Burnout and allostatic load in physicians: Examining the role of work stress dimensions

Burnout results from chronic work stress, and allostatic load (AL) represents cumulative physiological strain from stress exposure. Evidence linking burnout to AL is inconsistent, work stress is rarely examined, and studies over-rely on the Maslach Burnout Inventory (MBI).

Sixty male practicing physicians in Switzerland (30 with burnout, 30 controls) were studied using a primary categorical MBI classification and a secondary weighted MBI score. Vital exhaustion and the Shirom-Melamed Burnout Measure (SMBM) were exploratory burnout measures. AL was indexed by a five-biomarker Allostatic Load Index (ALI) defined as a clinical composite (ALI-clinical) and a quartile-based score (ALI-quartile). Work stress was measured by extrinsic (effort-reward-imbalance, ERI) and intrinsic (overcommitment, OC) components. Age-adjusted negative binomial regression models included burnout measures and either ER-ratio or OC as work stress indices.

Adjusted for OC, categorical burnout was associated with approximately twofold higher ALI-clinical (RR = 2.02, p = .044) and ALI-quartile (RR = 2.00, p = .043). OC showed inverse associations with ALI-clinical (RR = 0.875, p = .004) and ALI-quartile (RR = 0.892, p = .016), corresponding to 12.5% and 10.8% lower expected AL values per unit increase, respectively. A significant categorical burnout × ER-ratio interaction emerged for ALI-clinical (B = 1.726, p = .026) and ALI-quartile (B = 1.648, p = .013), indicating higher AL at higher ER-ratio in the burnout group, with the opposite trend in controls. These results were consistent across burnout measures.

Burnout was associated with increased AL, independent of OC. Intrinsic and extrinsic work stress dimensions showed opposing associations with AL, and the ERI-AL relationship differed by burnout status. Work stress should be conceptualized multidimensionally when examining burnout-related biology.