limited patient interaction time: reduced opportunities for meaningful patient care.
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• Restricted autonomy: minimal influence over clinical and operational decisions.
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• Poor workplace support: lack of managerial and peer support, experiences of bullying, harassment or aggression.
Additional factors
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• Lack of recognition: feeling undervalued or unacknowledged for contributions.
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• Role uncertainty: ambiguity in job expectations and conflicting responsibilities.
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• Organisational instability: frequent changes, poor communication and job insecurity.
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• Systemic pressures: bureaucratic demands, metrics-driven culture and value conflicts that hinder quality care.
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• Perceived injustice: experiences of unfair treatment, favouritism and lack of transparency.
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• Unsafe psychological climate: environments where staff mental health is not prioritised.
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• Barriers to support: stigma around help-seeking and limited access to well-being services.
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• Inadequate leadership: managers lacking time or skills to identify and support staff well-being.
A systematic review by O’Connor et al (Reference O’Connor, Muller Neff and Pitman2018) found that higher scores on burnout subscales were consistently linked to higher rates of burnout. Studies in the review consistently demonstrated that greater autonomy in the workplace, along with a perceived ability to influence work-related decisions, was associated with reduced burnout, particularly lower levels of emotional exhaustion and an enhanced sense of professional accomplishment (O’Connor Reference O’Connor, Muller Neff and Pitman2018). Reviews found that role ambiguity was associated with higher levels of emotional exhaustion (Kilfedder Reference Kilfedder, Power and Wells2001; Levert Reference Levert, Lucas and Ortlepp2003; Piko Reference Piko2006), whereas role clarity was linked to a greater sense of personal accomplishment (Green Reference Green, Albanese and Shapiro2014).
Nelson et al (Reference Nelson, Johnson and Bebbington2009) found that staff working in crisis resolution and home treatment teams in London reported a significantly higher sense of personal accomplishment compared with those in community mental health teams. They suggested that, although the demands of crisis resolution work was considerable, it may be offset by the greater autonomy experienced by staff and the advantages of working with a cohesive team. Similarly, in an earlier study Billings et al (Reference Billings, Johnson and Bebbington2003) looked at rates of satisfaction and burnout in London’s assertive outreach and community mental health teams. Their findings indicated that staff in assertive outreach teams experienced lower levels of depersonalisation and a greater sense of personal accomplishment than counterparts in community mental health teams. In a study involving a large sample of mental health professionals across England, Johnson et al (Reference Johnson, Osborn and Araya2012) found that support from colleagues and managers was associated with lower emotional strain and greater engagement with work.
Individual risk factors
Although organisational factors are dominant, individual characteristics such as those listed in Box 6 can also heighten vulnerability to burnout.
Individual risk factors for burnout in healthcare professionals
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• Being a trainee or early career professional.
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• Over-engagement, feeling excessive responsibility and having a ‘rescuer’ mindset.
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• Certain personality traits, such as competitiveness, sensitivity to stress and a tendency to internalise negative emotions.
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• Maladaptive coping styles, such as avoidance and emotion-focused and inflexible coping strategies.
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• Personal history of trauma, poor emotion regulation and difficulty setting boundaries.
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• Neurodiversity, which can create unique stress responses and coping needs.
Work–life balance and cultural pressures
A healthy work–life balance remains a challenge to many healthcare professionals. A recent UK study revealed that most doctors reported negative impacts of work demands on their personal relationships and hobbies (Parida Reference Parida, Aamir and Alom2021). Trainees, particularly women who have young children and those lacking peer support, are at greater risk of work–life strain (Rich Reference Rich, Viney and Needleman2016). The culture of self-sacrifice and high pressure often reinforces maladaptive habits formed during training.
Impact of burnout
Beyond its impact on well-being, burnout can adversely affect a person’s quality of working life and shape their career choices. Research involving healthcare practitioners has demonstrated strong associations between burnout and job dissatisfaction, disengagement and reduced organisational commitment.
A literature review of 170 observational studies found that doctors with burnout symptoms were significantly more likely to express job dissatisfaction and regret their career choice (Hodkinson Reference Hodkinson, Zhou and Johnson2022). Furthermore, those who experienced burnout were twice as likely to be involved in a patient safety incident. The UK healthcare sector is currently facing significant recruitment and retention challenges, with burnout frequently cited as a key factor contributing to workforce attrition.
Burnout also has considerable implications for job performance in healthcare. Strong associations have been identified between burnout, diminished empathy and compassion fatigue (Newell Reference Newell and MacNeil2010; Pavlova Reference Pavlova, Paine and Sinclair2023) and poor quality of staff–patient interactions (Montgomery Reference Montgomery, Panagopoulou and Esmail2019). It should be highlighted, however, that links between practitioner burnout and patient outcomes are not always found, as healthcare professionals make significant efforts to ensure that patients do not suffer, often at personal cost (Montgomery Reference Montgomery, Panagopoulou and Esmail2019; Teoh Reference Teoh, Singh and Medisauskaite2023).
