Burnout and Cognitive Load Among Primary Care Clinicians: A Cross-Sectional Mixed-Methods Survey Study

Burnout is highly prevalent among primary care clinicians (PCCs) and is associated with reduced job satisfaction, clinician turnover, and lower quality of care. While administrative burden and electronic health record (EHR) complexity are recognized contributors, less attention has been paid to cognitive load, the mental effort required to process and act on complex clinical information, as a potential mechanism underlying burnout. Cognitive load theory suggests that excessive mental and temporal demands may impair performance and increase strain, yet few studies have examined cognitive load and burnout concurrently in primary care. We aimed to assess the prevalence of burnout and cognitive load among PCCs, evaluate differences by clinician characteristics, and examine associations between cognitive load domains and burnout.

We conducted a cross-sectional survey of PCCs within the University of Washington Medicine Primary Care healthcare system (August-December 2023). Burnout was measured using the 9-item Abbreviated Maslach Burnout Inventory (aMBI) and defined as high emotional exhaustion (>8) and/or depersonalization (>5). Cognitive load was assessed using the NASA Task Load Index (NASA-TLX). Linear regression models examined associations between burnout status and NASA-TLX domains, adjusting for age, gender, race, ethnicity, percentage of time performing clinical work, and years of clinical practice. Open-ended responses were analyzed inductively using thematic analysis.

Among 68 clinicians with complete data (mean age 44.4 years; 73.5% non-male), 77.9% met criteria for burnout. PCCs with burnout reported significantly higher mental demand (β = 14.79, p = 0.01), temporal demand (β = 18.93, p = 0.01), and frustration (β= 34.59, p < 0.001) compared with those without burnout. Qualitative findings identified five themes: administrative overload and EHR complexity; time pressure and heavy workload; structural system gaps; diminished relational and diagnostic quality; and emotional exhaustion and moral injury. Clinicians with high burnout emphasized emotional depletion and systemic frustration.

Burnout among primary care clinicians was common and was associated with higher reported mental and temporal demands and frustration. These findings suggest that cognitive load and burnout are closely related within contemporary primary care environments characterized by high administrative and clinical complexity. Interventions aimed at optimizing workflows and reducing unnecessary cognitive burden warrant further investigation to determine whether addressing cognitive load may contribute to improved clinician well-being.