INTRODUCTION
Burnout is a pervasive occupational phenomenon in medicine and is recognized as a significant threat to both physician health and the quality of patient care worldwide. In the U.S., burnout was already widespread prior to the COVID-19 pandemic; however, the pandemic has clearly demonstrated that external factors such as workload, administrative burdens, and systemic inefficiencies significantly contribute to physician burnout and well-being.
In South Korea, however, even discussions about individual-level efforts to improve well-being have been infrequent and are often overlooked. Given the challenges that healthcare professionals in Korea have faced over the past year—challenges that will likely have lasting repercussions for years to come—it is crucial to engage in serious discussions about this issue before it escalates further and leads to more severe consequences.
While personal efforts to eliminate burnout and achieve wellness are essential, they cannot compensate for a healthcare system that continually demands more from an already overburdened workforce. Therefore, understanding the distinctions and implications between burnout and well-being is vital for implementing effective interventions at both the individual and systemic levels. This disconnect underscores the urgent need to address the deeper systemic issues contributing to burnout among anesthesiologists. Creating a supportive and sustainable work environment is key to mitigating the effects of chronic workplace stress. This strategy requires a multifaceted approach, including policy reforms, organizational support and also cultural changes within the healthcare setting.
Additionally, global trends and insights offer valuable lessons. Countries that have implemented comprehensive well-being initiatives report notable reductions in burnout rates. These initiatives often include appropriate staffing, fair compensation, access to mental health services, and opportunities for professional development. Implementing similar measures in South Korea could be highly beneficial for anesthesiologists, ensuring they receive the critical support needed to thrive in their demanding roles.
UNDERSTANDING BURNOUT AND WELL-BEING
Physician burnout is not merely job dissatisfaction, fatigue, or occupational stress, nor is it synonymous with mental illnesses that require treatment by specific medical professionals, such as depression. It is specifically defined by three symptoms: emotional exhaustion, depersonalization or cynicism, and a reduced sense of personal accomplishment [1-4], all directly related to work. When all three symptoms are present, it is termed Burnout Syndrome; when one or two are present, it is classified as being at high risk of burnout.
According to U.S.-based studies, physicians demonstrate higher resilience compared to other professions with similar educational backgrounds (resilience score of 6.49 vs. 6.25; mean difference, 0.24 [95% confidence interval [CI], 0.19-0.29]). Nevertheless, their risk of burnout is higher (37.9% vs. 27.8%) [5]. This ultimately serves as substantial evidence that medical burnout should not be dismissed as a personal weakness.
Anesthesiologists, in particular, consistently rank among the top specialties at risk [5]. A comprehensive study conducted in 2023, involving a substantial sample of 18,000 physicians, revealed that anesthesiologists exhibited the highest rates of intention to leave their positions among all medical specialties (46.8% vs. 32.6% in all professions). The findings also indicated that the risk of contemplating departure from the profession was notably higher among female physicians and younger physicians under the age of 40. Conversely, the study suggested that the intention to leave was lower among physicians of Asian descent, highlighting possible significant demographic or cultural variations in job retention intentions.
Recent surveys conducted specifically targeting anesthesiologists have unveiled a troubling trend that cannot be overlooked [6,7]. In 2020, a significant portion of anesthesiologists in the U.S.—60%—reported experiencing a high risk of burnout, a serious condition that can adversely affect their well-being and professional performance. Furthermore, 14% of the surveyed anesthesiologists met the clinical criteria for Burnout Syndrome, indicating an alarming level of distress among those working in this high-pressure field.
By 2024, the situation appears to have deteriorated even further. Data reveals that the percentage of anesthesiologists reporting a high risk of burnout has escalated to 68%, while the percentage meeting the criteria for Burnout Syndrome has risen to 19%. This disturbing trend signifies that nearly two-thirds of anesthesiologists are now at high risk of burnout, and one in five is suffering from the full-blown syndrome, highlighting an urgent need for intervention and support within the profession.
Research remains scarce in South Korea. A 2019 survey by Shin et al. [8], involving 992 physicians revealed that Korean physicians reported physical and mental quality of life scores three times lower than the general population, and significantly worse than their international peers. Regrettably, diverse assessment tools hinder the feasibility of direct comparisons. There is a pressing necessity for more systematic investigations utilizing internationally validated measures within Korea.
