Interventions to Reduce Burnout for Military Physicians: A Scoping Review

Physician burnout is an increasingly researched topic, particularly since the COVID-19 pandemic. Burnout reduction interventions, both organizational and individual, have been studied in the civilian healthcare setting. Few have been conducted in military settings. A 2022 United States (U.S.) Department of Defense (DOD) Inspector General report identified staff burnout and fatigue as a serious concern for Military Treatment Facilities. Other studies identified a significant association between burnout and suicidal ideation. From 2011 to 2022, the suicide rates in the Active component of the U.S. military have gradually increased, and per DOD Suicide Event Report forms, workplace problems were identified as a significant stressor for 26% of those who died by suicide in 2022. Since poor outcomes, staff shortages, and increased suicide risk are associated with burnout, identifying interventions that reduce burnout are vital for military physician retention and our fighting force's well-being. This scoping review aims to identify and analyze all intervention strategies since 2018 that sought to reduce physician burnout in military settings.

This literature search utilized PubMed, Embase, and the American Psychological Association's PsycINFO (APA) databases. Search criteria included the following keywords: "Burnout," "Physicians," "Military," "Interventions," and "Strategies." Eligibility criteria included studies after 2017 with pre- and post-intervention measures via a valid, reliable burnout survey method, like the Maslach Burnout Inventory (MBI) and the Professional Quality of Life Scale-5 (ProQOL-5), among physicians in a military setting.

Database searches produced 84 articles for screening, but only three studies met analysis criteria. The first study evaluated an OBGYN training program's wellness component and reported no significant difference in burnout (MBI surveys) at 0-, 6-, and 12-month time periods. The second study was a 12-month randomized controlled trial (RCT) that evaluated the effectiveness of a Web-based tool at reducing burnout in behavioral health clinicians treating post-traumatic stress disorder (PTSD), using the ProQOL-5 to assess for burnout, and it also reported no significant differences between the intervention and control groups. Finally, the third study evaluated healthcare workers' self-reported stress levels pre- and post-utilization of a Mindfulness-Based Stress Reduction toolkit at two Air Force Family Care clinics. This study did report a statistically significant decrease in both self-reported stress (P = .018) and burnout (P = .045).

Only three articles met evaluation criteria, illustrating the lack of evidence-based burnout reduction interventions in the military. Three additional studies did not meet eligibility criteria but offered promising interventions for further study, including a peer support network, simulations, and resiliency training programs. Further study of effective burnout reduction strategies in U.S. military healthcare settings is necessary to decrease personnel shortages, prevent suicide, and increase military physician well-being.