CONFERENCE PAPER
Published Online: January 29, 2024
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Advancing Healthcare Innovation: Multidisciplinary Collaboration and Translational Research
Research on risk factors for doctor burnout during
COVID-19 epidemic
Gaurav Bhatnagara |Pallavi Nidodeb | Pragya Bhatnagarc |Sunita Satapathyd |
Tarangini Maurya | Girish Kumar If
e
aMaharashtra Institute of Physiotherapy, Latur, India, Professor, Musculoskeletal Physiotherapy.
bESIC Medical College Kalaburgi, Karnataka, India, Assistant Professor, Department of Emergency Medicine.
cMaharashtra institute of dental sciences (Dental College), Latur, India, Tutor, Department of Oral Pathology and Microbiology.
dCenturion University of Technology and Management, Bhubaneswar, India, Assistant Professor, Department of Zoology.
eUttar Pradesh University of Medical Sciences, Saifai, Uttar Pradesh, India, Demonstrator, Faculty of Nursing.
fJSS Dental College, JSSAHER University, Mysore, India, Assistant Professor, Department of Orthodontics and dentofacial orthopedics.
Abstract Burnout, recognized as a syndrome linked to chronic workplace stress by the World Health Organization (WHO),
is a prevalent issue across various professions, irrespective of title or rank. Identifying exhaustion indicators and
implementing preventive or corrective measures are vital to mitigate long-term adverse impacts on quality of life. Utilizing
the "Maslach Burnout Inventory Human Services Survey (MBI-HSS)" through online analysis, this study aimed to establish
the frequency of Burnout Syndrome (BOS) within the target population. The risk of BOS development doubled when
participants financed their endeavors and faced abuse from patients' family members, while decreasing with participants'
average age. Female gender correlated with higher emotional fatigue, and male gender predicted depersonalization (DP).
Infection with or death from COVID-19 among coworkers or family members associated with elevated Employee
Engagement (EE) and diminished Personal Accomplishment (PA). The COVID-19 epidemic introduced additional elements
contributing to BOS, prompting measures such as providing psychological support, organizing working hours, adjusting pay,
supplying personal protective equipment, and offering instruction on safety measures.
Keywords: COVID-19, Burnout syndrome, Depersonalization, Employee engagement, Personal accomplishment
1. Introduction
The field of medicine is regarded as one of the most difficult and stressful careers available, with significant
repercussions resulting from poor decision-making that affects patient care. It is becoming apparent that the psychological
syndrome known as burnout, which has been described as physical weariness, decentralization, and feeling less successful in
day-to-day work, is a factor that affects not only the health of physicians but also the patients under their care (Amanullah et
al., 2020). The Global Healthcare Issues, Burning was a syndrome but believed from continuous job pressure that is not well
managed (Kurniawaty and Tawil, 2023). This illness, which has been given the designation of Cov-19, is fought for the whole
globe. As an outcome of the rapid spread of the illness and the large number of deaths that have occurred as a direct result of
the severity of the illness, the tactics that are implemented worldwide in an effort to overcome the pandemic have come to
the forefront. However, in contrast to the significant focus that has been placed on treatments and vaccinations, systemic and
meaningful actions have not been taken to address the risk factors that lead to burnout among healthcare personnel (ÖNEN
SERTÖZ et al., 2021). The term "burnout syndrome" refers to a collection of Behavioral symptoms, the root cause of prolonged
exposure to the psychological and interpersonal pressures that are present in the workplace. The following three aspects are
used to characterize indications and symptoms: mental and emotional weariness, a lack of personal achievement, and
depersonalization (Guastello et al., 2022). During the course of the epidemic, doctors faced a number of additional stressors
that contributed to their burnout. These included concerns regarding the support that their organization would provide for
their personal and family needs in the event that they contracted the infection, a rise in the need for childcare due to longer
workdays and school holidays, fears that would cause the illness to settle in their family, no accessibility to current information
and communication, and increased demands for childcare (Alkhamees et al., 2023). Figure 1 depicts the levels of burnout
syndrome. The term "burnout syndrome" refers to a collection of emotional symptoms, the root cause of prolonged exposure
to the psychological and interpersonal pressures that are present in the workplace. The following three aspects may be used
to characterize this group of indications and symptoms: mental and emotional weariness, a lack of personal achievement, and
depersonalization (Izdebski et al., 2023). Workers in the healthcare industry are more prone to experiencing burnout, which is
Multidiscip. Rev. (2023) 6:e2023ss001 Supplementary Issue: Medical (AlliedCon 2023)
Bhatnagar et al. (2023) 2
concerning when one considers clinical practice to be a crucial element in the emergence of burn-out, as it involves constant
interaction with patients and their suffering. Moreover, burn-out healthcare personnel may perform worse and have a
detrimental impact on the effectiveness of the medical system across the board as well as the particular division in which they
are employed.
