• Liselotte N Dyrbye, Colin P West, Andrea Leep Hunderfund, Christine A Sinsky, Mickey Trockel, Michael Tutty, Lindsey Carlasare, Daniel Satele, and Tait Shanafelt.
• Mayo Clinic, Rochester, MN, USA. dyrbye.liselotte@mayo.edu.
• J Gen Intern Med. 2020 May 1; 35 (5): 146514761465-1476.

BackgroundDespite the importance of professionalism, little is known about how burnout relates to professionalism among practicing physicians.ObjectiveTo evaluate the relationship between burnout and professional behaviors and cost-conscious attitudes.Design And ParticipantsCross-sectional study in a national sample of physicians of whom a fourth received a sub-survey with items exploring professional behaviors and cost-conscious attitudes. Responders who were not in practice or in select specialties were excluded.MeasuresMaslach Burnout Inventory and items on professional behaviors and cost-conscious attitudes.Key ResultsAmong those who received the sub-survey 1008/1224 (82.3%) responded, and 801 were eligible for inclusion. Up to one third of participants reported engaging in unprofessional behaviors related to administrative aspects of patient care in the last year, such as documenting something they did not do to close an encounter in the medical record (243/759, 32.0%). Fewer physicians reported other dishonest behavior (e.g., claiming unearned continuing medical education credit; 40/815, 4.9%). Most physicians endorsed cost-conscious attitudes with over 75% (618/821) agreeing physicians have a responsibility to try to control health-care costs and 62.9% (512/814) agreeing that cost to society is important in their care decisions regarding use of an intervention. On multivariable analysis adjusting for personal and professional characteristics, burnout was independently associated with reporting 1 or more unprofessional behaviors (OR 2.01, 95%CI 1.47-2.73, p < 0.0001) and having less favorable cost-conscious attitudes (difference on 6-24 scale - 0.90, 95%CI - 1.44 to - 0.35, p = 0.001).ConclusionsProfessional burnout is associated with self-reported unprofessional behaviors and less favorable cost-conscious attitudes among physicians.

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