ISSN: 2320-5407 Int. J. Adv. Res.

11(07), 458-468

Journal Homepage: - www.journalijar.com

Article DOI: 10.21474/IJAR01/17249

DOI URL: http://dx.doi.org/10.21474/IJAR01/17249

RESEARCH ARTICLE
LEVEL OF BURNOUT AND ITS DETERMINANTS AMONG PROGRAM PHYSICIANS OF DIFFERENT
SPECIALTIES IN MAKKAH CITY2023

Mawdda A. Hariri1, Hossam H. Saleem2 and Salman3

1. Preventive Medicine Resident, Saudi Board of Preventive Medicine Program, Makkah Health Cluster, Saudi
Arabia.
2. Preventive Medicine Resident, Saudi Board of Preventive Medicine Program, Makkah Health Cluster, Saudi
Arabia.
3. Preventive Medicine Consultant, Saudi Board of Preventive Medicine Program, Makkah Health Cluster, Saudi
Arabia.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Introduction: Burnout is a major problem that affect most of the
Received: 15 May 2023 residents and health care providers silently resulting in low level of
Final Accepted: 19 June 2023 satisfaction. Prior studies done in Saudi Arabia for the prevalence of
Published: July 2023 burnout among programs residents in different regions, none of them
was done in Makkah city. This study focuses on burnout among
residents in postgraduate training Among different specialties, which
can be stressful both physically and psychologically.
Methodology: It is an analytical cross-sectional study; data was
collected by questionnaire. Calculation of sample size was done by
Raosoft website. SPSS version 26 is used for data analysis.
Results: The study included 282 program physicians in Makkah City.
Results showed that 52.8% were female. Working hours per week
varied, with 26.6% working less than 48 hours and 8.2% working more
than 144 hours. 21.6% expressed a neutral opinion about their
specialty, while 65.6% reported being satisfied. Among the
participants, 29.8% had a low level of burnout, 27.7% had a moderate
level, and 42.6% had a high level of burnout based on the total MBI
scores. Factors associated with high-level burnout included maintaining
an unhealthy lifestyle, being neutral or satisfied with the specialty,
desiring to change the specialty, having fewer shifts per month, and
working longer hours per week. Age, gender, marital status, and years
of practice as a GP did not show significant associations with high-
level burnout.
Conclusion: This study sheds light on the prevalence of burnout and its
determinants among program physicians in Makkah City. The findings
underscore the significance of addressing burnout as a pressing concern
within the healthcare profession. Interventions targeting workload
management, career satisfaction, healthy lifestyle promotion, and
specialty-specific support may be crucial in mitigating burnout and
enhancing the well-being of physicians. Further research is warranted
to explore additional factors contributing to burnout and to develop

Corresponding Author:- Salman Alsubhi

Address:- Preventive Medicine Resident, Saudi Board of Preventive Medicine 458
Program, Makkah Health Cluster, Saudi Arabia.
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comprehensive interventions tailored to the specific needs of physicians

in different specialties and stages of their careers.

Copy Right, IJAR, 2023,. All rights reserved.

……………………………………………………………………………………………………....
Introduction:-
Burnout is a major problem that affect most of the residents and health care providers silently resulting in low level
of satisfaction. Prior studies done in Saudi Arabia for the prevalence of burnout among programs residents in
different regions, none of them was done in Makkah city.

The term Burnout was introduced by World Health Organization as a syndrome conceptualized as
resulting from chronic workplace stress that has not been successfully managed. It is characterized
by three dimensions:
1. feelings of energy depletion or exhaustion;
2. Increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job career
3. Reduced professional efficacy.

The most common approach to quantify this phenomenon is the Maslach Burnout Inventory (MBI). It was
developed by Maslach in 1976, which comprises of 22 items measuring 3 domains of burnout:
1) emotional exhaustion: the depletion of emotional energy by continued work-related demands,
2) depersonalization: a sense of emotional distance from one’s patients or job,
3) low personal accomplishment, which is a decreased sense of self worth or efficacy related to work.

