The coronavirus disease 2019 (COVID-19) pandemic has been characterized by high levels of infectivity, asymptomatic infection, and early transmission (1, 2), and continues to be a public health emergency globally. Moreover, many countries are experiencing enormous pressure on their healthcare systems (3). The government of China has taken comprehensive action to contain the spread of the disease (4). However, the pandemic has altered the habits of healthcare workers as they had to adhere to more stringent cleaning routines and quarantine measures, implement the use of personal protective equipment, such as masks, face shields, gloves and gown, and separate patients with respiratory infections from others (5). Adhering to these strategies in practice can be time-consuming and sometimes difficult. Physical and emotional exhaustion associated with managing large numbers of patients and family members, the risk for nosocomial infections, and improving case identification, have rendered healthcare workers more vulnerable to the physical and psychological effects of the COVID-19 pandemic (6, 7).

Around September 2021, with the implementation of effective prevention and control measures, the COVID-19 pandemic in China entered a relatively stable period. However, a few cities in China continue to have local outbreaks due to various reasons, leading to unpredictable local lockdowns. Many places in China are simultaneously under lockdown. As the public’s patience with the COVID-19 pandemic wears thin, fatigue and numbness build, and clear signs of a new pandemic are rapidly emerging.

Frontline health professionals have been exposed to a higher risk for experiencing physical and mental health problems including depression, anxiety, distress, and symptoms of post-traumatic stress during the COVID-19 pandemic (8–10). Burnout syndrome is a biological symptom influencing the body and mind (11), a combination of high exhaustion and depersonalization, and low personal accomplishment (12). Burnout syndrome has profound effects on the mental health status of healthcare workers (13), it affected cognitive, behavioral, and psychomotor function, and could lead to delayed reactions, reduced motivation, and poor judgment (9). These negative impacts can lead to an increase in medical errors and/or treatment failure (10), a high burden on healthcare systems due to high rates of turnover and resignation among healthcare workers with poor mental health outcomes (14). The prevalence of burnout syndrome is highest among nurses, younger persons, and trainees (13). The most frequent risk factors associated with burnout syndrome among healthcare workers include stress, lack of family support, and organizational risk factors such as prolonged night shifts, length of experience, and exposure to traumatic events (13).

As such, there is an urgent need to review the problems encountered by health workers over the past year and take early preventive measures to prevent burnout from worsening. The pandemic will not subside anytime soon, and healthcare workers remain directly involved in responding to this emergency and are subject to significant psychological stress related to the uncertain duration of the crisis, the lack of proven therapies and/or vaccines, and the potential shortage of medical resources.

In this study, healthcare workers in Taizhou, Zhejiang Province, were selected as research subjects. This research mainly aimed to reveal the level of burnout of healthcare workers in a certain period of the pandemic and to define its personal predictors. It is also a timely investigation study to assess the burnout syndrome of medical staff in hospitals or other medical systems in medical emergency situations (such as COVID-19). This study highlights burnout syndrome in the context of long-term epidemiology, and includes various medical professionals, not just doctors and nurses.

A total of 286 (25.9%) of the 1,103 healthcare workers surveyed reported experiencing COVID-19 burnout syndrome, including 246 (22.3%) and 40 (3.6%) with mild and moderate burnout, respectively. Personal and job characteristics of the participants are summarized in Table 2. The study cohort comprised 934 females and 169 males, 63.6% were nurses, 16.7% were physicians, 11.8% were medical technicians, and 7.9% held administration or part-time positions.

Of the participants’ professional qualifications, 53.8% were primary and below, 46.2% were intermediate and senior. Moreover, 78.0% of the participants had undergraduate and above education and 88.0% did not have an underlying disease.

Data reported in Table 3 reveals that emotional exhaustion among healthcare workers was related to occupation (p < 0.001), education level (p < 0.001), and professional qualifications (p < 0.001). Professional efficacy was related to gender (p < 0.001), occupation (p < 0.001), education level (p = 0.001), and professional qualifications (p = 0.001). Cynicism was related to occupation (p < 0.001) and underlying disease(s) (p = 0.046). The total post-analysis Cronbach’s alpha coefficient for this study was 0.84, and 0.95, 0.95, and 0.95, for the three domains, respectively.

The MBI-GS score was associated with gender (p = 0.005), occupation (p < 0.001), education level (p = 0.03), and professional qualifications (p = 0.007).

Results of the multivariate linear regression models are summarized in Table 4.

Regression analysis revealed the following associations between burnout syndrome and emotional exhaustion among healthcare workers: medical technician vs. physician (β −2.16 [95% CI −3.74 to −0.59]; p = 0.007); undergraduate and above vs. college and below (β 1.29 [95% CI 0.17 to 2.40]; p = 0.02); intermediate and senior vs. primary and below (β 1.62 [95% CI 0.74 to 2.51]; p < 0.001). Burnout syndrome affected professional efficacy among healthcare workers as follows: male vs. female (β 1.06 [95% CI 0.12 to 2.00]; p = 0.03); nurse vs. physician (β −0.99 [95% CI −1.93 to −0.06]; p = 0.04); medical technician vs. physician (β −1.78 [95% CI −2.88 to −0.67]; p = 0.002); administration or part-time position vs. physician (β −1.46 [95% CI −2.80 to −0.11]; p = 0.03). Analysis of healthcare worker cynicism revealed the following: nurses vs. physicians (β −2.74 [95% CI −4.24 to −1.24]; p < 0.001); and underlying disease (yes vs. no) (β −2.03 [95% CI −3.71 to −0.35]; p = 0.02). MBI-GS scores demonstrated the following association: medical technician vs. physician (β −7.40 [95% CI −12.09 to −2.71]; p = 0.002).

