Loneliness, Burnout, and Other Types of Emotional Distress Among Family Medicine Physicians

Results From a National Survey

Samuel Ofei-Dodoo, PhD, MPA, MA; Rebecca Mullen, MD, MPH; Andrew Pasternak, MD, MS; Christina M. Hester, PhD, MPH; Elisabeth Callen, PhD, GStat; Edward James Bujold, MD; Jennifer K. Carroll, MD, MPH; Kim S. Kimminau, PhD


J Am Board Fam Med. 2021;34(3):531-541. 

In This Article


The response rates were 16.3% (401 of 2456) for all the physicians, 7.0% (113 of 1606) for the AAFP NRN member physicians, and 33.9% (288 of 850) for the AAFP member insight physicians. There was a 4.5% margin of error at a 95% confidence level between the study sample and the overall physicians who were members of the AAFP population, demonstrating that our sample generally represented the overall AAFP population.[45] Table 2 summarizes the prevalence of loneliness, burnout, depression, and fatigue. Throughout the document, we used the term depression to indicate a positive screen for depressive symptoms.

Loneliness. The overall prevalence of loneliness was 44.9% (165 of 367). The mean score and standard deviation on the 3-item UCLA Loneliness Scale was 5.3 ± 1.9, with more than half of the physicians sometimes or often feeling a lack of companionship, left out, or isolated from others (Figure 1). The mean loneliness score varied by gender, with female respondents scoring higher (5.6 ± 1.9) than male respondents (5.1 ± 1.9, P = .012; Table 2). As Table 3 shows, loneliness was significantly associated with years in clinical practice. Physicians with more years in practice had lower levels of loneliness (P = .019). There was not a significant association between age-group, gender, employment status, practice location, or membership and loneliness score.

Figure 1.

Percentage of responses to the 3-item University of California, Los Angeles (UCLA) Loneliness Scale

Burnout. In aggregate, 45.1% of the physicians reported at least 1 manifestation of burnout. The manifestation of burnout varied by sex, with 56.9% of female respondents compared with 41.7% of male respondents reporting manifestations of burnout (P = .004).

Depression and Fatigue. Overall, 44.3% (163 of 368) of the respondents screened positive for depression. Depression by sex, with 51.0% (100 of 196) of female respondents versus 36.8% (63 of 171) of male respondents screening positive (P = .004). Nearly 46.9% (161 of 343) of the respondents reported excessive fatigue during the prior week. The level of fatigue varied by sex as 55.2% (101 of 183) of the female respondents compared with 36.9% (58 of 157) of the male respondents reported experiencing excessive fatigue during the prior week (P < .001).

Loneliness and Other Types of Emotional Distress

As shown in Table 4, respondents with higher loneliness scores reported at least 1 manifestation of burnout (69.1% vs 27.4%, P < .01), were more likely to screen positive for depression (66.0% vs 27.6%, P < .01) and experienced a higher degree of fatigue (59.5% vs 32.4%, P < .01).

Findings of the mixed model analyses indicated that there was a significant positive association between loneliness and depression (odds ratio [OR] = 5.08; 95% confidence interval [CI], 4.64–7.94; P < .001; Table 3). This association remained significant after adjusting for the respondent age, gender, employment status, practice location, and membership (adjusted OR [aOR] = 2.24; 95% CI, 0.97–5.19; P < .001). In addition, respondents who reported a high level of overwhelming exhaustion experienced a higher level of loneliness (OR = 7.19; 95% CI, 4.03–12.02; P < .001; Table 3). This association remained significant after adjusting for all respondent characteristics (aOR = 1.26; 95% CI, 0.99–1.61; P < .01).

A higher level of loneliness associated positively with manifestations of burnout (OR = 4.61; 95% CI, 2.96–7.19; P < .001; Table 3), high score of depersonalization (OR = 4.76; 95% CI, 2.58–8.77; P < .001; Table 3), and a high degree of fatigue (OR = 4.63; 95% CI, 1.91–7.63; P < .001). These associations were not significant after adjusting for the respondent's age, gender, employment status, practice location, and membership.