Prior studies have found that burnout can affect all physicians in all specialties throughout their career as early as
medical students to senior consultants and not limited to junior physicians. Stressors for residents can be categorized
into 3 main themes:
1) Situational (workload, sleep deprivation, poor learning environment, and lack of support)
2) Personal (family, social isolation, and financial burden)
3) professional (overwhelming work responsibility, and information).

This study focuses on burnout among residents in postgraduate training Among different specialties, which can be
stressful both physically and psychologically.

This Study aims to evaluate the burnout level among physicians, and Identify the Reasons of burnout among
program physicians to control it and improve the programs policies in the future.

Methodology:-
This Study usedAnalytical cross-sectional design which has been carried out using an online questionnaire obtained
from 282 Residents training in Saudi programs among different specialties in different centers in Makkah city at the
period from January 2023 till June 2023.

The primary outcome is level of burnout among Saudi board residents and the independent variables are: Age,
gender, marital status, Sleeping hour, healthy food, Exercise,specialty, Residency level, satisfaction about specialty,
number of working hours, number of on calls and shifts.

Data Analysis done using (SPSS) version 26 the most recent version of statistical computer program used for data
entry analysis, with a P –value < 0.05 considered as a significant, appropriate statistical test has been considered.

Ethical approval obtained from Security Forces Hospital in Makkah IRB committee and written consent obtained
from all participants.

Results:-
Sociodemographic and other parameters of all participants evaluated for Burnout Table 1 shows the
sociodemographic and other parameters of the participants who were evaluated for burnout. The study included 282
participants. In terms of gender, 47.2% were male, while 52.8% were female. Regarding marital status, 39.4% of

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participants were single, 22.0% were married without children, 31.9% were married with children, and 6.7% were
divorced. Regarding age, the majority, 76.2%, fell within the 25-30 years range. A smaller proportion, 17.7%,
belonged to the 31-35 years category, and only 6.0% were over 35 years old.Participants' working hours per week
varied significantly. Approximately 26.6% worked less than 48 hours, 36.9% worked between 48 and 96 hours,
28.4% worked between 96 and 144 hours, and 8.2% worked more than 144 hours.Regarding lifestyle, 26.2%
reported having a healthy lifestyle, while 23.8% indicated that they did not have a healthy lifestyle. The majority,
50.0%, responded that they sometimes maintained a healthy lifestyle.In terms of satisfaction with their specialty,
21.6% of participants expressed a neutral opinion, 65.6% reported being satisfied, and 12.7% indicated being
unsatisfied.Regarding the desire to change their specialty, 27.0% of participants responded affirmatively, while the
remaining 73.0% indicated that they did not want to change their specialty.Regarding residency level, 16.3% were in
R1, 23.0% were in R2, 27.0% were in R3, 24.5% were in R4, 8.5% were in R5, and only 0.8% belonged to R6 and
R7 levels.

Table 1:- Sociodemographic and other parameters of all participants evaluated for Burnout:
Frequency Percent
(n=282)

