{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T04:26:43Z","timestamp":1789187203091,"version":"build-2803163510"},"reference-count":51,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,1,8]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Primary 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Cross-sectional study, online survey evaluating burn-out, moral distress and associated factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>California 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>FPs practising in California were eligible. The final sample included 218 physicians.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>FPs 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Female 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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-089980","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T12:46:02Z","timestamp":1739277962000},"page":"e089980","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["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"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1710-0863","authenticated-orcid":false,"given":"Avital Sabrina","family":"Fischer","sequence":"first","affiliation":[{"name":"Psychiatry and Behavioral Sciences, Stanford Health Care, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reece","family":"Fenning","sequence":"additional","affiliation":[{"name":"Family Medicine, Sutter Health, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7324-4663","authenticated-orcid":false,"given":"John Michael","family":"Robb","sequence":"additional","affiliation":[{"name":"School of Medicine, University of California Irvine, Irvine, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Slater","sequence":"additional","affiliation":[{"name":"Family Medicine, Sutter Health, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uyen","family":"Mai","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of California Irvine, Irvine, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tien","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of California Irvine, Irvine, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Paolo","family":"De La Cruz","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of California Irvine, Irvine, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Billimek","sequence":"additional","affiliation":[{"name":"Health Policy Research Institute, University of California Irvine, Irvine, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of California Irvine, Irvine, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tan","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of California Irvine, Irvine, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Haq","sequence":"additional","affiliation":[{"name":"Family Medicine, University of California Irvine School of Medicine, Irvine, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"2025101813300038000_15.2.e089980.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2001191"},{"key":"2025101813300038000_15.2.e089980.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0238217","article-title":"Factors contributing to healthcare professional burnout during the COVID-19 pandemic: A rapid turnaround global survey","volume":"15","author":"Morgantini","year":"2020","journal-title":"PLoS ONE"},{"key":"2025101813300038000_15.2.e089980.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.5893"},{"key":"2025101813300038000_15.2.e089980.4","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.3976","article-title":"Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019","volume":"3","author":"Lai","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025101813300038000_15.2.e089980.5","unstructured":"World Health Organization . 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