2.1. Using the MBI to Measure Physician Burnout during COVID-19

For the first part of the evaluation of physician burnout in this review, the Maslach Burnout Inventory (MBI) was used. The MBI questionnaire contains 22 items that were designed to evaluate three particular components of burnout: emotional exhaustion, depersonalisation and personal accomplishment ^[1]. To our knowledge, there have only been three studies so far that have explored physician burnout during this pandemic using the MBI.

Wu et al. first explored the prevalence of burnout amongst medical staff in China, when China was the epicenter of the virus ^[7]. This study surveyed 220 physicians, with an equal split between males and females. All participants were given the Maslach Burnout Inventory–medical personnel (MBI-HSS(MP)) to complete. The results recorded an 86% response rate ^[7]. When individually asked about their attitudes towards COVID-19, the results demonstrated that only 23% of physicians had felt more burnout compared with before the COVID-19 crisis, 15% of respondents neither disagreed nor agreed to feeling ‘more burnout’ and 62% disagreed to feeling more burnout ^[7]. Results from MBI suggested that almost 25% of the sample felt increased emotional exhaustion and depersonalisation, with almost half of the participants reporting decreased personal accomplishment ^[7]. In comparison, another study was conducted by Guisti et al. who surveyed healthcare professionals working in a health institution in Northern Italy ^[11]. This study included a sample of 330 healthcare professionals who took part in the online survey that assessed burnout using the Maslach burnout Inventory-Human Service Survey (MBI-HSS). Results showed that more than two-thirds of participants had reported moderate to severe levels of emotional exhaustion and reduced personal accomplishment, and more than a quarter of the sample reported moderate to severe levels of depersonalisation. This level of physician burnout was further supported by Dimitriu et al. who also assessed burnout using the Maslach Burnout Inventory- Medical Personnel (MBI-HSS(MP)) ^[12]. One hundred medical residents were sent questionnaires including the 22 questions from the MBI. On average, 76% of the sample reported burnout. The authors noted that this level of burnout was “superior to studies conducted in normal periods” ^[12].

When Wu et al. further questioned them about their main worries and stress, 64% reported that they worried about becoming infected and 76% were worried about their families contracting the virus ^[7]. Both Wu et al. and Dimitriu et al. also found that there was a higher prevalence of burnout syndrome in staff working in regular wards compared to those working on the front line ^[7][12]. This idea will be further discussed in 5.1 Occupational Factors.

Guisti et al. also found that several personal and work-related factors contributed to the level of burnout ^[11]. The main reported predictors of burnout amidst this pandemic included:

• occupational factors such as department of work,

• female gender,

• increased work hours.

2.2. Other Survey Instruments to Measure Physician Burnout during COVID-19

Two other studies have reported the impact of COVID-19 on physician burnout, however, they have used other survey instruments other than the Maslach Burnout Inventory.

The first study by Morgantini et al. analysed 2707 responses from healthcare workers across 66 countries on their experiences ^[13]. Assessment of burnout was indicated by a “single item measure of emotional exhaustion” ^[13]. Hence, depersonalisation and personal accomplishment were not taken into account. More than half, 51.4%, of respondents reported burnout purely due to their work circumstances. The results found that adequate personal protective equipment (PPE) was a protective factor against reported burnout. The lack of PPE has been raised in many different countries and has led to significant levels of frustration ^[13]. Contrary to the findings from Wu et al. and Dimitriu et al., Morgantini et al. found that burnout was associated with exposure to COVID-19 patients (95% CI = 1.05–1.32, p = 0.005) ^[13].

The second study by Kannampallil et al. included a web-based survey which was sent to 1375 US physician trainees that assessed burnout using the Stanford Professional Fulfillment Index (PFI) ^[14]. The three components of burnout measured using the MBI, emotional exhaustion, depersonalization and personal accomplishment, correlates with the PFI, however, the authors’ decision to use PFI over MBI was due to the fact that the questions from the PFI captured burnout in the “past two weeks” ^[14]. There was a 29% response rate, and the sample was broadly split into “exposed group” and “unexposed group” accordingly, based on their response to the question about caring for patients currently being test for COVID-19 ^[14]. The results overall found certain predictors for burnout, which further supports the earlier mentioned predictors of burnout: female gender, increased work hours and family concerns. Doctors have often expressed the risks to their families but also one can recognise the feeling of being ‘alone’, with no one to turn to for help. Existential questions about what will happen to their families if they fall ill are bound to be prominent fears. There are a few studies that have addressed this question, but this will likely come up in the next few months.

Emerging papers ^[15] further reinforced these finding from listening sessions that were conducted with healthcare professionals. Along with inadequate access to PPE, other causes of anxiety leading to burnout were thought to be lack of access to up to date information and communications and unknowingly bringing COVID-19 infection home.