Gender Male 133 47.2

Female 149 52.8

Marital Status Single 111 39.4

Married without children 62 22.0

Married with children 90 31.9

Divorced 19 6.7

Age 25-30 Years 215 76.2

31-35 Years 50 17.7

> 35 Years 17 6.0

Working Hour Per week < 48 Hours 75 26.6

48 -96 Hours 104 36.9

96 - 144 Hours 80 28.4

> 144 Hours 23 8.2

Do You Have a Healthy Life Style Yes 74 26.2

No 67 23.8

Sometimes 141 50.0

Satisfied with Specialty Neutral 61 21.6

Satisfied 185 65.6

Unsatisfied 36 12.7

Want to Change Specialty Yes 76 27.0

No 206 73.0

Residency Level R1 46 16.3

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R2 65 23.0

R3 76 27.0

R4 69 24.5

R5 24 8.5

R6 & R7 2 0.8

Different parameters related to duties of participants evaluated for Burnout

Table 2 shows different parameters related to the duties of the participants who were evaluated for burnout.
Regarding On-Calls per month, 25.2% reported having no on-call shifts, while 4.9% had 2-4 on-call shifts. The
majority, comprising 63.1% of participants, had 5-7 on-call shifts per month. A smaller proportion, 6.7%, had more
than 7 on-call shifts. Regarding No. of Shifts per month, 43.3% reported having no shifts in a month. A small
percentage, 4.3%, had less than 10 shifts, and the same proportion, 4.3%, had from 10 to 15 shifts. A significant
portion, 36.2%, had 16 to 20 shifts per month, while 12.1% had more than 20 shifts. Regarding No. of Years
Practicing as a GP, 83.3% of participants, had been practicing for 0-2 years. A smaller proportion, 13.1%, had 3-5
years of experience, while only 3.1% had more than 5 years of experience as GPs.

Table 2:- Different parameters related to duties of participants evaluated for Burnout:
Frequency (n=282) Percent

No. of On-Call Per Month None 71 25.2

2-4 14 4.9

5-7 178 63.1

More than 7 19 6.7

No. of Shifts per Month None 122 43.3

< 10 12 4.3

10 - 15 12 4.3

16 - 20 102 36.2

> 20 34 12.1

No. of Years Practicing as a GP 0-2 235 83.3

3-5 37 13.1

>5 9 3.1
Burnout category between high emotional exhaustion, high depersonalization, and low personal accomplishment
among physicians

Table 3 shows the distribution of burnout categories among physicians based on high emotional exhaustion, high
depersonalization, and low personal accomplishment. The table also includes the total scores for the Maslach
Burnout Inventory (MBI) scale and the burnout subscales.

Table 3:- Burnout category between high emotional exhaustion, high depersonalization, and low personal
accomplishment among physicians:

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Low-Level Moderate-Level High-Level

Burnout Burnout Burnout

Total MBI Score 84(29.8) 78(27.7) 120(42.6)

Burnout Subscales of MBI Scale

Emotional Exhaustion 183(64.9) 79(28.0) 20(7.1)

Depersonalization 86(30.5) 76(27) 120(46.2)

Personal Accomplishment 206(73) 32(11.3) 44(15.6)

Burnout Level of Participants Based on Total MBI Scores

Figure 1 shows the burnout level of participants based on the total MBI score. Among the physicians evaluated,
29.8% were categorized as having a low level of burnout, 27.7% had a moderate level of burnout, and 42.6%
exhibited a high level of burnout based on their total MBI scores.

Figure 1:- Burnout Level of Participants Based on Total MBI Scores:

50.%

42.6%

37.5%

29.8%
27.7%
Percentages

25.%

12.5%

0.%
Low-Level Burnout Moderate Burnout High-Level Burnout
Burnout Level of participants Based on Emotional Exhaustion category of MBI score

In terms of emotional exhaustion, the majority of physicians, 64.9%, fell into the low-level burnout category,
whereas 28.0% were categorized as having a moderate-level burnout, and only 7.1% exhibited a high-level burnout
as shown in Figure 2.

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Figure 2:- Burnout Level of participants Based on Emotional Exhaustion category of MBI score:
Level of Burn Out Based on Section A
70.% 64.9%

52.5%
Percentages

35.%
28.%

17.5%

7.1%

0.%
Low-Level Burnout (>17) Moderate Burnout (18-29) High-Level Burnout (>30)
Burnout Level of Participants Based on Depersonalization category of MBI score
For depersonalization, 46.2% of physicians were classified as having a high-level burnout, 27.0% were in the
moderate-level burnout category, and 30.5% demonstrated a low-level burnout as shown in Figure 3.

Figure 3:- Burnout Level of Participants Based on Depersonalization category of MBI score:
50.%

42.6%

37.5%

30.5%
27.%
Percentages

25.%

12.5%

0.%
Low-Level Burnout(<5) Moderate Burnout (6-11) High-Level Burnout (>12)

Burnout Level of Participants Based on Personal Achievements category of MBI score

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Regarding personal accomplishment, the majority of physicians, 73.0%, showed a low-level of burnout, while
11.3% were classified as having a moderate-level burnout, and 15.6% fell into the high-level burnout category as
shown in Figure 4.

