Our study was the first nationwide survey that comprehensively investigated the prevalence of burnout and job satisfaction among psychiatrists in China. The sample of > 4000 psychiatrists, covering all the TPHs in China, represents the largest study of psychiatrist burnout in the literature.
We found a high rate of burnout (38.4%) among psychiatrists working at TPHs in China. This rate was concordant with those reported in HICs such as the US (36.9%) [27] and Japan (40.0%) [28]. More specifically, our study found that 25.4% of psychiatrists in China had high levels of EE, 32.9% had high levels of DP, and 20.7% had low levels of PA. These rates were also consistent with the overall estimated pooled prevalence for high levels of EE, higher levels of DP, and low levels of PA among mental health professionals [10]. There are many causes that may lead to burnout among psychiatrists in China, such as widespread stigma towards mental illness [29], heavy workload [30], low salary [31], and poor physician-patient relationships [32–35]. Interestingly, although the prevalence of burnout among psychiatrists in China is comparable to those in HICs, the percentage of job satisfaction among psychiatrists in China is much lower than those reported in HICs [36–38]. For example, 88% of Australian psychiatrists were satisfied with their work and proud of their profession [38]. In contrast, only 64.4% of respondents in our study were satisfied with their jobs in general. For those experiencing burnout, the percentage of psychiatrists reporting job satisfaction was even lower (43.2%). Despite the fact that burnout and job dissatisfaction are closely interrelated, this finding supports the view that burnout and job dissatisfaction are two distinct indicators of job morale with different etiologies [39].
Our study suggests that male psychiatrists in China seem to be at higher risk of burnout and job dissatisfaction. This is inconsistent with the findings from HICs, e.g., the US [40], Austria [41], and France [42]. One possible interpretation is that psychiatrists in China often have to live with unsatisfactory payment [31] and deep-rooted stigmatization towards mental health professionals [29], which conflicts with the expectations attached to males in China to gain more wealth and higher status. We also found that early-career psychiatrists reported lower rates of burnout and job dissatisfaction, which was again inconsistent with the findings in North American psychiatrists [40] and European psychiatrists [43]. There may be two explanations. Firstly, because of relatively low tuition costs, medical students in China rarely reply on student loans to finish their medical schools. So, unlike many early-career psychiatrists in HICs, their counterparts in China are often not burdened with medical school debts after graduation and are therefore faced with less financial stress. Indeed, several studies have found strong associations between medical school debts and burnout among early-career physicians [44, 45]. Secondly, most psychiatrists in China start residency training immediately after receiving medical bachelor’s degrees, as demonstrated in Table 1. Therefore, early-career psychiatrists in China are usually much younger than those in many HICs, which makes them to some extent freed from household debts, as well as other family responsibilities.
Till now, there have been an enormous body of evidence suggesting that longer working hours [42, 43, 46, 47] and less control over one’s job [40] can lead to burnout and job dissatisfaction. Similarly, our study also reported that longer working hours were significantly associated with both burnout and job dissatisfaction. Regarding job control, it should be noted that our study asked its respondents whether they had leadership roles in their workplaces instead of asking directly how much control they had over their jobs. However, team leaders are often considered to have more control over their jobs. Accordingly, our data suggest that having leadership roles in the workplace was significantly associated with less burnout and more job satisfaction among psychiatrists in China.
It is often reported that psychiatrists have a lower rate of burnout compared with other specialists [27, 48, 49]. Our study also showed a lower rate of burnout (38.4%) among psychiatrists than those among other specialists, such as neurologists (53.2%) [50], anesthesiologists (69%) [16], and oncologists (51%) [17], in China. There are several possible explanations for this finding. Firstly, psychiatrists may be more aware of their own emotional and psychological needs than other specialists. Also, psychiatrists may be more skilled at stress relieving and have better access to mental health services.
Out study had several limitations. First, we utilized self-report measures of burnout and job satisfaction. Although both MBI and MSQ were well validated in China and in other countries, their self-report nature makes their validity still questionable. Second, our study included psychiatrists working in psychiatric hospitals but not those working in other health care settings such as primary care facilities. However, according to the official data from China’s National Health Commission, 80.2% of mental health professionals in China worked in psychiatric hospitals [5]. Accordingly, our study can still stand out as being of crucial importance to landscape and investigate job morale among psychiatrists in China. Third, the cross-sectional survey method does not allow assessment of the direction of effect for the associations described in this study.