Strategies for Preventing and Managing Burnout

RELEASE DATE

October 1, 2025

EXPIRATION DATE

October 31, 2027

FACULTY

Katherine Hale, PharmD, BCPS, MFA
Freelance Medical Writer
Richland, Washington

FACULTY DISCLOSURE STATEMENTS

Dr. Hale has no actual or potential conflicts of interest in relation to this activity.

Postgraduate Healthcare Education, LLC does not view the existence of relationships as an implication of bias or that the value of the material is decreased. The content of the activity was planned to be balanced, objective, and scientifically rigorous. Occasionally, authors may express opinions that represent their own viewpoint. Conclusions drawn by participants should be derived from objective analysis of scientific data.

ACCREDITATION STATEMENT

acpePharmacy
Postgraduate Healthcare Education, LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

UAN: 0430-0000-25-105-H01-P
Credits: 2.0 hours (0.20 ceu)
Type of Activity: Knowledge

TARGET AUDIENCE

This accredited activity is targeted to pharmacists. Estimated time to complete this activity is 120 minutes.

Exam processing and other inquiries to:
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DISCLAIMER

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

GOAL

To familiarize participants with the characteristics of burnout and potential strategies and resources available for burnout prevention and management.

OBJECTIVES

After completing this activity, the participant should be able to:

  1. Define burnout syndrome and the dimensions that characterize burnout.
  2. List factors that contribute to burnout and methods to assess it.
  3. Discuss individual and organizational strategies to prevent and manage burnout.
  4. Identify practical tools and resources that may be used to prevent and manage burnout.

ABSTRACT: Considered an occupational phenomenon resulting from chronic workplace stress, burnout affects many pharmacists and other pharmacy staff across all sectors of practice. Burnout rates as high as 75% have been reported in community pharmacists and as high as 50% or more in hospital and ambulatory care settings and by pharmacy technicians. High workloads, staffing concerns, and a mismatch between job demands and resources contribute to burnout and have led to increased concerns for patient safety and pharmacist and pharmacy staff well-being. Many individualized, organizational, and national strategies have been proposed to prevent and mitigate burnout. Numerous practical tools and resources are available to facilitate burnout prevention and management and promote positive workplace culture and well-being.

More than 80% of individuals experience some form of stress in the workplace, affecting life outside of work for 50% or more.1 Initially presented and studied as early as the 1970s, burnout has been a focus of research for several decades. Burnout is considered an occupational phenomenon that is occurring in a multitude of professions that are oriented toward serving others (e.g., healthcare, education, and human services) and now non–service-oriented professions as well. Burnout is characterized by three dimensions: exhaustion, depersonalization, and reduced personal accomplishment (see TABLE 1).2-9

In 2019, the World Health Organization (WHO) further defined burnout in the 11th revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon (not a medical condition). The WHO defined burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed” with the designated code QD85.5,6 The three dimensions of burnout were further defined as 1) exhaustion/depleted energy; 2) job-related cynicism/negativism and/or increased mental distance; and 3) decreased efficacy.5-8 While burnout and other mental health conditions, such as depression, may occur concomitantly, it should be noted that burnout and depression are not the same. Depression is a medical diagnosis, while burnout is considered a job-related occupational phenomenon.4

Burnout decreases quality of care and worker morale and increases absenteeism and job turnover. Individually, burnout increases personal dysfunction, and relationships suffer. Physical symptoms, such as physical exhaustion, sleep disorders, gastrointestinal symptoms, and changes in eating habits, may occur. Increases in the occurrence of substance use have also been reported.3,9,10

Prior to the COVID-19 pandemic, a 2019 survey (N = 2,000) indicated that 74% of Americans were concerned about healthcare professional burnout, with 91% indicating that their clinician should employ strategies to avoid burnout. Additionally, 77% indicated that if their clinician was feeling burnout, safety and care would be a concern.11

During the pandemic, high numbers of pharmacists reported at least one dimension of burnout, and rates have remained elevated postpandemic.12,13 Physical exhaustion and emotional exhaustion were reported by 45% and 53% of pharmacists, respectively. Depersonalization (25%), depression/sadness (25%), and anxiety (40%) were also reported.12 In the community pharmacy setting, emotional exhaustion (68.9%), depersonalization (50.4%), and decreased personal accomplishment (30.7%) were reported by pharmacists (N = 411), with 74.9% reporting burnout in at least one dimension overall.14 An additional study of community pharmacists (N = 1,425) found that 67.2% experienced burnout.15 A survey of hospital and health-system pharmacists (N = 380) found that 55.5% were at risk for burnout.16 Reported burnout among ambulatory care pharmacists is as high as 88%, and among pharmacy technicians it as is high as 52%.17,18