Figure 4:- Burnout Level of Participants Based on Personal Achievements category of MBI score.
80.% 73.%

60.%
Percentages

40.%

20.% 15.6%
11.3%

0.%
Low-Level Burnout(<33) Moderate Burnout 33-39) High-Level Burnout (>40)

Burnout Category based on Total MBI (Maslach Burnout Inventory) Score among physicians of different specialty
Table 4 shows the burnout categories based on the total Maslach Burnout Inventory (MBI) scores among physicians
of different specialties. In terms of high-level burnout categories, some specialties stand out. Pediatric has the
highest proportion with 20 physicians (16.7%) classified as high-level burnout. Other specialties with a notable
presence in the high-level burnout category include Emergency Medicine with 15 physicians (12.5%), Critical care
medicine with 14 physicians (11.7%), Obstetrics and Gynecology with 10 physicians (8.3%), General Surgery with
6 physicians (5.0%), and Preventive Medicine with 9 physicians (7.5%). Comparatively lower proportions of
physicians in high-level burnout categories can be observed in specialties such as Ophthalmology, Orthopedic
Surgery, Pediatric Surgery, and Plastic Surgery, where the numbers range from 3 to 6 physicians.

It is important to note that the significance value (<0.001) indicates that the distribution of burnout categories
significantly differs across different specialties, suggesting that burnout experiences are influenced by the nature of
the specific medical field.

Table 4:- Burnout Category based on Total MBI (Maslach Burnout Inventory) Score among physicians of different
specialty:
Burnout Category Total Sig. Value

Low- Moderate High-Level

Level - Level

Cardiac Surgery 1(1.2) 2(2.6) 2(1.7) 5(1.8) <0.001

Critical Care Medicine 0(0) 2(2.6) 14(11.7) 16(6.7)

Dermatology 3(3.6) 2(2.6) 0(0) 5(1.8)

Diagnostic Radiology 2(2.4) 1(1.3) 5(4.2) 8(2.8)

Emergency Medicine 2(2.4) 8(10.3) 15(12.5) 25(8.9)

Family Medicine 12(14.3) 3(3.8) 7(5.8) 22(7.8)

General surgery 4(4.8) 11(14.1) 6(5.0) 21(7.4)

internal Medicine 12(14.3) 3(3.8) 12(10.0) 27(9.6)

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Obstetrics and Gynecology 1(1.2) 11(14.11) 10(8.3) 22(7.8)

Ophthalmology 4(4.8) 3(3.8) 3(2.3) 10(3.5)

Orthopedic Surgery 1(1.2) 3(3.8) 6(5.0) 10(3.5)

Pediatric Surgery 0(0) 2(2.6) 4(3.3) 6(2.1)

Pediatrics 9(10.7) 6(7.7) 20(16.7) 35(12.4)

Plastic Surgery 1(1.2) 4(5.1) 0(0) 5(1.8)

Preventive Medicine 25(29.8) 15(19.2) 9(7.5) 49(17.4)

Other 7(8.3) 2(2.6) 7(5.8) 16(5.7)

Total 84(100) 78(100) 120(100) 282(100)

Determinants of High-Level Burnout among Physicians

Table 5 shows the determinants of high-level burnout among physicians. The analysis examines various factors to
identify determinants associated with high-level burnout among physicians. Age does not show a significant
association with high-level burnout (B = -0.108, Sig. = 0.281, Exp(B) = 0.897). Similarly, gender does not appear to
be a significant determinant, as male physicians do not exhibit a significantly higher likelihood of high-level burnout
(B = -0.159, Sig. = 0.704, Exp(B) = 0.853). In terms of marital status, being single is considered the reference
category. Physicians who are married with children (B = 0.499, Sig. = 0.325, Exp(B) = 1.647) and married without
children (B = 0.587, Sig. = 0.226, Exp(B) = 1.798) show slightly higher odds of high-level burnout, but the
associations are not statistically significant. Similarly, being divorced (B = 0.495, Sig. = 0.542, Exp(B) = 1.640)
does not significantly impact the likelihood of high-level burnout.