Figure 1 Level of Burnout Syndrome.
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The remaining text of the essay is as follows: Part 2 of the study summarizes the relevant studies, Section 3 gives the
suggested strategy, Section 4 shows the outcome and Section 5 summarizes the paper.
2. Related works
Respiratory syndrome coronavirus (MERS-CoV) is responsible for large outbreaks. Using a questionnaire package that
included the analyzing themeselves disquiet scalling, the analyzing themeselves despair scalling and the shortened coping style
survey, a cross-sectional survey was carried out in Gansu. To identify the factors that influence the indications of depression
or anxiety, a linear regression was applied (Zhu et al., 2020). People who suffer from noncommunicable illnesses (also known
as NCDs) can contract coronavirus disease (COV-19) as well as develop problems as a result of the pandemic. In India, the
incidence of noncommunicable diseases (NCDs) and associated risk factors vary among states (Revu, et al., 2023). (Restauri
and Sheridan 2020) presented a discussion on the link. This study provided a framework for evaluating the sound effect of the
COVID-19 outbreak on doctors and provided a systems-based solution to react to these difficulties through a literature analysis
that focused on healthcare personnel before and after the outbreak. (Ivanov and Dolgui 2021) discussed the present state of
related research as well as potential future avenues for studying flowout in the context of an epidemic. The existing works
published in international publications under the heading "Operational Research" (OR) were analyzed by our team. The
purpose of our research is to make two significant contributions in response to two research issues. (Lotfi et al. 2022) created
a robust optimization (RO) strategy based on regression to effectively anticipate data. The major goal is to analyze the dynamics
of the COVID-19 outbreak and provide insightful information that will determine the resources that are needed. To analyze
and integrate credible articles, Dehghani et al. (2023) performed a systematic literature review (SLR). The report claims that
the ML/DL techniques employed in the pandemic include imaging techniques, survival analysis, forecasting, overcoming
geographic and economic challenges, medication development, monitoring techniques, and hybrid applications. Ndeh et al.
(2022) suggested the use of the seasonal autoregressive integrated moving average (SARIMA) model to detect respiratory
infection cases when no public health interventions were in place. Next, the observed instances were compared to the
anticipated number of cases. Hosseini and Ivanov (2022) provided a technique for simulating and evaluating the effects of SC
disruption after a pandemic through the creation of multilayer Bayesian network (BN) models.
3. Materials and Methods
Doctor burnout during the COVID-19 epidemic has become a concern, as healthcare workers worldwide have faced
unprecedented challenges in managing the disease. The COVID-19 epidemic has resulted in high demand for healthcare
services, long working hours, and increased exposure to COVID-19. These factors, in addition to the emotional distress caused
by the pandemic, have contributed to high levels of burnout among doctors. Several factors contribute to doctor burnout
during the COVID-19 epidemic, including a heavy workload, shortage of personal protective equipment (PPE), fear of
contracting COVID-19 and lack of control. Doctors who work in high-pressure environments, have inadequate access to PPE
and have direct contact with COVID-19 patients are at risk.
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3.1. Subtopic title Data Collection
The first segment included three sections of the analysis questionnaire on sociodemographic traits and employment-
related topics. The second section discusses how doctors have dealt with COVID-19 cases and fatalities associated with them,
as well as how they see the COVID-19 situation in Egypt. The Maslach Burnout Inventory Human Services Survey (MBI-HSS),
which was utilized in the third part after obtaining the necessary clearance, was used to assess burnout syndrome. The latter
includes 22 questions that investigate the three aspects of burnout. According to a typical method of diagnosis, respondents
who scored the EE or the DP were considered to be burned. Alternative approaches have been used by other studies, which
define burnout as having the highest EE, any extra credit, a higher DP score, or the lowest PA score (PA score 33). As the second
technique examines all three aspects of burnout when making a diagnosis, we adopted it in our research.