Managing burnout: key points to remember
Effective prevention, prompt recognition and timely intervention are critical in addressing burnout. It should be recognised as an organisational issue rather than a medical diagnosis, requiring identification of root causes and appropriate treatment. Organisations need to set reasonable expectations for employees’ workloads, monitor working hours and improve recognition among managers and staff of the long-term risks associated with sustained overload and excessive demands. Clear communication about the manifestation of burnout is vital, with an understanding that it is a gradual process, often beginning subtly but intensifying over time. Awareness of related syndromes, their differences and management strategies is equally important, as is acknowledging that managing stress alone may not be sufficient to combat burnout.
Active engagement of all stakeholders, together with commitment at every level of the organisation, is essential. The use of recommended tools to measure burnout across all organisational levels, from departments to teams, can help interventions and evaluate effectiveness. Although individual-level changes should be prioritised, a combined approach incorporating organisational, team-based and individual-focused strategies is often the most effective. Managers must be provided with training, support and adequate time to fulfil their responsibilities, and employees should be made aware of the support available to them. Accessibility to these resources, encouragement of informal peer support and the removal of barriers to well-being improvements are all key components of a comprehensive strategy.
Anyone can experience burnout, and supporting them requires a person-centred approach, with reasonable adjustments to help them return to work. Importantly, managing burnout must be seen as a long-term strategy of identification, intervention and evaluation.
Conclusions
Organisations cannot afford to ignore burnout. The direct and indirect costs to healthcare services are enormous. Burnout not only poses a significant risk to the health and well-being of staff, but also undermines job performance, increasing the likelihood of suboptimal care and serious patient safety incidents.
Burnout is a common reason for high staff turnover and is of grave concern, given the current staff shortage in the UK’s healthcare services. Unfortunately, burnout is frequently misconceptualised as an individual problem – viewed as an ‘illness’, a failure to cope or even a sign of personal weakness – thereby obscuring its underlying causes. As a result, interventions tend to focus predominantly on individual resilience, rather than addressing the unhealthy organisational practices that lie at the core of burnout. Awareness of its presentation, and understanding how it develops gradually over time, can support the early identification of signs of distress in burnout. Although approaches focused on the individual are essential, they will not be effective in isolation unless accompanied by organisational interventions that are embedded into policy and practice.
Employee surveys can be used to track levels of burnout and identify organisational risk factors over time. At the same time, attention must be paid to early detection and proactive management. Such an approach comes with challenges, as health and social care professionals take pride in maintaining high performance even when experiencing burnout, resulting in difficulties in recognising the condition at a critical stage. Including burnout as a quality metric could help raise awareness of its wide-ranging costs and highlight the need for evidence-informed interventions. Care must be taken, however, to ensure that any sector-level monitoring processes are adequately resourced and do not add to pressures faced by managers or healthcare staff.
Many approaches can help reduce the impact of vicarious trauma, particularly among trainees. Regular supervision offers a structured setting to reflect on and process clinical experiences, while peer support programmes foster connection and shared coping strategies. Resilience-building practices – such as mindfulness, self-care training and structured debriefing – help trainees to manage emotional demands. Additionally, some trainees experience vicarious resilience, gaining a deeper sense of professional fulfilment and emotional growth through their work with trauma survivors. Further research is needed to understand reasons for reduced rates of burnout in teams such as crisis and assertive outreach.
MCQs
Select the single best option for each question stem
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1 The core dimensions of burnout include:
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a depersonalisation
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b fatigue
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c self-harm
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d emotional instability
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e psychosis.
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2 The burnout trajectory typically includes:
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a mania
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b psychosis
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c pessimism and early job dissatisfaction
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d generalised anxiety
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e rumination.
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3 Personality traits and coping styles linked to burnout include:
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a avoidance
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b humour
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c impulsivity
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d paranoia
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e sociopathy.
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4 Psychodynamic theories highlight an association between burnout and:
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a defence against threats to the superego
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b projection
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c identity erosion
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d reaction formation
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e nihilism.
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5 Monitoring and managing burnout can be assisted by:
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a employment surveys
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b including burnout as quality metric
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c supervision
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d resilience-building practices
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e all of the above.
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MCQ answers
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1 a
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2 c
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3 a
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4 c
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5 e
Data availability
Data availability is not applicable to this article as no new data were created or analysed in this study.
Acknowledgements
We thank Victoria Drake and Olivia Marcoulidies for their review and comments on the draft article. W.A. thanks Dr Girish Kunigiri for support with formulating ideas on the topic and a staff survey on burnout. We made use of ChatGPT to assist with searching for articles relevant to the topic of burnout, to check for overlap of text with published material and to collate references.
Author contributions
W.A. was responsible for developing ideas for the article, reviewing the literature and preparing the draft. V.J. was responsible for updating the draft with current evidence, the case vignettes, MCQs and references.
Funding
This research received no specific grant from any funding agency, commercial or not-for-profit sectors.
Declaration of interest
None.
eLetters
No eLetters have been published for this article.