This study confirms the ability of two single item measures of emotional exhaustion and depersonalization to provide important information on the likelihood of high burnout among physicians and medical students. Among those who answered a “few times a year” or less on the single item measures for emotional exhaustion or depersonalization, less than 7% had a high degree of burnout in that domain on the overall MBI. In contrast, among those who answered “a few times a week” or more on the single item measures, >90% had a high degree of burnout in each domain on the overall MBI. Supposing a baseline prevalence of high emotional exhaustion of 30% and the likelihood ratios found in this study, responding “A few times a year or less” to the question “I feel burned out from my work” indicates a probability of high emotional exhaustion on the full MBI of only 2.5%. Similarly, supposing a baseline prevalence of high depersonalization of 25% and the likelihood ratios found in this study, responding “A few times a week” to the question “I have become more callous toward people since I took this job” indicates a probability of high depersonalization on the full MBI of 92.5%.
Although these results show that response to single item measures of emotional exhaustion and depersonalization meaningfully stratify the risk of high burnout in the relevant domain, these two questions should not be viewed as replacements for the full MBI, which has a robust literature supporting its usefulness, validity, and reliability in assessing burnout in medical professionals. Burnout is a multifaceted construct, and no single item can fully reflect each domain of burnout. Therefore, these items are not meant to provide comprehensive assessment or monitoring of burnout for individual respondents. However, our study indicates that results on these two questions can serve as useful surrogates for the MBI in settings where it is not possible to administer the full 22-item instrument. For example, these two questions may be easily integrated into large surveys of medical workers that can only devote one or two items to a given topic. Thus, workplace “snapshots” of burnout may be obtained with administration of the full MBI where additional clarity is required.
This study’s main strength is its large sample size, inclusion of participants from a variety of practice settings including national samples of physicians and medical students, and the striking consistency of the results across samples. Our aggregate sample of 10,525 physicians and medical students compares favorably with the original MBI validation sample of 1,104 physicians and nurses. However, this study does have limitations. First, response rates in the individual samples ranged from 32–84% and nonresponse bias could occur. Second, it is possible that the results do not generalize to medical workers other than physicians, although the consistency of our findings across the studied groups may argue against this. Third, although the medical student and surgeon cohorts in this study were derived from national multi-center studies, the internal medicine resident and faculty cohorts were from a single academic institution. Finally, it is important to emphasize the present analysis is not intended to develop a new instrument for the assessment of burnout, but rather to evaluate how the characteristics of two questions from the MBI correlate with the full overall MBI domain score.
In summary, response to the single question “I feel burned out from my work” on the 7-point Likert scale developed by Maslach provides meaningful stratification of risk of high burnout in the domain of emotional exhaustion. Similarly, response to the single question “I have become more callous toward people since I took this job” on the 7-point Likert scale developed by Maslach provides meaningful stratification of risk of high burnout in the domain of depersonalization. These two questions may be useful in assessing burnout in medical professionals in settings where the full MBI cannot be practically applied.