Maintaining a healthy lifestyle is compared to not having a healthy lifestyle, which serves as the reference category.
Physicians who sometimes have a healthy lifestyle (B = -1.933, Sig. = 0.000, Exp(B) = 0.145) and those who have a
consistently healthy lifestyle (B = -1.256, Sig. = 0.024, Exp(B) = 0.285) show significantly lower odds of high-level
burnout.

Satisfaction with specialty is analyzed with an unsatisfied specialty serving as the reference category. Physicians
who report being neutral about their specialty (B = 2.480, Sig. =0.002, Exp(B) = 11.939) and those who are satisfied
with their specialty (B = 1.115, Sig. = 0.155, Exp(B) = 3.050) have significantly higher odds of experiencing high-
level burnout. Additionally, physicians who express a desire to change their specialty (B = 1.550, Sig. = 0.010,
Exp(B) = 4.713) are also more likely to exhibit high-level burnout. The number of on-call shifts per month does not
have a statistically significant association with high-level burnout (B = -0.231, Sig. = 0.050, Exp(B) = 0.793).
However, the number of shifts per month shows a significant impact. Physicians who have fewer than 10 shifts per
month (B = 3.334, Sig. = 0.000, Exp(B) = 28.044), 10-15 shifts per month (B = 3.852, Sig. = 0.000, Exp(B) =
47.079), or 16-20 shifts per month (B = 2.179, Sig. = 0.001, Exp(B) = 8.836) demonstrate significantly higher odds
of high-level burnout compared to those with no shifts. The number of working hours per week shows a significant
positive association with high-level burnout (B = 0.030, Sig. = 0.001, Exp(B) = 1.030). However, the years of
practice as a GP do not have a statistically significant impact on high-level burnout (B = -0.364, Sig. = 0.097,
Exp(B) = 0.695).

Table 5:- Determinants of High-Level Burnout Physicians:

B Sig. Exp(B)

Age -.108 .281 .897

Gender (Male) -.159 .704 .853

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Marital status (Single) .605 REF

Marital status (Married with Children) .499 .325 1.647

Marital status (Married Without Children) .587 .226 1.798

Marital status (Divorced) .495 .542 1.640

Healthy Lifestyle (No) .000 REF

Healthy Lifestyle (Sometimes) -1.933 .000 .145

Healthy Lifestyle (Yes) -1.256 .024 .285

Satisfied with Specialty (Unsatisfied) .002 REF

Satisfied with Specialty (Neutral) 2.480 .002 11.939

Satisfied with Specialty (Satisfied) 1.115 .155 3.050

Want to Change Your Specialty (Yes) 1.550 .010 4.713

No. Of On-Calls Per Month -.231 .050 .793

No. Of Shifts Per Month (None) .000 REF

No. Of Shifts Per Month (< 10) 3.334 .000 28.044

No. Of Shifts Per Month (10-15) 3.852 .000 47.079

No. Of Shifts Per Month (16-20) 2.179 .001 8.836

No. Of Shifts Per Month (>20) 1.169 .162 3.219

No. Of Working Hours Per Week .030 .001 1.030

Years of Practice as GP -.364 .097 .695

Constant -.374 .902 .688

Discussion:-
Our study aimed to investigate the level of burnout and its determinants among program physicians of different
specialties in Makkah City during the period of 2022-2023. The findings revealed important sociodemographic
characteristics and duty-related parameters of the participants, as well as their burnout levels based on the Maslach
Burnout Inventory (MBI) scores.

In terms of sociodemographic characteristics, the study included a total of 282 participants, with a nearly equal
distribution of gender, where 47.2% were male and 52.8% were female. The majority of participants fell within the
age range of 25-30 years (76.2%), with only a small proportion over 35 years old (6.0%). This age distribution
suggests that the study sample primarily comprised young physicians. The participants ’working hours per week
varied, with a notable percentage (8.2%) working more than 144 hours. Regarding lifestyle, a considerable number
of participants (50.0%) reported occasionally maintaining a healthy lifestyle, indicating a need for interventions to
promote healthier habits among physicians. Additionally, satisfaction with specialty was relatively high, with 65.6%
of participants expressing satisfaction and 12.7% reporting dissatisfaction.