3.2. Analytical Statistics
Minitab 17.1.0.0 for Windows was used for the statistical analysis. Continuous information was provided, whereas
percentages and values were used to display categorical information. The data were examined using the Kolmogorov‒Smirnov
test. One-way “analysis of variance” (ANOVA) was used for separate t tests, and individual correlation coefficient tests were
applied to determine the connection between participant satisfaction and BOS domain scores, as well as the connection
between various demographic information about participants and some risk factors. To identify any potential predictors for
BOS and its three dimensions, more than one logistic regression model was run using the progressive reduction approach and
adjustments for sex, age, marital status, comorbidity, and marital status. A P value of 0.05 or less was required for each two-
sided test to be deemed significant. To protect the confidentiality and identity of the respondents, precautions were taken.
The physician's agreement to participate in the research was deemed upon the submission of the completed study.
3.3. Sociodemographic Data and Employment Characteristics of the Participants
The survey included 230 medical doctors. The majority of responders were young doctors (mean age, 33.42 ± 5.28
years), and the ages were equal between the sexes. The majority were married and had kids. Cairo and Alexandria were home
to the majority of people. One-tenth of them had received doctorates, and approximately half had finished their master's
degrees. Pulmonologists made up 34.09% of the research population, while anesthesiologists and intensivists made up 14.55%.
Table 1 lists further sociodemographic information and participant employment characteristics (Ning et al., 2020).
Table 1 Statistics about the individuals’ occupations and socioeconomic status.
Feature Total (n = 220)
Age
Mean ± SD 34.42 ± 6.28
No. %
Gender
Men 112 51.46
Women 110 50.57
Relational status
Unmarried 59 27.35
Married 152 69.65
Other 12 6.00
Having kids
Yes 144 66.01
No 78 36.01
Have a chronic illness
Yes 45 21.02
No 177 81.03
Smoking behaviors
Smoker 28 13.28
Nonsmoker 194 88.74
Place of residence
Cairo 88 40.57
Alexandria 64 29.63
Delta 40 18.74
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The Workplace
Same as the residence area 196 89.65
Other 26 12.37
Higher grade received
MBBCh 71 33.83
Diploma 22 10.56
Doctorate 23 11.01
Specialty
Anesthesia and ICU 33 15.57
Internal medicine 22 10.56
Family medicine 12 6.01
Surgery 12 6.01
Others 42 19.64
Years of work
<5 years 51 23.75
5–10 years 88 40.56
10–20 years 74 34.19
More than 20 years 11 5.56
Shift in the time period after COVID-19
Minimized 110 50.56
Maximized 52 24.19
Stable 61 28.28
Source: Ning et al. (2020)
4. Results and Discussion
The risk factors for doctor burnout during the COVID-19 epidemic were investigated. Approximately 81% of participants
worked in diagnostic or isolation hospitals and had contact with COV-19 patients and their samples. The majority (73.66%) had
paid for their own PPE purchases. Approximately one-fourth (27.75%) of the respondents reported COVID-19 patient mortality.
Nearly two-thirds of the patients received sufficient medical attention according to the COVID-19 treatment protocols and cure
rates. Approximately 65% of them were dissatisfied with how assessment and isolation hospitals worked together. Figure 2
and Table 2 depict the mean scores on the domains of BOS among the participants. Little more than 40% of the participants
had dealt with bullying from COVID-19 patient families. Participants stated that, in contrast to their relatives (3.67%), their
coworkers had a high infection rate (59.57%). The mortality rates of the participants who worked as coworkers and relatives
were modest (4.56%).
Figure 2 Score of the BOS domain.
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Table 2 BOS domain scores.
BOS domain Score Level (%)
Mean SD
EE 21.67 14.34
DP 8.2 7.14
PA 19.53 11.19
4.1. Prevalence of BOS and the Severity of Each Domain
BOS was present in 36.36% of the sample of doctors. For PA, DP, and E. mutans, the average scores of the domains of
the BOS were 20.67 ± 13.34, 7.20 ± 6.14, and 18.53 ± 10.19, respectively. Figure 3 and Table 3 show that the severity of each
BOS domain is listed.
Figure 3 The severity of BOS domains among individuals.
Table 3 Severity of the BOS domains.
