Understanding the Origins and Factors of Burnout in Physical Medicine and Rehabilitation: Grounded Theory Analysis

BACKGROUND: Physician burnout is highly prevalent in Physical Medicine and Rehabilitation (PM&R), but its origins and drivers remain poorly understood. OBJECTIVE: This study aims to explore the factors contributing to burnout among Canadian physiatrists. METHODS: Using Charmaz's Constructed Grounded Theory within a qualitative interpretivist paradigm, we interviewed 30 Canadian physiatrists about their experiences with burnout. Analysis was informed by Cooley's looking-glass self theory. RESULTS: Burnout in PM&R in Canada stems from a medical culture prioritizing academic excellence over compassionate care. Canadian physiatrists report shame and self-criticism when unable to meet these high standards. Retrospective accounts from Canadian physiatrists suggest that burnout peaks during residency, where autonomy is low and demands are high. Participants also described feeling unprepared to handle patients' emotional needs and experiencing moral distress when necessary care cannot be delivered due to systemic barriers. Health care bureaucracy further compounds burnout. CONCLUSIONS: Addressing burnout in PM&R in Canada requires upstream systemic and contemporary cultural change.