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The burnout levels among the participants were assessed based on three dimensions of the MBI: emotional
exhaustion, depersonalization, and personal accomplishment. The results showed that 29.8% of physicians had a low
level of burnout, 27.7% had a moderate level, and 42.6% exhibited a high level of burnout based on their total MBI
scores. Analyzing each dimension separately, the majority of physicians experienced a low level of emotional
exhaustion (64.9%) but a higher proportion had high depersonalization (46.2%). However, a majority showed low
levels of burnout in terms of personal accomplishment (73.0%). Our study results are consistent with previous
research indicating a high prevalence of burnout among physicians. A study by Rotenstein et al. (2018) reported
similar levels of burnout among physicians in a different geographical region, suggesting that burnout is a global
issue among healthcare professionals (8). Additionally, a study conducted by Patel et al. (2018) found that
physicians across various specialties experience high levels of burnout, emphasizing the need for comprehensive
interventions to address this problem (9).

Analyzing the burnout categories across different specialties, our study revealed significant differences in burnout
experiences among physicians in various medical fields. Pediatric, Emergency Medicine, Critical care medicine,
Obstetrics and Gynecology, General Surgery, and Preventive Medicine were identified as specialties with a notable
presence in the high-level burnout category. Conversely, specialties such as Ophthalmology, Orthopedic Surgery,
Pediatric Surgery, and Plastic Surgery had comparatively lower proportions of physicians experiencing high-level
burnout. These findings suggest that the nature of the medical specialty can influence burnout levels among
physicians (10), (11).

The determinants of high-level burnout among physicians were also investigated in our study. The analysis revealed
several significant factors associated with high-level burnout. Maintaining a healthy lifestyle, including occasional
or consistent healthy habits, was found to be negatively associated with high-level burnout. This finding aligns with
previous research highlighting the importance of self-care and wellness interventions in mitigating burnout among
healthcare professionals (12), (13).

Furthermore, satisfaction with specialty played a crucial role in burnout levels. Physicians who expressed neutrality
or satisfaction with their specialty were more likely to experience high-level burnout compared to those who were
unsatisfied. This finding suggests that despite satisfaction with their chosen field, physicians may still face
significant burnout challenges due to various work-related factors. Similar results were reported in a study by Rao et
al. (2020), emphasizing the complex relationship between specialty satisfaction and burnout (14).

Additionally, physicians who expressed a desire to change their specialty exhibited a higher likelihood of high-level
burnout. This finding supports the idea that dissatisfaction or mismatch between a physician’s career choice and
their actual preferences can contribute to burnout (15). The number of shifts per month and the number of working
hours per week were positively associated with high-level burnout, indicating that excessive workload and long
working hours contribute to burnout among physicians. These findings align with previous research linking
workload factors to burnout (16).

It is essential to note some limitations of our study. First, the study sample was limited to program physicians in
Makkah City, which may limit the generalizability of the findings to other regions or healthcare systems. Second,
the cross-sectional design of the study prevents the establishment of causal relationships between the determinants
and burnout. Future research could consider longitudinal studies to explore the temporal associations between these
factors. Lastly, the self-reported nature of the data may be subject to response bias or social desirability effects.

Conclusion:-
This study sheds light on the prevalence of burnout and its determinants among program physicians in Makkah City.
The findings underscore the significance of addressing burnout as a pressing concern within the healthcare
profession. Interventions targeting workload management, career satisfaction, healthy lifestyle promotion, and
specialty-specific support may be crucial in mitigating burnout and enhancing the well-being of physicians. Further
research is warranted to explore additional factors contributing to burnout and to develop comprehensive
interventions tailored to the specific needs of physicians in different specialties and stages of their careers.

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