Health care professionals (HCP) are at high risk of burnout with a prevalence rate of 70% amongst physicians [1] and somewhat 50% amongst nurses [2,3]. Even a few burnout staff members can tarnish the image of any hospital, however reputed, by becoming the source of poorer patient satisfaction, impaired professionalism and communication, suicidal ideations, professional errors and near misses resulting in adverse patient outcomes.

Jawahar Lal Nehru Medical College Hospital (JNMCH) at Aligarh, India is a busy 1300 bedded tertiary care center. The twin objectives of this observational, quantitative cum qualitative, single-center cross sectional study at JNMCH, were to evaluate prevalence of burnout of HCP at Jawahar Lal Nehru Medical College and to determine which of the three subscale categories of burnout (Emotional Exhaustion [EE], Depersonalization [DP] and sense of Low Personal Achievement [LPA]) is affected the most and whether it differ between doctors and nurses. 

After institutional approval, a sample size of 60, 30 for each of the two groups i.e., doctors and nurses, was made in accordance with Green & Thorogood 2004 guideline [4].The data was collected from doctors and nurses between 15-28^th February 2021. A 22-item questionnaire based on Maslach Burnout Inventory for Healthcare workers was randomly distributed to doctors and nurses to assess the three domains of burnout: Emotional Exhaustion (EE), Depersonalization (DP), sense of Low Personal achievement (LPA) [5]. These questionnaires are shown in Table 1. 

Table 1: The 22-item Maslach Burnout Inventory for Healthcare workers used to assess the three domains of burnout.

For this project, we adopted the 7-point Likert score that was used by Lim et al, [6] to assess the burnout response of doctors and nurses to each of the 22 question- 0: Never, 1: A few times a year or less, 2: Once a month or less, 3: A few times a month, 4: Once a week, 

5: A few times a week, 6: Every day. Since each subscale (EE, DP and LPA) measures its own unique dimension of burnout and it has been strongly recommended that the scores should not be combined to form a single burnout scale and hence the scores of each subscale (EE, DP, and LPA) were categorized as: 

• Low

• Moderate and,

• High levels 

of burnout [6]. Hopefully, this shall provide a better understanding of the problem by administrators of the hospital where the survey is conducted, which in this case was JNMCH. 

We could categorize burnout levels as follows:

• For EE: low level burnout: (0–16 score), moderate (17–26 score) and high (>27 score).

• For DP: low level or burnout: (0–6 score), moderate (7–12 score) and high (>13 score). 

• For LPA: low (<31 score), moderate (32–38 score) and high (>39 score).

It was made clear to all participants that their participation was purely voluntary without any coercion. They were ensured that their identity would not be disclosed at any stage of this project.

All the participants were distributed the hard copy of this questionnaire proforma and were requested to give responses from their viewpoint within a week. Participants were advised not to mention their name in this proforma. They were assured that their response would remain anonymous.

However, within the stipulated time-period, 5 staff nurses failed to return the proforma while another 3 nurses had submitted forms that were inadequately filled and hence were excluded and not considered for data analysis. Hence the final survey number was 52 participants and their responses were analyzed using independent sample t-test to compare the difference in responses of doctors and nurses. 

As can be observed from Table 2, the gender distribution of participants was nearly identical in both the groups. 70% or more were females in either group. Amongst doctors, those with less than 5 years experience showed greater willingness to participate in this study (73.3%). 

Table 2: Demographic variables of doctors and nurses.

M- Male, F- Female, No.- Number, P value- Probability value

Table 3 shows that Emotional Exhaustion was noted to be low or zero amongst both the doctors and nurses (19 each). Surprisingly, 30% doctors reported high level of emotional exhaustion as compared to only 1 nurse (4.5%).

Table 3: Comparisons of subscale cut-off values in relation to Emotional Exhaustion in the two groups.

MBI-HCW: Maslach Burnout Inventory-Healthcare Worker 

As can be seen from Table 4, none of the nursing staff members at Jawahar Lal Nehru Medical College report high or moderate effect of Depersonalization. On the contrary, over 33% of doctors reported high or moderate depersonalization. It is evident that depersonalization affected doctors in a significantly greater number as compared to nursing staff members (p= 0.011) in this prestigious institution.

Table 4: Comparisons of subscale cut-off values and depersonalization symptoms in the two groups.

MBI-HCW: Maslach Burnout Inventory-Healthcare Worker

Feeling of low personal achievement was either 0 or of a very low level amongst both the doctors and nursing staff members (Table 5). No difference was noted amongst either group (p=0.387) in this subscale of burnout. 

Table 5: Comparisons of subscale cut-off values and symptoms of Low Personal Achievement in the MBI-HSS.

MBI-HCW: Maslach Burnout Inventory-Healthcare Worker

There was a significantly high prevalence of high or moderate emotional exhaustion (p=0.024) and depersonalization (p= 0.040) amongst female doctors as compared to male doctors. This gender inequality was not noted amongst nursing staff members. This may be attributed to a small sample size of the present survey and necessitates a larger survey size to confirm these vital issues among female doctors. On the contrary, sense of low personal achievement did not show any gender inequality amongst doctors and nursing staff members (p= 0.506) in this survey (Table 6).

