Recognizing and Fighting Burnout Among Healthcare Professionals

Healthcare is one of the most meaningful careers a person can choose, and one of the most demanding. Long hours, high-stakes decisions, and near-constant exposure to human suffering take a toll, and for generations, the culture of medicine has treated that toll as simply part of the job.

Ask a group of researchers to define burnout, though, and you may get very different answers back. Dr. Srijan Sen, a psychiatrist and neuroscientist who directs the Eisenberg Family Depression Center at the University of Michigan, co-authored a 2018 systematic review published in JAMA that examined 182 studies on physician burnout and found dramatic inconsistency in how researchers defined and measured it. “There were 140 different definitions of burnout in the scientific literature. Everyone had a different definition,” he says. “I don’t think it’s a great term. It just captures stress.”

That confusion matters, especially for students who are still deciding whether this career is right for them. Understanding what burnout actually is, what drives it, and how to protect against it can shape how a person approaches training long before they ever set foot in a hospital.

Dr. Adrienne Mann knows that toll firsthand. After the birth of her second child, she hit a wall: “I got profoundly burnt out,” she says. “Through that burnout, I ended up hiring a coach, and that transformed my relationship to myself, my work, and my understanding of whose job my own well-being was in this career, which turns out is my job.” Dr. Mann, a hospitalist at the Rocky Mountain Regional VA Medical Center in Denver, later built that lesson into Better Together, a coaching program now used by physicians and trainees at institutions across the country.

Keep reading to learn what burnout really is, what’s driving the mental health crisis among healthcare workers, and what aspiring providers can do to protect themselves before they even start their training.

Burnout has become a catch-all term. Dr. Mann relies on the Maslach Burnout Inventory, the standard research tool for measuring the condition. “Burnout has three domains: emotional exhaustion, depersonalization, and personal accomplishment,” she explains. “The inventory looks at how people are doing in regard to those three domains, and burnout is when you score a certain number on that scale. Certainly burnout and depression can be comorbid, meaning they can happen at the same time, but they’re not the same thing. They’re not interchangeable.”

Dr. Sen takes a more skeptical view of the term itself. He believes burnout, as it’s commonly measured, overlaps heavily with depression and anxiety, and that the field would be better served by studying those conditions directly. “When burnout is measured, it looks pretty similar to depression, but it’s really hard to study consistently because everyone means something different when they talk about burnout,” he says. He also notes that using the word can serve a purpose: it may feel safer than naming depression or suicide risk directly. “I think saying burnout is a way of avoiding stigma. It helps people acknowledge that they’re struggling without having to deal with that stigma,” he notes.

The two researchers point to different, complementary root causes. For Dr. Sen, whose Intern Health Study has followed tens of thousands of physicians from before their training begins through their most difficult early years, the data points to one dominant factor: workload. “Far and away, the biggest driver is workload,” he says. “We’re asking too few people to do too much work.” Much of that load has nothing to do with patient care. “A lot of that work is not face-to-face work with patients, but working on a computer, documenting, trying to get insurance coverage and prior authorizations, things that are not generative and not enjoyable.”

The Intern Health Study has actually tracked this in real time. As duty-hour restrictions cut intern work weeks from roughly 70 hours to the high 50s, depression and burnout rates among interns dropped by about 30 percent, a finding consistent with Sen’s other published research showing depression risk climbs steadily as weekly work hours rise. “There hasn’t been any other factor that has been shown in a causal way to be nearly as related to burnout and depression,” Dr. Sen says.

Dr. Mann’s research looks more at the culture that surrounds that workload. She describes a deeply ingrained system in medicine that prizes self-sacrifice above all else. “There’s a belief that we have to be perfect all of the time, a belief that we have to sacrifice ourselves, our social lives, our personal lives, at the altar of patient care or academics or this identity we chose, often when we were so young,” she says. “We’re socialized in medicine to self-sacrifice, and then we’re surprised later when we don’t have ourselves anymore.”

Dr. Mann connects that pattern to a well-established framework in psychology. Self-determination theory, developed by psychologists Edward Deci and Richard Ryan, holds that people thrive when three basic needs are met: autonomy, competence, and relatedness. Dr. Mann’s ongoing research looks at burnout through that lens. “Burnout is a symptom of loss of self-determination,” she says. “It’s a symptom of not feeling like we have agency or autonomy in our training or our work, of feeling disconnected from each other and our patients, and of losing a sense of competency, of feeling like we’re not doing a good enough job. A lot of things about medical training make those domains hard to hold onto.”

That socialization doesn’t land equally on everyone. Dr. Mann’s research has found that women physicians shoulder a disproportionate share of the burden, both because of broader cultural expectations and because of measurable disparities within medicine itself. “Women are also socialized to be hyper-responsible, to manage everything, to do endless amounts of cognitive and emotional labor,” she says. 

