The initial search yielded 126 total articles; after duplicates were removed and grey literature was added, 95 articles remained for screening. Screening these 95 individual abstracts yielded 32 potentially relevant articles. The full-text of these 32 articles were evaluated, which resulted in 10 total articles meeting this study’s inclusion criteria. Articles excluded at full text screening are available in Additional File 1. Characteristics of these ten included studies are reported in Table 3.
This scoping review identified three surveys of chiropractic students [21,22,23], four surveys of licensed chiropractors [24,25,26,27], one survey of chiropractic faculty [28], and two narrative reviews [29, 30]. Articles meeting our inclusion criteria were published between 2011 and 2024. Most of the included studies (8/10) were conducted in the United States [23,24,25,26,27,28,29,30], while 2 of the included studies were conducted in Europe [21, 22].
Burnout outcome measures utilized
Six of the ten articles meeting our inclusion criteria measured burnout using the Maslach Burnout Inventory (MBI), which is considered to be the gold standard questionnaire for identifying burnout [31, 32]. Two studies used the MBI questionnaire, in combination with the Perceived Stress Scale (PSS) [21, 22]. while the remaining two studies used only subsections of the MBI [23, 26]. One study used the SCORE survey (Safety, Communication, Operational Reliability, and Engagement) [24] and two studies generated their own survey instruments in an attempt to target their questions for practicing chiropractors and non-practicing chiropractors that have left the profession [27]. Two studies used additional measures, in combination with the MBI, in order to determine the impact on emotional exhaustion by incorporating the Professional Fulfillment Index (PFI) and the Epidemic-Pandemic Impacts Inventory (EPII) questionnaires [23, 28].
Licensed chiropractor burnout
Four surveys reported on the experiences of a total of 2,376 licensed chiropractors [24,25,26,27]. Many of these studies focused on the rates of burnout within the chiropractic profession, compared to other healthcare professions. Chiropractors surveyed in the Northeastern United States reported lower rates of burnout, when compared against burnout rates for medical providers, nurses, physical therapists, occupational therapists, and dentists [26]. Williams et al. 2013 reported that greater time spent dedicated to administrative duties was associated with statistically increased rates of depersonalization and lower-rated feelings of personal accomplishment. The investigators found that chiropractors working in acute or chronic care settings, experiencing work-related injuries, having diverse philosophical perspectives, and facing negative public perception significantly contributed to burnout. The most common factors reported by surveyed chiropractors as contributing to emotional exhaustion were insurance regulations, limited reimbursement, scope of practice issues, negative public perception, business and administrative duties, and mental and emotional demands [25, 27].
A narrative review proposed a variety of factors potentially contributing to burnout for chiropractors [29]. These included high rates of work-related injury, empathy fatigue, financial concerns secondary to insurance regulation, and market competition with other providers of manual therapy [29]. The study by Williams et al. 2013 reported that chiropractors demonstrated lower rates of burnout when compared to the reported rates of burnout in the medical, nursing, dentistry, and physical therapy professions [26]. A narrative review focusing on attrition from the chiropractic profession suggested burnout as one of many potential causes of attrition and further outlined that chiropractors may still practice while actively experiencing burnout [30].
According to the Maslach Burnout Inventory (MBI), higher levels of emotional exhaustion and depersonalization, as well as lower levels of personal accomplishment are the major factors that lead to professional burnout [32]. The most common factors chiropractors reported as contributing to emotional exhaustion in descending order include insurance regulations (33%), insurance reimbursement (26.8%), scope of practice issues (21.3%), business and administrative duties (16.4%), public perception and acceptance (16.1%), intra-professional stress (13%), and self-perception/purpose (11.2%) [27]. Factors found to be protective against burnout were longer duration of time in practice, philosophy-based approach to practice, older age, being of male gender, and marital status.
Chiropractic student burnout
Three surveys reported on the experiences of a total of 298 chiropractic students (n = 190 European, n = 108 US) [21,22,23]. The two surveys involving European chiropractic students used both the MBI and PSS questionnaires [21, 22]. One of these student surveys identified chiropractic students as having higher rates of burnout, when compared to the general population as well as pharmacy and physical therapy students [22]. Additionally, this survey reported the rates of burnout were higher in more recently accredited institutions (i.e., newer chiropractic programs) [22]. Another survey investigated the impact of the COVID-19 pandemic lockdown on chiropractic students in Spain [21]. Interestingly, this Spanish study reported lower levels of stress during the pandemic when compared to a pre-pandemic cohort of chiropractic students, while heightened levels of cynicism were reported in the COVID-19 cohort. Female chiropractic students involved in this Spanish study reported higher levels of stress and exhaustion when compared to their male counterparts, and younger students reported higher levels of stress as compared to older peers as well as the general population.
The survey involving chiropractic students in the United States followed participants over multiple time points throughout the clinical year of their training and found that approximately half of all students at this stage of their training had burnout [23] and further identified students in clinical term two as having the highest rates of burnout. However, the second term also had the lowest survey response rate. This rate of burnout is consistent with reporting from physicians and other healthcare providers [33, 34].
Chiropractic college faculty
One survey reported on the experiences of a total of 43 chiropractic faculty members at a single doctor of chiropractic program [28]. Participating faculty scored a lower median for emotional exhaustion and depersonalization subscales, combined with higher levels of personal accomplishment when compared with other healthcare college faculty. Adjunct faculty reported lower emotional exhaustion compared to their full-time peers, and faculty that recently left the college reported emotional exhaustion that was four times higher than the median. Faculty participants who had worked at the college for more than ten years and whose courses did not involve a hands-on component reported higher rates of emotional exhaustion.
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