Table 6: Comparisons of male versus female subscale cut-off values and burnout symptoms in the MBI-HSS.

MBI-HCW: Maslach Burnout Inventory-Healthcare Worker

This survey, first of its kind at JNMCH, highlighted the important issue of burnout amongst its doctors and staff nurses in this prestigious institution. The findings were disturbing since they suggest 100% prevalence of burnout as against a burnout range of 50-70% reported in other international surveys [1,2,3]. This high prevalence rate at JNMCH during our survey may be attributed to the timing of this survey. The present survey was carried out during the peak of Covd-19 pandemic that had overwhelmed the entire world and had specifically hurt the HCW. It is well recognized that job stress contributes to significant occupational hazard that can

impair both health and work performance [7,5]. A burnout survey at JNMCH in normal times may give a different result.

Two important findings of this survey were that burnout issues were more common amongst doctors as compared to nursing staff members and female doctors face a significantly higher incidence of EE and DP as compared to male doctors. 

The incidence of burnout amongst doctors and nurses were of different magnitude at JNMCH. Emotional exhaustion was of high category amongst doctors (30%) as compared to only 4.5 % in nursing staff. Similarly the incidence of Depersonalization of moderate intensity was 23% amongst doctors as compared to none in nursing staff. In contrast, Sense of low personal achievement was of low intensity in both the groups ranging between 96.6-100%). This finding is in agreement to Medscape National Physician Report, which indicates that women physicians reported more commonly symptoms of burnout (in 2015, 51% female vs 43% male and in 2020, 48% female vs 37% male) [8].

Our finding of higher burnout prevalence amongst female HCW at JNMCH is in agreement to some large surveys reported by other workers. A recent survey conducted in 2017 comprising 15,000 physicians from 29 specialties observed that burnout was 48 percent amongst female physicians as compared to 38 percent in male physicians [9]. Other similar surveys too found that female HCW were more likely to exhibit burnout symptoms than their male counterparts [10,11].

It is of outmost importance for the hospital administrators to address the causes of burnout with practical solutions.

Personal management strategies may be suggested to the hospital administrators for HCW overcome burnout phenomenon, which may include motivation to do regular physical exercise, pursuing hobbies, meditation, and spiritual strategies, social support, and communication with expert psychotherapists. 

At another level, this prestigious institution may include certain interventions and safeguards for tackling the burnout issue by mandating a maximum of 48 working hours per week rule, protected rest periods during and between shifts, and counseling services. 

The administrators at Jawahar Lal Nehru Medical College should take appropriate steps when they notice difficult colleagues, fear among employees of making mistakes, and HCW being blamed without appreciation. Creating a “no blame” culture in this institution may minimize burnout. 

In conclusion, this study observed that all grades of HCW at JNMCH reported burnout with higher severity prevalence amongst doctors as compared to its nursing staff members. Female participants demonstrated a higher tendency to burnout as compared to their male counterparts. 

1. Lamothe, M. et al. “To Be or Not to Be Empathic: The Combined Role of Empathic Concern and Perspective Taking in Understanding Burnout in General Practice.” BMC Family Practice, vol. 15, 2014, p. 15.

2. Gelsema, T. et al. “A Longitudinal Study of Job Stress in the Nursing Profession: Causes and Consequences.” Journal of Nursing Management, vol. 14, no. 4, 2006, pp. 289–299.

3. Poncet, M.C. et al. “Burnout Syndrome in Critical Care Nursing Staff.” American Journal of Respiratory and Critical Care Medicine, vol. 175, no. 7, 2007, pp. 698–704.

4. Green, J., and N. Thorogood. “Qualitative Methods for Health Research.” Sociological Research Online, vol. 9, no. 4, 2004, pp. 177–180.

5. Maslach, C. et al. Maslach Burnout Inventory Manual. 4th ed., Mind Garden, Inc., 1996–2016.

6. Lim, W.Y. et al. “The Abbreviated Maslach Burnout Inventory Can Overestimate Burnout: A Study of Anesthesiology Residents.” Journal of Clinical Medicine, vol. 9, 2020, p. 61.

7. Leiter, M.P., and C. Maslach. “Areas of Worklife: A Structured Approach to Organizational Predictors of Job Burnout.” Research in Occupational and Well-Being, vol. 3, 2003, pp. 91–134.

8. Medscape. National Physician Burnout and Suicide Report 2020. Medscape, 2020, https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460.

9. Peckham, C. Medscape National Physician Burnout and Depression Report 2018. Medscape, 2018, https://www.medscape.com/slideshow/2018-lifestyle-burnoutdepression-6009235.

10. Shenoi, A.N. et al. “Burnout and Psychological Distress among Pediatric Critical Care Physicians in the United States.” Critical Care Medicine, vol. 46, no. 1, 2018, pp. 116–122.

11. Shanafelt, T.D. et al. “Burnout and Career Satisfaction among US Oncologists.” Journal of Clinical Oncology, vol. 32, no. 7, 2014, pp. 678–686.