A survey of pharmacy residents (N = 163) across 1 year of residency found variable rates of burnout, disengagement, and exhaustion at different survey points. Increased rates occurred in each dimension across 1 year, ranging from 35% to 85% (P <.001). Poor sleep and nutrition and perceptions of not feeling supported by residency program directors may have impacted burnout.19

The cost of burnout in healthcare providers is high. Prepandemic estimated costs of burnout were $4.6 billion, owing to increased turnover and changes in clinical hours. For physicians, turnover related to burnout costs $2.6 billion to $6.3 billion per year as a whole and an estimated $7,600 per physician per year.9,20 Among nursing staff overall, burnout-related turnover costs are much higher at $9 billion yearly.9 While physician and nurse burnout costs have been estimated, the direct and indirect costs of pharmacist burnout in all sectors (community, ambulatory care, hospital, and others) is not clear. Attrition rates are also high. The 2024 National Pharmacist Workforce Survey found that 36.1% and 25.5% of pharmacists would likely/very likely search for new employment or leave their current job within the next year, respectively.21 Physicians (20%) and nurses (40%) have or will have left practice.8

What Drives Burnout?

Several explanatory and complementary theories exist describing the why and how of burnout development. These include social cognitive, social exchange, organizational, structural, job demands-resources, and emotional contagion theories (see TABLE 2).2 Self-doubt regarding effectiveness at one’s job is the basis of social cognitive theory, while a perceived mismatch between effort contributed and results obtained is the basis of social exchange theory. Job demands-resources theory is a mismatch between the demands of the job and resources available to complete the work. Failed individual coping strategies in response to workplace stress is the structural theory approach. Organizational theory is considered a combination of lack of adequate individual coping strategies coupled with organizational and work stressors. Emotional contagion theory focuses on shared beliefs and emotions as part of interactions among work groups as part of shared situations and emotions and may affect burnout development at home and at work. Initially proposed as singular theories for burnout development, based on dimensions of burnout syndrome as noted in the WHO definition, many of these theories overlap in burnout cause and development.2-6

A multitude of factors have been cited to drive burnout and support the above theories (see TABLE 3).2, 7-9 Increased job demands and reduced resources are often primary drivers of burnout. High or excessively high workloads increased from 2014 to 2024 and were highest in chain pharmacies versus independent pharmacies or patient-care–oriented settings.21 In recent years, increased workloads, understaffing, and lack of resources available to complete needed tasks led to pharmacist strikes owing to increased concern for patient safety.22-24 Additional drivers and risk factors for burnout in pharmacists include longer working hours or more hours worked per week, professional advancement (e.g., board certifications), increased nonclinical and administrative tasks, female gender, younger age, less experience, poor work-life balance, distribution roles, lack of burnout-management resources or not knowing how to access or ask for resources, and lack of appreciation by colleagues for professional contributions.17,25-30

Physician satisfaction and drivers of burnout have been linked to obstacles preventing provision of high-quality care, technology and electronic health record challenges, autonomy, organizational leadership, reimbursement, and health reform.31 Many of these factors hold true for pharmacists, regardless of practice location.

In 2008, the Triple Aim was introduced. This aim focused on improving patient-care experiences, population health management, and cost reduction.32 Since its introduction, many changes have occurred systemwide and among the healthcare professions to address and meet these goals and objectives. Demand continues to exceed resources, however, furthering burnout occurrence among healthcare professionals. Therefore, provider well-being has been proposed as a fourth aim.33

Effects of Burnout

Burnout has been linked to reduced patient access and time to complete visits, increased litigation and malpractice claims, increased costs, increased staff and provider turnover, and care-quality reduction.7-9,34-36 Individually, burnout is associated with higher risk of chronic health conditions, such as type 2 diabetes, cardiovascular disease, chronic pain and/or fatigue, gastrointestinal symptoms, sleep disturbances, and occupational injury.7-9,37 Higher rates of depression, anxiety, and substance use have been correlated with burnout in healthcare professionals. Rates of suicide among pharmacists and other healthcare professionals have been shown to be higher than in the general population.7,8,38

Increased risk of medical and medication errors is associated with burnout.7,8,34,35 Globally, when receiving healthcare services, one in 20 patients (5%) may experience medication-related harm. One-half to one-third of medication-related harm is associated with the prescribing/ordering and monitoring/reporting stages of medication use.39 Medication errors are estimated to cost $42 billion annually worldwide.40 Pharmacists may identify up to 70% of errors in the medication-ordering process and reduce medication errors.40 Many factors contribute to medication errors, including lack of training/knowledge, poor communication, language barriers, high/excessive workload, technology, need for protocols/procedures, and interruptions and distractions.41-43