A 2023 study in the Journal of the American Medical Informatics Association backs this up: women physicians receive significantly more patient messages through their electronic health record inboxes than their male counterparts, a gap that widened further during the pandemic and is just one of several ways the disparity shows up in day-to-day practice.

Catching the early signs of burnout or depression is far easier than recovering once someone is deep in it, though what those signs look like differs from person to person.

Dr. Mann describes learning to recognize her own pattern only after going through it more than once: “For me, it shows up as a story I tell myself, that I’m overextended and nobody appreciates all the work I’m doing,” she says. “I think burnout looks different for everybody, but for many people, it takes going through it and coming out of it a couple of times before you can say, ‘I remember how this feels,’ and get help earlier.”

Dr. Sen points to more concrete signals to track: a mood that stays low for a sustained period, a loss of interest in things that usually bring joy, changes in sleep patterns, and pulling away from other people. “Trying to understand ourselves better before getting into it is important,” he says. “What helps people cope with stress and what their triggers are are different for everyone.” He recommends that students think now about what matters most to their own well-being, whether that’s sleep, exercise, or time with people they love, so they have a plan to prioritize it before the stress hits.

A common critique of interventions like coaching is that they place the burden of fixing a systemic problem back onto the individual.

“I will always combat the idea that it’s one or the other,” Dr. Mann says. “Coaching is a powerful tool that, for the right people, can be transformative in their relationship to themselves and their work. And there need to be systemic changes that will take a very long time to happen.” 

Her confidence is backed by data: a pilot randomized controlled trial of Better Together found statistically significant improvements in burnout, self-compassion, and imposter syndrome among participating physicians. 

At the same time, she’s direct about where personal responsibility begins. “It’s nobody’s job but yours,” she says of protecting your own well-being. “We can’t walk around expecting the school or the residency program or the institution to know what we need. It’s up to us to figure out what we need and find a way to have that need met.”

Dr. Sen frames the systemic responsibility even more pointedly, particularly for the people who run healthcare organizations. “Healthcare organizations, CEOs of healthcare systems and hospitals, really have the power,” he says. “The solutions are largely to hire more people: training more doctors, hiring physician assistants, nurse practitioners, and clerks to offload work that doesn’t need to be done by doctors, so doctors can focus on the work only doctors can do.” 

He acknowledges the cost, but argues it pays for itself. “Doctors who aren’t depressed perform better, can do more work and higher quality work, and it’s undoubtedly better for patients. It’s probably cheaper to hire somebody to handle insurance work than it is to replace a doctor in the long run.”

Despite the scale of the problem, one population offers proof that meaningful change is possible: training physicians.

“We reduced depression and burnout, when measured, by about 30 percent over the last 20 years, and that’s mostly been driven by work hours going down,” Dr. Sen says. He believes the same playbook, reducing workload and building out support staff, could work more broadly across medicine and even beyond it. “We’ve made progress in this one group of doctors. That gives me hope we could do it more broadly, both in medicine and even more broadly given the increase in depression and anxiety we’re seeing across the country.” He’s pointing to a well-documented trend: diagnosed depression and anxiety among U.S. adolescents and young adults have both climbed sharply over the past decade.

Dr. Mann sees progress in how openly the next generation talks about their own struggles. “Burnout is in the vocabulary now in a way that it wasn’t 10 years ago when I was in training,” she says. “Residents come to me and say, ‘I’m really burnt out,’ and that’s great, not that it’s great they’re burnt out, but that they have the awareness to notice it.” 

Dr. Sen agrees the culture is shifting, even if there’s more work to do. “How openly medical students today talk about their mental health with classmates and colleagues is a night-and-day difference from 20 or 25 years ago,” he says. “A much higher proportion of medical students and residents today get treatment, either therapy or medication.”

For students still deciding on a path into healthcare, that self-knowledge starts now, long before residency.

“Know and understand yourself, whether that’s through coaching, therapy, or just connecting with friends and mentors,” Dr. Mann says. “Meet yourself there with grace and acceptance, and recognize that this is a hard job we do. We need help in different ways, and all of us are different, and that’s what makes us good at this job.” She also encourages students evaluating programs to look beyond curriculum and match rates. “Look for medical schools or training programs that offer opportunities for not only your professional growth, but your personal growth as well. That tells you a school is invested in the whole person, not just the career.”

Dr. Sen encourages students to seek out mentors and specialties that fit their own lives, not just their ambitions. “Finding doctors in practice who have a career and lifestyle you think you’d want for yourself, and trying to work toward that, is important,” he says. “Different types of medicine have different stressors. Figuring out which ones fit best for you, personally and for your life and career goals, matters.”