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Nash, C. Physician Burnout: Historical Context, Psychosomatic Division, Evolution, Results, Solutions, and Recommendations. Encyclopedia. Available online: https://encyclopedia.pub/entry/58461 (accessed on 05 December 2025).
Nash C. Physician Burnout: Historical Context, Psychosomatic Division, Evolution, Results, Solutions, and Recommendations. Encyclopedia. Available at: https://encyclopedia.pub/entry/58461. Accessed December 05, 2025.
Nash, Carol. "Physician Burnout: Historical Context, Psychosomatic Division, Evolution, Results, Solutions, and Recommendations" Encyclopedia, https://encyclopedia.pub/entry/58461 (accessed December 05, 2025).
Nash, C. (2025, June 06). Physician Burnout: Historical Context, Psychosomatic Division, Evolution, Results, Solutions, and Recommendations. In Encyclopedia. https://encyclopedia.pub/entry/58461
Nash, Carol. "Physician Burnout: Historical Context, Psychosomatic Division, Evolution, Results, Solutions, and Recommendations." Encyclopedia. Web. 06 June, 2025.
Peer Reviewed
Physician Burnout: Historical Context, Psychosomatic Division, Evolution, Results, Solutions, and Recommendations
This is a peer-reviewed entry published in Encyclopedia Journal, full entry can be found at 10.3390/encyclopedia5020074

Physician burnout is a psychosomatic syndrome that arises from feeling overwhelmed with confronting issues in those with dedication or commitment to their job. It presents with emotional, mental, and physical fatigue that negatively influences patient treatment decisions and care, representing a primary occupational hazard affecting a significant number of these healthcare providers at some point in their career such that there is an urgency to the need for improvement.

physician burnout treatment decisions patient care
Physician burnout has garnered significant attention. In a PubMed search from 2020 to April 2022, more than 7000 articles were returned on it [1]. As physician burnout remains a timely topic, investigating its history, evolution, results, and solutions is relevant.

1.1. Burnout Is Defined

Physician burnout researchers introduce burnout as a concept simultaneously and independently recognized by Freudenberger and Maslach in the 1970s [2][3][4]. Yet Fredenberger coined the term with his 1974 publication [5] regarding his observations of volunteer service providers of alternative organizations, and Maslach states the primacy of this work in her 1976 publication [6]—the first of hers on this topic—that includes reports on physicians among other professionals. Both publications are narratives. Frendenberger references only three publications—his own—and Maslach cites none. It is unusual in academic assessments that recognition is given to narrative researchers as the founders of a topic of study [7]—making the scale and impact of their contribution all the more remarkable. An author on physician burnout who has recognized the priority of Fredenberger’s publication over that of Maslach presents the subsequent research of Maslach with Jackson for developing the most widely accepted standard for burnout assessment—the 1981 Maslach Burnout Inventory (MBI) [8]—including a Human Services Survey applicable to healthcare professionals [9]. The 2005-created [10] Copenhagen Burnout Inventory (CBI) now represents an additional esteemed method for burnout assessment [11]. With his death in 1999 [12], publications by Fredenberger on burnout did not continue into the 21st century, and the most recent work on burnout by Maslach is from 2009, written in Spanish [13]. In the last publication by Freudenberger on burnout in 1989, he notes his astonishment regarding the speed of adoption of the concept; however, physician burnout per se was still not a focus of his research. One researcher who has published significantly on all aspects of burnout in the current decade—particularly for physicians—is Rotenstein [14][15][16][17][18][19]. Her most cited work remains the 2018 systematic review on the topic [20], which continues to stress the importance of the work of Freudenberger and Maslach in developing the concept of physician burnout.