In hospital settings, interruptions and distractions were identified as a primary factor contributing to medication errors, in addition to reduced staff and higher workload.44 Community pharmacists experience seven or more interruptions per hour, ranging from fewer than five to more than 20 times/hour.40,45 In the hospital setting, pharmacists and technicians experience 6.7 and 5.2 interruptions per hour, respectively.46 Interruptions occur every 2 minutes on average and may last up to 100 seconds.47 Nursing studies have shown a 12% increase in risk of error with each interruption.48,49 During the pandemic, concern for having made a medication error was two times that for pharmacists reporting high stress versus lower stress (odds ratio [OR] = 2.08, 95% CI = 1.15-3.74) and similar to that of pharmacists reporting burnout versus no burnout (OR = 1.97, 95% CI = 1.12-3.48).13

Burnout Assessment

Multiple validated instruments are available to assess burnout.50 Several are publicly available, and many are translated into multiple languages.

The Maslach Burnout Inventory (MBI) is perhaps the oldest and most commonly used tool to assess burnout. Multiple iterations and expansions have occurred since the MBI was introduced in 1981. The MBI was developed to assess each of the three burnout dimensions and is considered a standard assessment tool.3,4 The MBI has multiple options available specific to the group assessed (e.g., healthcare personnel, educators). The MBI is a 22-item assessment tool. Items are written in the form of statements specific to personal feelings and attitudes (e.g., “I feel burned out…” or “I don’t really care about…”) and answered based on a seven-point frequency scale.3 The MBI-Human Services Survey for Medical Personnel (MBI-HSS MP) is a modified version of the original MBI that is applicable to healthcare workers.50

Released in 2005, the Copenhagen Burnout Inventory (CBI) assesses two burnout dimensions, exhaustion and disengagement from work, via three areas of burnout (personal, work-related, and client-related). Nineteen items are answered via a five-point frequency scale.4,50 While no pharmacy-specific burnout assessment tools have been developed, the CBI has been validated to assess pharmacist burnout.51

Released in 2002, the Oldenburg Burnout Inventory is a 16-item survey distinguishing between physical and psychological exhaustion by assessing the two burnout dimensions of exhaustion and work disengagement via a four-point frequency scale.4,50

The Well-Being Index (WBI) is a seven- or nine-item assessment tool that was released in 2010 and designed to focus on multiple dimensions of wellness. These include burnout, fatigue, low mental/physical quality of life, depression, and anxiety/stress. Items are answered via yes/no responses.50 Use of the nine-item WBI was evaluated in a 2019 study of pharmacists (N = 2,231). The mean overall score of the WBI was 3.3 + 2.73, with burnout symptoms present in 59.1% of respondents. Higher WBI scores indicated increased odds of fatigue, burnout, and concern for a major medication error.52

Coping Mechanisms

How individuals respond to stress and burnout is variable. Coping is considered a two-part process that is based on primary appraisal of the event and secondary appraisal of individual coping mechanisms.53 Is the event harmful or threatening? How will the potentially stressful event/situation be managed? Reduced rates of burnout are associated with positive coping strategies, while negative coping strategies have the opposite effect. Positive coping strategies include humor, exercise, spending time with pets/friends/family, job skill improvement, maximizing job resources, and active coping and help seeking.10 Active acceptance is also considered a positive adaptive coping strategy that allows the individual to move on and change his or her emotional reaction to a potentially unchangeable situation.54 Negative coping strategies include avoidance, substance use/abuse, alcohol use/abuse, changes in eating habits (e.g., not eating or binge eating), and social withdrawal.10,53

Positive coping strategies identified by the American Psychological Association in response to workplace stress include55:

  • Monitor stressors to identify patterns and reactions
  • Implement healthy responses by focusing on good nutrition, minimizing or avoiding alcohol/substance use, practicing good sleep hygiene, incorporating physical activity, and participating in new/ongoing hobbies and activities
  • Establish boundaries between work and home
  • Rest and recharge by using vacation days or taking any increment of time off where possible, reduce/limit technology use, focus on activities not related to work, and make time to re-energize
  • Develop relaxation techniques such as deep breathing, meditation, and mindfulness
  • Discuss with supervisor methods to manage workplace challenges and stress to optimize performance
  • Develop and use a support system that may include friends, family, employee assistance programs, and/or a psychologist.

Positive and negative self-identified coping mechanisms that have been used by community pharmacists (N = 1,310) include self-care, integrative medicine, personal time, support of family and friends, delegation and time management, substance use, working off the clock (early, late, and on days off), pharmacotherapy, and no coping mechanisms.15

Prevention and Mitigation of Burnout

Methods and strategies to prevent and mitigate burnout may occur at multiple levels, ranging from individual to organizational and national levels.

