Journal of Rehabilitation Medicine 51-11 | Page 59

Systematic review of burnout in PM&R
are unique to the USA, potential causative factors, and
rates of burnout in allied health disciplines.
In the present study, the authors were surprised by
the paucity of data outside of the American context.
The fundamental structural differences between the
American healthcare system, in which most individu-
als’ healthcare is purchased in a private marketplace
with a multi-payer system, and socialized, single-payer
systems which are most common in Canada and Europe
(16), make it difficult to determine whether system and
organizational factors contribute to burnout in physici-
ans in the same way. One study from Italy that did not
meet inclusion criteria for this review examined burn­
out in a multidisciplinary rehabilitation team, finding
a “medium-low” pooled level of burnout amongst all
team members, including physicians and other allied
healthcare workers (17). Although this study did not
report the prevalence of burnout in physicians or other
allied health providers, such as physiotherapists, un-
derstanding the prevalence and risk/protective factors
for burnout amongst all members of multidisciplinary
teams may be critical for individuals and institutions
committed to tackling burnout and developing orga-
nizational culture that promotes wellbeing.
Limitations of this systematic review include the ex-
clusion of non-English language studies, and the narrow
scope, focussing solely on burnout rather than all mental
or physical ailments that might contribute to physician
distress. The present study is also limited by the small
number of available studies, small sample sizes in
many of these studies, low quality and American-only
evidence of PM&R-specific burnout literature.
Scientific journals specific to rehabilitation medicine
have featured diverse opinions on burnout, ranging
from acknowledging that physicians in PM&R are at
increased risk by the nature of work they do (18), to
rebuking burnout as a legitimate condition threate-
ning physician wellbeing and viewing it as a “myth”
and a “cop-out” (19), to describing the prevalence of
burnout as a research priority (20). This systematic
review presents evidence that strongly challenges the
notion that burnout amongst physiatrists is a myth, and
underscores the need for additional research to eva-
luate the prevalence of burnout in PM&R physicians
outside of the American context, to confirm or refute
current evidence with larger sample sizes, to explore
why physicians in PM&R experience such high rates
of burnout, and to better understand risk and protective
factors specific to physiatrists. Given that burnout has
well-established detrimental consequences for physici-
ans, patients, and healthcare institutions, the physiatry
community needs to take burnout seriously, parti-
873
cularly because burnout is preventable and treatable
(5–7). As a crucial first step, it must be acknowledged
that burnout is prevalent in PM&R.
There is no consensus on how best to prevent or treat
burnout. To date, the authors are not aware of any studies
of prevention or treatment of burnout in specialists or
trainees in PM&R. Previous recommendations ranged
from individual and organizational interventions (5, 7,
22) to focusing on physiatrists’ mission (20) to using
collective action to target root causes of marginaliza-
tion amongst our patients (21). On an individual level,
PM&R specialists and trainees should be given tools to
understand, prevent, identify, and treat burnout. Establis-
hing relevant core competencies in residency training
and continuing medical education resources for specia-
lists are two important ways to start. However, placing
the onus solely on individuals, and judging burnout as
an individual problem, ignores the larger context in
which burnout develops. National associations outside
of the USA should also undertake to better understand
the prevalence of burnout in their members, possible
risk or protective factors, and design further initiatives
around these findings. Our understanding of putative risk
factors amongst physiatrists comes from a single large
study (12) that identified system and institutional factors
as the main drivers of burnout in PM&R specialists.
The authors therefore recommend that departments,
institutions, and national associations make burnout a
priority to support the health and wellbeing of PM&R
specialists and trainees, which is an investment to ensure
the delivery of the best possible rehabilitative care.
Conclusion
As far as the authors are aware, this is the first systema-
tic analysis of literature regarding burnout in PM&R.
Three studies report burnout prevalence in specialists
in PM&R and 2 report burnout in trainees in PM&R.
The prevalence of burnout ranged from 48% to 62%
in surveys of USA-based PM&R specialists; the pre-
valence of burnout ranged from 22.2% to 83.3% in
trainees in different stages of training at one institution,
and was 50% in a national survey of second-year resi-
dents. In the only study (12) reporting risk factors for
burnout amongst physiatrists, system and institutional
factors were the main drivers of burnout; individual
factors were not significantly associated with burnout.
All 5 studies use survey methodology and are of low-
quality evidence. All available data come from a single
country; there is no data on the prevalence of burnout
in PM&R specialists or trainees outside of the USA,
indicating a significant gap in knowledge.
J Rehabil Med 51, 2019