1.2. Historical Circumstances Precipitating Physician Burnout

Physician burnout is deemed a historical constant [21]; however, circumstances particular to the 1960s and early 1970s were such that physician burnout became obvious, widespread, and particularly detrimental by the mid-1970s when it was first described [6]. The ability of physicians to help patients recover from illnesses resulting from a focus on microbiological factors regarding disease following World War II, one not previously available to physicians before this focus [22][23], was the basis for complete patient trust in physicians [24]. This faith in physicians by patients precipitated physician self-confidence, often evolving into arrogance by the beginning of the 1960s [25]. Concomitantly, the baby boom following World War II until the mid-1960s [26] increased the proportion of young people in society, making their demographic increasingly influential in decision-making by the end of the 1960s [27]. A focus on democratic decision-making by these young people began the questioning of physician authority [25]. With this questioning came the promotion of patient-centered care [28] through the new field of bioethics, holding the physician responsible for—and demanding patients share in—their treatment decision-making [29]. The result was increasing malpractice suits against physicians, raising their insurance rates [30], and creating the evolving view that physicians should be public servants rather than small business owners [31], leading to the proletarianization of the medical profession [32]. A new view of who was appropriate as a physician came with a “brain drain” [33] and an increase in the number of women [34] and minorities [35] who gained admission to medical schools. As such, although the ability of physicians during this period to heal patients was more than ever before [36], the status of the physician became significantly reduced [37], as was the ability of the physician to gain the type of remuneration previously expected [38]. These were systematic problems [39] unsolvable by individual physicians that, by the mid-1970s, came to an apex, making physician burnout widespread and seemingly insurmountable [40].