Strategies developed and implemented by organizations have been shown to reduce clinician burnout.7-9,56-58 In 2023, the American Pharmacists Association (APhA), the American Society of Health-System Pharmacists (ASHP), and the National Association of Boards of Pharmacy (NABP) convened to establish actionable solutions that organizations, associations, and individuals could implement to improve well-being long-term.59

The summit reconvened in June 2025 (“Implementing Solutions Summit 2.0: Building a Sustainable, Healthy Pharmacy Workforce and Workplace”) to reevaluate and identify new strategies to strengthen the pharmacy workforce and prioritize well-being and mental health.60 At the organizational level, identified actionable solutions included the leverage and expansion of pharmacy technician responsibilities, reimbursement model improvement, address performance metrics, evaluate and modify staffing and scheduling, streamline hiring/onboarding processes, and optimize technology. Additionally, staffing and developing a culture of well-being were suggested by 50.2% and 17.2% of pharmacists (N = 1,425), respectively, when surveyed.15 Although not all-inclusive, TABLE 4 lists additional potential organizational strategies for reducing burnout and increasing well-being.

Promoting a positive work environment is imperative. Environments with strong teamwork, good communication, and positive culture have been found to decrease burnout.9,63 Workplace culture should be evaluated by healthcare organizations and strategies implemented to achieve positive culture, increase employee engagement, and establish a culture of health and value.9 The U.S. Surgeon General advisory recommends building a commitment to the health and safety of health workers into the organization and commit at the highest leadership levels. Regular health and safety assessments and interventions should occur. Development of mental health support services, increased access to quality and confidential mental health care, and community and social connections are recommended. Strategies to reduce bias, discrimination, and health misinformation in the workplace are also recommended.9

Because each organization is unique, a variety of methods may be used to implement burnout prevention and mitigation strategies. Many tools exist, and more will likely be developed in the future.

Individual strategies incorporate more than just self-care. First, it is important to recognize and acknowledge signs of burnout, distress, and mental health concerns when they occur.

Additional strategies include 1) staying connected to family, friends, and coworkers to combat social isolation and loneliness; 2) maintaining good health habits, focusing on nutrition, sleep hygiene, and physical activity; 3) finding moments of joy and prioritizing them; 4) practicing mindfulness; 5) using employee assistance programs; 6) journaling; 7) participating in recreational activities; 8) participating in counseling/therapy; 9) being a voice to advocate for change; and 10) learning new skills and technology.9,63,64

Various strategies that may be employed by national, state, and local associations, insurance companies and payors, and family/friends/coworkers to reduce burnout rates have also been proposed and summarized.6-9,59

Resources and Tools

Commitment to pharmacist, pharmacy personnel, resident, and student well-being and resilience has been affirmed by APhA, ASHP, and the American Association of Colleges of Pharmacy (AACP).65-67 These commitments are in addition to numerous other organizations that are striving to address provider burnout and promote well-being.68 To increase public awareness of suicide within the pharmacy profession, September 20th was established as Pharmacy Workforce Suicide Awareness Day.69 Additionally, March 18th was established as national Health Workforce Well-Being Day.70

Many practical tools to assist in burnout prevention and management are available in a variety of formats. WellBeing & You (available via ASHP) provides a calculator to estimate the cost of occupational burnout, multiple learning bursts, webinars, podcasts, and resources to assist individuals and organizations in promoting a culture of well-being in the workplace.71

NABP has well-being self-evaluation tools, an anonymous and confidential reporting tool allowing pharmacy personnel to submit positive/negative workplace experiences to help facilitate change, and many other resources available for pharmacy personnel. Courses in mental health first aid, work and fatigue online training, and trauma and healing are also available.72 For residents and student learners, resource guides and toolkits are available from ASHP and AACP to implement well-being, resilience, and burnout-reduction programs.73,74

The National Academy of Medicine has created a compendium of key resources that may be used to facilitate actionable steps to address burnout and well-being.75 The American Medical Association STEPS Forward program was created to provide numerous playbooks, podcasts, webinars, toolkits, success stories, and a program called “The Innovation Academy.” Each is designed to address practice challenges, optimize time management, optimize workflows, enhance patient experiences, improve well-being, and reduce burnout.76

Many non–healthcare-related smartphone apps and computerized applications, books, workshops, and podcasts are also available that promote positive coping strategies and well-being and reduce burnout. Counseling, therapy, and additional medical resources are needed for those with more severe mental health concerns.

Conclusion

The health and well-being of pharmacists, pharmacy personnel, and other healthcare providers remain a focus across all sectors of pharmacy and healthcare. Increasing feelings of being overwhelmed, stress, and burnout continue to threaten the pharmacy workforce, raising the risk for error and reducing care quality. Strategies to mitigate and prevent burnout may be employed not only by individuals and healthcare organizations but by local, regional, and national entities. Many tools are available to facilitate change related to stress and burnout management.

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