Burnout: The Exhaustion You Feel is Not a Sign of Weakness-It’s Proof of How Much You Have Given

Dear Editor, In 2023, an editorial by Dr. Diab in the Arab Board Medical Journal highlighted that physician burnout in the United States is driven by administrative burdens and the pressure to consult more patients in less time.[1] This contrasts with environments that report lower burnout rates, such as Lebanon, where meaningful physician–patient interactions exist.[1] Physician burnout remains a critical issue today, particularly in the UK, where General Practitioners (GPs) report experiencing exhaustion, identity struggles, and a reluctance to seek help.[2] Many face isolation, overwhelming workloads, and even suicidal thoughts.[2] As a GP clinical supervisor and a GP trainee from Portugal, we find these findings deeply concerning. They align with a recent Portuguese study showing that one in four medical interns report severe symptoms of burnout.[3] This highlights a critical issue at the very start of medical careers—emphasizing that early prevention is key. Early-career physicians face intense pressures, including long working hours (both on and off duty), lack of financial support for training, and work-life imbalance, further deepened by the need for continued studying and training outside of working hours.[3,4] Systemic inefficiencies have been identified as a major driver of burnout, emphasizing the need for reforms to improve working conditions and mental health support.[3] Similarly, previous research in northern Portugal found burnout rates among GP trainees ranging from 8.6% to 34.3%, depending on the definition used.[5] Among GPs, the prevalence was 17.0%,[6] four times higher than reported in earlier studies.[7] The Portuguese data highlights the widespread nature of burnout and its systemic roots, while experiences from the UK illustrate the profound impact on the lives of GPs. GPs are deeply committed to their patients and communities; however, the exhaustion from their persistent dedication is leading some to consider leaving the profession entirely. Together, these perspectives portray a broad picture of healthcare systems in crisis, where physicians at all stages of their careers face enormous pressures. Too often, physicians are expected to “cope” or “build resilience”.[2,3] In response, Portuguese family practice units have developed programs aimed at this,[8] with mixed success. Nonetheless, such approaches often overlook the systemic factors driving burnout. Reframing burnout as a work-related condition,[2,3] rather than a sign of personal weakness in GPs, is essential, as it is classified as an occupational phenomenon in the 11th Revision of the International Classification of Diseases and not as a medical condition.[9] Healthcare systems must prioritize both individual support and structural reform.[2] In Portugal, the Family Medicine specialization training program (Order 125/2019),[10] establishes that GP trainees have a 40-hour workweek, with dedicated time within their schedule for nonclinical activities.[10] These 8 hours are reserved for relational learning, tutoring, and mentoring, planned jointly by the trainee and the clinical supervisor.[10] This represents a step forward in reducing off-duty study and training hours and contributes to improving work-life balance for young GPs. Dr. Diab emphasized the importance of meaningful physician–patient interactions,[1] yet in Portugal, this resource is severely limited by oversized patient lists and excessive bureaucratic tasks. We believe that creating sustainable working conditions is essential to ensuring GPs provide high-quality care without sacrificing their well-being or leaving the profession.