Burnout, as defined by Maslach, is a syndrome that involves overwhelming mental and psychological exhaustion, a decreased sense of accomplishment and self-esteem and depersonalisation (detachment from the job).¹ Burnout is a common phenomenon amongst those whose occupation involves constant contact with people.² Although working with people may be gratifying, the stress of dealing with peoples’ heightened emotions on a regular basis has the potential for psychological burden¹ which, if not handled appropriately, may lead to burnout. Burnout is multifactorial and often signifies the inability of an individual to cope with work demands and interpersonal stressors at work.

Emotional exhaustion may manifest as fatigue, loss of energy, a feeling of helplessness or loss of enthusiasm. Depersonalisation may be noticed when a physician develops negative work attitude and begins to treat patients like objects. Similarly, lack of accomplishment may manifest as difficulty coping with work and decreased work productivity.^3,4 Physicians who experience burnout are at risk of suicidal ideation, developing alcohol use disorders and dysfunctional interpersonal and work-related relationships. Adverse effects on quality of care and the risk for medical errors are other important complications that may result from burnout.⁵

Worldwide, the incidence of physician burnout is increasing and studies have estimated a lifetime risk of burnout in one-third of practicing physicians.⁶ In a study on burnout and satisfaction with work–life balance amongst US physicians relative to the general US population, 45.8% of physicians reported at least one symptom of burnout.⁶ Physicians in Ghana, and Africa in general, are faced with a myriad of challenges. Overcrowded outpatient departments, emergency rooms, specialist clinics and wards with inadequate doctor-to-patient ratios are common.^7,8 Hospitals and clinics generally lack essential diagnostic equipment, medications and supporting staff.^7,9 In addition, low remuneration, poor work–life balance, challenges with postgraduate training and identification of mentors to provide guidance prevail.¹⁰ These potentially put stress on doctors regularly. Although these factors predispose physicians to burnout, it is difficult to identify a specific cause.

In a South African study, 81% of physicians had clinically significant burnout.¹¹ In Jos Plateau, Nigeria, a study amongst primary care physicians showed that 34.8% had a high degree of burnout.¹² Patel et al. in a review cited work-related factors contributing to burnout as excessive workloads, long working hours, frequent night and weekend calls, and time spent at home.¹³ Even though some of these factors are anticipated to prevail amongst doctors in Ghana, the literature on it is lacking.

We, therefore, conducted this pilot study to assess the prevalence of burnout amongst a sample of physicians in Ghana. It was also to determine whether there is any association between burnout and factors such as age, gender, medical specialty and years of practice.

The aim of this preliminary study was to determine the prevalence of burnout amongst physicians in Ghana who attended the AGSM, Ghana Chapter, of the WACP. The second objective was to elicit possible associated factors between burnout and age, sex, medical specialty and years of practice. The prevalence of the three components of burnout was 10.8% for emotional exhaustion, 5.5% for depersonalisation and 7.8% for personal achievement. These figures were lower than those obtained, respectively, in Saudi Arabia and Nigeria; 70% and 25.4% for emotional exhaustion; 26% and 9.9% for depersonalisation; and 12% and 31.6% had a low level of personal accomplishment.^2,14 In an earlier study on Career Satisfaction and Burnout conducted in Ghana, the level of burnout was also found to be low and emotional exhaustion was found to be moderate.¹⁵ We surmise that the lower prevalence of burnout seems to be a reflection of the Ghanaian physicians’ attitude to work where the satisfaction of the work itself often overrides the challenges they face daily. This situation has been documented with other cadres of health workers in other sub-Saharan countries like Tanzania.¹⁶ Then again, the vast differences in burnout prevalence rates in these countries may be attributed to the different study designs and sample sizes, different burnout assessment tools and socio-demographic dynamics pertaining to health systems in different countries.¹⁷

From our study, socio-demographic characteristics such as physician’s age and sex had no statistically significant relationship with their assessment of burnout. However, a previous study explored associations between burnout and physician age, sex and age of children and postulated that looking after children younger than 21 years increased burnout risk by 54%.¹⁸ A Norwegian study reported that women were found to have higher exhaustion rates which were linked to work–home conflicts.¹⁹

Furthermore, our study could not establish any association between burnout and years of practice or clinical specialty. Previous data available showed that primary care physicians and emergency physicians have higher rates of burnout as compared with physicians in other specialties.²⁰ Reasons proffered for this are the large numbers of clients seen, undifferentiated conditions which require longer consultation periods and the mix of chronic and emergency cases seen daily.²⁰

It was quite striking that physicians who had practised between 10 and 19 years had higher levels of burnout for all three dimensions of the MBI, whereas other age groups recorded lower levels (albeit not statistically significant). Although our study did not explore any factors peculiar to this age group, our findings are in contrast to a global study that found that the risk of burnout in physicians younger than 55 years was more than double the risk in those older than 55 years.²¹ The stress of starting a family and the quest for financial stability that compel young physicians to take up multiple job opportunities are thought to heighten the risk of burnout.¹⁴ However, the situation of higher burnout amongst the older physicians in Ghana could be explained by the feeling of inadequate preparation for impending retirement, financial and other demands of extended family, societal expectations, career or academic expectations, which are all heavy strains on the Ghanaian physician. Retirement with a pension in Ghana was found to be protective from major depressive illness only in males aged 60 years and above in a recent cross-sectional study.²²

These findings underscore the need for well-structured career guidance and counselling for secondary and tertiary-level students as well as young doctors. It is imperative that the choice of a medical profession or clinical specialty should be guided by a person’s appreciation of unique characteristics, strengths, resilience and coping skills. Policymakers and health system administrators should also institute measures to prevent burnout at the workplace and support staff members who suffer from this. This would ensure efficient and increased work output, staff and patient satisfaction.

Our study has demonstrated that burnout within the medical fraternity is prevalent and remains relevant, although it is a relatively unexplored subject in much of sub-Saharan Africa. Despite the fact that there were no statistically significant associations between burnout and sex, age, medical specialty and years of practice, continuous efforts should be made to identify burnout-related factors at the workplace and build capacity of physicians to address them. Our findings are useful for future studies that should recruit a larger study population across the medical and surgical specialties. This would permit a more rigorous testing of the variables as well as other key research questions to enhance the current body of knowledge and influence policy shift where required.