References

  1. Nishimura, Y. Primary Care, Burnout, and Patient Safety: Way to Eliminate Avoidable Harm. Int. J. Environ. Res. Public Health 2022, 19, 10112.
  2. Arnold-Forster, A.; Moses, J.D.; Schotland, S.V. Obstacles to Physicians’ Emotional Health—Lessons from History. N. Engl. J. Med. 2022, 386, 4–7.
  3. Marchalik, D. Physician Burnout in the Modern Era. Lancet 2019, 393, 868–869.
  4. Guille, C.; Sen, S. Burnout, Depression, and Diminished Well-Being among Physicians. N. Engl. J. Med. 2024, 391, 1519–1527.
  5. Freudenberger, H.J. Staff Burn-Out. J. Soc. Issues 1974, 30, 159–165.
  6. Maslach, C. Burned-Out. Hum. Behav. 1976, 9, 16–22.
  7. Dunwoodie, K.; Macaulay, L.; Newman, A. Qualitative Interviewing in the Field of Work and Organisational Psychology: Benefits, Challenges and Guidelines for Researchers and Reviewers. Appl. Psychol. 2023, 72, 863–889.
  8. Maslach, C.; Jackson, S.E. The Measurement of Experienced Burnout. J. Organ Behav. 1981, 2, 99–113.
  9. West, C.P.; Dyrbye, L.N.; Shanafelt, T.D. Physician Burnout: Contributors, Consequences and Solutions. J. Intern. Med. 2018, 283, 516–529.
  10. Kristensen, T.S.; Borritz, M.; Villadsen, E.; Christensen, K.B. The Copenhagen Burnout Inventory: A New Tool for the Assessment of Burnout. Work. Stress. 2005, 19, 192–207.
  11. Reisdorff, E.J.; Johnston, M.M.; Lall, M.D.; Lu, D.W.; Bilimoria, K.Y.; Barton, M.A. Prospective Validity Evidence for the Abbreviated Emergency Medicine Copenhagen Burnout Inventory. Acad. Emerg. Med. 2024, 31, 782–788.
  12. Canter, M.B.; Freudenberger, L. Obituary: Herbert J. Freudenberger (1926–1999). Am. Psychol. 2001, 56, 1171.
  13. Maslach, C. Comprendiendo El Burnout. Cienc. Trab. 2009, 11, 37–43.
  14. Rotenstein, L.S.; Sinsky, C.; Cassel, C.K. How to Measure Progress in Addressing Physician Well-Being: Beyond Burnout. JAMA 2021, 326, 2129.
  15. Rotenstein, L.; Harry, E.; Wickner, P.; Gupte, A.; Neville, B.A.; Lipsitz, S.; Cullen, E.; Rozenblum, R.; Sequist, T.D.; Dudley, J. Contributors to Gender Differences in Burnout and Professional Fulfillment: A Survey of Physician Faculty. Jt. Comm. J. Qual. Patient Saf. 2021, 47, 723–730.
  16. Rotenstein, L.S.; Apathy, N.; Landon, B.; Bates, D.W. Assessment of Satisfaction With the Electronic Health Record Among Physicians in Physician-Owned vs Non–Physician-Owned Practices. JAMA Netw. Open 2022, 5, e228301.
  17. Rotenstein, L.S.; Cohen, D.J.; Marino, M.; Bates, D.W.; Edwards, S.T. Association of Clinician Practice Ownership With Ability of Primary Care Practices to Improve Quality Without Increasing Burnout. JAMA Health Forum 2023, 4, e230299.
  18. Rotenstein, L.S.; Hendrix, N.; Phillips, R.L.; Adler-Milstein, J. Team and Electronic Health Record Features and Burnout Among Family Physicians. JAMA Netw. Open 2024, 7, e2442687.
  19. Rotenstein, L.S.; Molina, M. Exploration of Electronic Health Record Patterns of Emergency Physicians—Charting the Digital Burden. JAMA Netw. Open 2024, 7, e2429749.
  20. Rotenstein, L.S.; Torre, M.; Ramos, M.A.; Rosales, R.C.; Guille, C.; Sen, S.; Mata, D.A. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA 2018, 320, 1131.
  21. Sigsbee, B.; Bernat, J.L. Physician Burnout: A Neurologic Crisis. Neurology 2014, 83, 2302–2306.
  22. Shorter, E. Doctors and Their Patients: A Social History, 1st ed.; Routledge: London, UK, 2017; ISBN 978-0-203-79304-6.
  23. Ebert, R.H. Medical Education at the Peak of the Era of Experimental Medicine. Daedalus 1986, 115, 55–81.
  24. Cassell, E.J. The Changing Concept of the Ideal Physician. Daedalus 1986, 115, 185–208.
  25. Elston, M.A. The Politics of Professional Power-Medicine in a Changing Health Service. In The Sociology of the Health Service; Gabe, J., Calnan, M., Bury, M., Eds.; Routledge: London, UK, New York, NY, USA, 1991; pp. 58–88. ISBN 978-0-415-03158-5.
  26. Van Bavel, J.; Reher, D.S. The Baby Boom and Its Causes: What We Know and What We Need to Know. Popul. Dev. Rev. 2013, 39, 257–288.
  27. Owram, D. Born at the Right Time: A History of the Baby-Boom Generation; University of Toronto Press: Toronto, ON, Canada; Buffalo, NY, USA, 1996; ISBN 978-0-8020-8086-8.
  28. Laine, C. Patient-Centered Medicine: A Professional Evolution. JAMA 1996, 275, 152.
  29. Pellegrino, E.D. The Origins and Evolution of Bioethics: Some Personal Reflections. Ken 1999, 9, 73–88.
  30. Robinson, G.O. The Medical Malpractice Crisis of the 1970’s: A Retrospective. Law Contemp. Probl. 1986, 49, 55–81.
  31. Stevens, R.A. Public Roles for the Medical Profession in the United States: Beyond Theories of Decline and Fall. Milbank Q. 2001, 79, 327–353.
  32. Michalec, B.; Cuddy, M.M.; Price, Y.; Hafferty, F.W. U.S. Physician Burnout and the Proletarianization of U.S. Doctors: A Theoretical Reframing. Soc. Sci. Med. 2024, 358, 117224.
  33. Wright, D.; Flis, N.; Gupta, M. The “Brain Drain” of Physicians: Historical Antecedents to an Ethical Debate, c. 1960-79. Philos. Ethics Humanit. Med. 2008, 3, 24.
  34. Lester, L.A. The 1970s: The Effect of Title IX and Related Legislation. In Women and the Practice of Medicine; Springer International Publishing: Cham, Switzerland, 2021; pp. 48–74. ISBN 978-3-030-74138-9.
  35. Johnson, L., Jr. Minorities in Medical School and National Medical Fellowships, Inc. 50 Years and Counting. Acad. Med. 1998, 73, 1044–1051.
  36. Girdwood, R.H. Prospects for Medicine in the 1970s. Scott. Med. J. 1972, 17, 121–129.
  37. Johnson, T.M. Physician Impairment: Social Origins of a Medical Concern. Med. Anthr. Q. 1988, 2, 17–33.
  38. Cutler, D.M. Equality, Efficiency, and Market Fundamentals: The Dynamics of International Medical-Care Reform. J. Econ. Lit. 2002, 40, 881–906.
  39. Schaufeli, W.B.; Leiter, M.P.; Maslach, C. Burnout: 35 Years of Research and Practice. Career Dev. Int. 2009, 14, 204–220.
  40. Maslach, C.; Schaufeli, W.B. Historical and Conceptual Development of Burnout. In Professional Burnout; Routledge: London, UK, 2017; pp. 1–16. ISBN 978-1-315-22797-9.
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Subjects: Psychology
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Book: Encyclopedia of Social Sciences
Online Date: 06 Jun 2025
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