Evidence map›Paper›PMID 39933805›Full record

ArticleBMJ open2025

Impact of moral distress on burn-out: a cross-sectional survey of front-line family physicians during the initial wave of the COVID-19 pandemic.

Avital Sabrina Fischer, Reece Fenning, John Michael Robb, Allison Slater, Uyen Mai, Tien Lam, Jan Paolo De La Cruz, John Billimek, Johanna Shapiro, Tan Nguyen and 1 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Avital Sabrina FischerPsychiatry and Behavioral Sciences, Stanford Health Care, Stanford, California, USA avitalf@stanford.edu.ORCID http://orcid.org/0000-0002-1710-0863
Reece FenningFamily Medicine, Sutter Health, Sacramento, California, USA.
John Michael RobbSchool of Medicine, University of California Irvine, Irvine, California, USA.ORCID http://orcid.org/0009-0003-7324-4663
Allison SlaterFamily Medicine, Sutter Health, Sacramento, California, USA.
Uyen MaiDepartment of Public Health, University of California Irvine, Irvine, California, USA.
Tien LamDepartment of Public Health, University of California Irvine, Irvine, California, USA.
Jan Paolo De La CruzDepartment of Public Health, University of California Irvine, Irvine, California, USA.
John BillimekHealth Policy Research Institute, University of California Irvine, Irvine, California, USA.
Johanna ShapiroDepartment of Family Medicine, University of California Irvine, Irvine, California, USA.
Tan NguyenDepartment of Family Medicine, University of California Irvine, Irvine, California, USA.
Cynthia HaqFamily Medicine, University of California Irvine School of Medicine, Irvine, California, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesPrimary care clinicians are especially prone to burn-out. The primary objective of this study was to investigate factors contributing to burn-out and moral distress and their relationship among practising family physicians (FPs) in California early in the COVID-19 pandemic.

designCross-sectional study, online survey evaluating burn-out, moral distress and associated factors.

settingCalifornia FPs between July and August 2020 practising in community health centres, hospital systems, private clinics and university systems were surveyed with a 22-item online questionnaire.

participantsFPs practising in California were eligible. The final sample included 218 physicians. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary independent variable was frequency of moral distress and the primary outcome variable was worsening burn-out. Moderator variables included gender and employer support.

resultsFPs experiencing higher burn-out and moral distress were more likely to report concerns regarding personal COVID-19 risk and lack of personal protective equipment. Practising self-care and personal wellness were associated with decreased moral distress. Female physicians were 3.86-fold more likely to report worsening burn-out compared with male physicians. Employer support was associated with a 59% reduced burn-out risk and 54% reduction in frequent moral distress. Frequent moral distress was associated with a 3.12- fold higher burn-out risk. Gender moderated the relationship between moral distress and burn-out. Moral distress was associated with a 3.55-fold increase in burn-out risk among females.

conclusionsFemale FPs experienced greater levels of moral distress and burn-out than male physicians. Moral distress was differentially associated with increased burn-out among female physicians. Employer support was a protective factor against moral distress and burn-out.

Indexed as

Burnout, ProfessionalCOVID-19MoralsPhysicians, FamilyAdultCaliforniaCross-Sectional StudiesEthical DilemmasFemaleHumansMaleMiddle AgedSARS-CoV-2Sex FactorsSurveys and QuestionnairesBurnoutCOVID-19Health WorkforcePhysicians

Identifiers

PMID39933805
PMCPMC11815442

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.