BOS domain Severity (%)
Mild Moderate Severe
EE 50.09 23.73 29.18
DP 48.73 21.45 32.82
PA 5.55 7.36 90.09
4.2. Relationships between the Three BOS Domains and Other Risk Factors and Demographic Characteristics
These findings imply that the severity of BOS was impacted by the sociodemographic features of the participants.
Ayouths were highly favored and connected with greater DP and EE scores and with the lowest PA score (r = 0.23, P = 0.005
for both); insufficient knowledge was a major factor correlated with a low PA score (r = 0.22, P = 0.004). Figure 4 and Table 4
show the mean severity scores. Higher EE scores were correlated with female sex (P = 0.01), working alone in a hospital ICU
(intensive care unit) (p = 0.008), and having a coworker who had COVID-19 infection (P = 0.03). The lowest PA ratings were
associated with the patient rate of cure dissatisfaction (P = 0.05) and the mortality of a coworker or family from COVID-19
infection (P = 0.06). Higher EE and DP ratings were linked to paying for PPE outside of pocket (P= 0.001 and 0.004, respectively)
and being harassed by patients' relatives at work (P= 0.001 for both).
4.3. Among Participants, BOS Predictors
The BOS of the patients was predicted using the logistic regression model (Table 5). Both have to pay for PPE outside of
pocket, and harassment by patients' relatives increases the risk of developing BOS by up to two times (odds ratios (ORs) = 2.17
and 2.03; P = 0.04 for both). On the other hand, doctors who were older had a lower risk of developing BOS (OR = 0.9; P =
0.002). Age did not have any effect, and patients wanted to purchase PPE or pressure from their families in the PA area, in
contrast to the other two BOS areas. Being employed by a triage hospital and feeling unsatisfied with the COVID-19 cure rate
are therefore indicators for this region. Both being employed by a triage hospital and being satisfied with the COVID-19 patient
cure rate reduced the likelihood of having low PA scores (OR = 0.35, P = 0.03 and OR = 0.27, P = 0.01, respectively).
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Figure 4 Mean severity score.
Table 4 Mean severity score.
BOS domain Severity (%)
Mean SD
EE 9.96 1.454
DP 3.795 1.188
PA 44.27 2.02
Table 5 Participants as BOS Predictors.
Elements OR 95% CI P
Age .93 (.8425, .9681) .001
Gender (male) 1.57 (.8588, 2.9162) .16
Relational status (single) 1.28 (.4946, 3.1568) .67
Having kids (yes) 1.47 (.5767, 3.8137) .44
Comorbidity (yes) 1.52 (.7044, 3.1472) .34
Invest your own money in PPE (yes) 2.19 (1.0364, 4.5495) .06
Monitoring death in the workplace with COVID-19 (yes) 1.18 (.5837, 2.3237) .69
Patients' families harassing staff while working with COVID- 2.05 (.9924, 4.1537) .04
19 patients (yes)
COVID-19 caused the death of coworkers or family (yes) 1.12 (.2711, 4.3724) .93
Burnout syndrome is a condition characterized by mental and physical fatigue due to job or care responsibilities. The
key characteristics of this condition are limited personal achievement, depersonalization, and emotional weariness.
Depersonalization is a cynical "isolationist" attitude against regular encounters with other people, while a wearied state of
mind indicates emotions of excess and exhaustion of emotional reserves. The respondent will feel less competent in their
position when they sense less personal achievement. BOS has emerged as a severe mental health issue among medical
practitioners in several nations, with a prevalence close to or surpassing 50%. BOS has negative effects on patient satisfaction,
the likelihood of medical mistakes, and depression. The COVID-19 pandemic is an uncommon circumstance that might cause
risk factors for BOS in healthcare professionals, particularly doctors.
5. Final considerations
Research has identified several risk factors for doctor burnout during the COVID-19 epidemic. A high workload, lack of
PPE, emotional distress, lack of social support, and lack of control are some of the factors that contribute to burnout among
doctors during the pandemic. The inclusion of doctors and the results indicate that the COVID-19 epidemic has contributed
additional demographic and occupational variables to the development of BOS. In our opinion, the government and the general
public should adopt a number of actions to help doctors at this time. These approaches include moral and psychological support
via various media outlets. Along with infection control, PPE usage and COVID-19 safety training, further approaches should
include improving work schedules, modifying pay, providing supplies and establishing better work hours.
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Ethical Considerations
Not Applicable.
Conflict of Interest
The authors declare no conflict of interest.
Funding
The current review did not receive any financial support.
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