The World Health Organization has formally recognized burnout as a medical syndrome, defining it as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed [1].” Similarly, the U.S. National Academy of Medicine emphasized the importance of a systemic approach to clinician well-being in its landmark report Taking Action Against Clinician Burnout [9].
Burnout should not be viewed in isolation; it frequently correlates with depression, substance use disorder, and even suicide, underscoring the necessity for a holistic approach to well-being initiatives.
Burnout is closely linked to the intention to leave (ITL) and actual turnover rates (odds ratio [OR] 1.62 [95% CI, 1.49-1.55]) [5]. Consequently, ITL serves as a common indicator for assessing burnout levels; physicians indicating an intention to leave within the next two years—by answering "definitely" or "likely"—face an increased risk.
WHY ARE ANESTHESIOLOGISTS PARTICULARLY VULNERABLE?
Cultural factors in medicine
Despite their inherent resilience, physicians are particularly susceptible to burnout as a direct consequence of the entrenched cultural environment cultivated throughout their extensive training [10]. Medical education often instills relentless ambition, perfectionism, and an overwhelming desire for excellence from an early stage in their careers. This intense focus on achievement frequently leads physicians to prioritize work over fundamental self-care practices, family commitments, and personal relationships. As a result, they may resort to unhealthy coping mechanisms and maladaptive behaviors, which exacerbate the risk of emotional exhaustion and compassion fatigue. It becomes increasingly evident that addressing these systemic issues within medical training is crucial not only for fostering healthier practitioners but also for ensuring the well-being and safety of the patients they serve.
Our specialty, anesthesiology, presents unique challenges. Anesthesiologists often work in isolation and face constant exposure to needles, body fluids, anesthetic gases, and a range of drugs. They also frequently deal with criticism or mistreatment from surgical teams. As will be discussed later, since peer support is essential for preventing burnout and promoting well-being, the remote nature of anesthesiology makes it particularly susceptible to burnout. Furthermore, anesthesiologists rarely receive direct recognition or rewards for their contributions, which heightens their dissatisfaction.
Additional risk factors for burnout
Recent anesthesiology studies consistently identify "little to no support at work" as the most significant risk factor [6,7]. OR for burnout syndrome and a high risk of burnout were six and nine times greater, respectively, when workplace support was absent [11]. Additional risk factors include moderate workplace support, staffing shortages, long working hours, hostile work environments (work overload, lack of control, toxic communities, bullying, disrespect), stigma around mental health, and psychological unsafety. Contrary to expectations—and consistent with the idea that burnout is a work-related issue—the absence of support at home did not have a significant OR as a risk factor for burnout.
External pressures and changing practice environments
Physicians often experience psychological distress following adverse patient outcomes, a situation that can trigger what is known as "second victim syndrome [12].” This syndrome is characterized by a range of intense emotions, including feelings of shame, guilt, anxiety, self-doubt, and insomnia. Such emotional turmoil significantly contributes to physician burnout, which poses a serious challenge in medical practice, particularly in the field of anesthesia. The stress is compounded by the legal responsibilities that physicians face, especially when supervising less experienced staff, which can elevate anxiety levels and feelings of inadequacy.
Additionally, the absence of supportive leadership behaviors—indicated by an OR of 0.83—lack of peer support (OR 0.93), and misalignment between personal and organizational values (OR 0.81) are all negatively correlated with ITL [5]. These factors underscore the critical need for supportive structures within healthcare settings to mitigate these adverse effects and enhance overall well-being among physicians.
CONSEQUENCES OF PHYSICIAN BURNOUT
Impact on physicians
There is no doubt that burnout negatively impacts physicians' mental health, increasing the risks of depression, suicidal thoughts, reduced self-confidence, and impaired clinical performance. It may also hinder the education of future generations and contribute to higher turnover rates. Regarding second-victim syndrome, most anesthesiologists face perioperative catastrophic events at least once in their careers. Studies indicate that one in five never fully recovers from such experiences, resulting in long-term disruptions in both personal and professional lives [13,14].
Impact on hospitals and healthcare systems
As shown in (1) and (2) above, burnout incurs significant financial losses. Increased physician turnover and reduced clinical hours cost an estimated $2.6-6.3 billion annually in the U.S. alone [17]. Staff shortages increase workloads for remaining employees, perpetuating a vicious cycle of burnout. One study showed that anesthesia care teams where anesthesiologists supervise three to four concurrent operations experience a 14% increase in surgical morbidity and mortality compared to teams managing fewer cases [18].
FUTURE DIRECTIONS
Defining well-being
Merely focusing on reducing burnout is not enough to enhance the experiences of doctors, patients, and the healthcare system. We must ultimately approach this with the goal of pursuing well-being.
Reducing burnout alone does not guarantee well-being. Strategies that focus solely on individuals are also unproductive in addressing these complex issues, as numerous studies and trials over the past 20 years have shown. Historically—and still, in some countries like South Korea—physicians have been viewed as “superhuman,” with sleeplessness and overwork being normalized. Such perspectives cannot sustain our medical system or ensure the quality and safety of patient care.
Genuine well-being includes a positive, fulfilling work environment defined by engagement, autonomy, competence, and connectedness. Work engagement, a positive affective-motivational state, encompasses vigor, dedication, and absorption. This state is negatively correlated with burnout and can act as a protective factor [19-21]. Antecedents of engagement include psychological safety, organizational justice, and job crafting—principles from organizational psychology that can be leveraged to enhance physician well-being [22].
Second-victim experiences also require formal support systems. Establishing non-punitive, fair-minded cultures and utilizing tools like the Second Victim Experience and Support Tool (SVEST) can facilitate recovery and prevent burnout [12].
The concept of physician well-being is increasingly recognized as a critical component within the broader framework of healthcare quality goals. As healthcare systems evolve, the importance of healthcare professionals’ well-being has come into sharper focus. The Quadruple Aim, a well-regarded initiative in health care, emphasizes that maintaining the well-being of healthcare teams is not merely an ancillary concern but an essential element directly linked to the provision of high-quality patient care. This recognition underscores the idea that when healthcare providers are well-supported and healthy, they are better equipped to deliver effective and compassionate care to their patients [23,24].
In a further expansion of these ideas, the Quintuple Aim introduces health equity into the conversation, framing it as a critical dimension that must be pursued alongside the well-being of providers. This addition reflects an understanding that achieving health equity is fundamentally tied to the conditions under which healthcare professionals operate. Thus, promoting the well-being of these individuals is not only beneficial for them personally but is also a strategic approach to ensuring equitable health outcomes for all patients. By prioritizing both provider well-being and health equity, healthcare systems can strive toward a more holistic approach to quality care that benefits everyone involved.
It becomes increasingly imperative to cultivate an environment in which physicians feel secure and supported when disclosing their mental health challenges. The journey toward normalizing mental healthcare within the medical community is not just beneficial but essential. Reducing the stigma surrounding mental health issues is a critical step in this process, as it allows healthcare professionals to seek the help they need without fear of judgment or repercussions. By prioritizing mental well-being and fostering open discussions about mental health, we can create a more resilient and compassionate healthcare ecosystem.
CONCLUSION
In South Korea, the study of burnout is a nascent area of research that is beginning to gain attention. It is imperative that we disseminate precise, evidence-based information about burnout and mental well-being among our medical colleagues. Most crucially, we need to ascertain the true prevalence of burnout within our profession through rigorous investigation and data collection.
The extraordinary circumstances we are currently navigating present a unique opportunity to bring to the forefront the persistent issues of burnout and well-being that have often been overlooked, echoing the revelations brought about by the COVID-19 pandemic in the United States. Despite the ongoing societal stigma that makes it challenging for healthcare professionals to openly acknowledge their struggles with burnout and to pursue mental wellness, we are at a pivotal moment in which we must earnestly engage with these pressing concerns. This critical self-reflection is essential as we formulate a comprehensive vision for the future of medicine.
The author earnestly hopes that this article will ignite your contemplation and act as a catalyst for an extensive dialogue on these vital topics.
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