The present study yielded several main findings. First, 25.9% of healthcare workers experienced burnout syndrome. Second, emotional exhaustion among participants was associated with occupation, education level, and professional qualifications. Third, professional efficacy of the participants was associated with gender and occupation. Fourth, cynicism among participants was associated with occupation and underlying disease. Fifth, physicians had higher MBI-GS scores than other medical professions.

Healthcare workers are susceptible to burnout syndrome due to the high intensity of their work, heavy responsibilities, and high occupational risks. Serious job burnout will threaten the physical and mental health of healthcare workers, affect the quality of medical and health services, and negatively impact the harmonious and stable development of society.

Burnout among healthcare workers has been exacerbated by the COVID-19 pandemic (19). Before January 2021, a systematic review and meta-analysis provided a complete assessment of the prevalence of fatigue across various medical staff, and found that the pooled overall prevalence of burnout was 52% (19). Our research revealed that 25.9% of healthcare workers experienced burnout in Taizhou, China, in September 2021. As COVID-19 continues to evolve, the incidence of burnout may also be changing as the pandemic is effectively brought under control.

Before COVID-19, the number of patients per nurse in our hospital was less than 8, and the number of doctors per nurse was more than 1:1.15, in accordance with China’s standard for Class A tertiary hospitals (20, 21). After the COVID-19 pandemic, some medical staff must participate in additional work on COVID-19 prevention and control (such as nucleic acid sampling and other events for COVID-19 prevention and control), resulting in an increase in the per capita workload. Some nurses may have to care for more than 8 patients on duty. Moreover, with the progress of COVID-19 and the repeated changes of various COVID-19 epidemics in 2020 and 2021, the burnout syndrome among healthcare workers had accumulated to a new level by September 2021.

In studying job burnout, emotional exhaustion mainly refers to the exhaustion of personal emotional resources, which is mainly manifested as work pressure, lack of motivation, fatigue, and continuous tension and frustration with work (22). With the spread of COVID-19, the increased workload has created greater stress and emotional problems for healthcare workers as they become more prone to emotional exhaustion (23–25). This is especially true among frontline healthcare workers (25), such as nurses and physicians. In our study, we found that medical technician vs. physician, undergraduate and above vs. college and below education level, intermediate and senior vs. primary and below were associated with emotional exhaustion among healthcare workers. Therefore, it is reasonable to suggest that, to control the emotional exhaustion of hospital staff, we should focus on physicians, staff with low educational levels, and those with primary and below professional qualifications.

It is well known that professional efficacy is very important in the field of medicine. Chinese healthcare workers exert more external effort to maintaining high levels of professional efficacy (26), which appears to be a positive coping mechanism in the short term but can lead to energy exhaustion and disengagement over time. A previous study reported that individuals who are constantly tired and cynical eventually experience professional inefficacy (27). Burnout is different between the sexes and the determinants of burnout also differ between the sexes (28). An interesting finding in our research was that professional efficacy was associated with sex and occupation: male vs. female, nurse vs. physician, medical technician vs. physician, administration or part-time position vs. physician. In other words, compared with females, males tended to have low professional efficacy compared with other medical personnel, and physicians were prone to the problem of low professional efficacy. We speculate that to address the problem of low professional efficacy, more attention should be devoted to male physicians.

Cynicism is another symptom of burnout and can fuel the intent to leave work (29). Males have reported higher cynicism than females (30). However, in our study, there was no significant difference in cynicism between males and females. Healthcare workers are mildly cynical toward their institutions and nurses experience organizational cynicism at an intermediate level (29). In our study, we found that cynicism among participants was associated with occupation and underlying disease. Compared with physicians, nurses reported higher levels of cynicism, which may be caused by lower pay, longer work hours, and not being valued or appreciated (29).

Nurses are particularly prone to burnout, and the risk is even higher for those working in emergency departments (31). Being a nurse increases the risk for burnout compared with physicians (32). We found that physician experienced higher level of burnout than medical technician according to MBI-GS score. There were no statistically significant differences in burnout syndrome between nurses and physicians, or between administration or part-time position and physicians, which contradicts some previous studies (31, 32). This may be because physicians have higher job expectations, and when those expectations are not met, satisfaction declines and emotional exhaustion sets in, leading to job burnout. It may also be due to the need for COVID-19 prevention and control, leading to extended work hours and increased complications of routine work processes, resulting in low work efficiency and resulting in job burnout. Of course, the clinical work of physicians and nurses is interwoven, with nurses assuming more responsibility for infection prevention and control and relevant vaccinations, nucleic acid monitoring, and sampling work, thus leading to clinical nursing shortages, which may require physicians to take on more clinical work, which, in turn increases the incidence of job fatigue among physicians.

Research has also shown that remuneration is related to job burnout and that improving the remuneration system may reduce the occurrence of burnout among medical staff (33); however, the overall salary level of physicians in China deviates from the labor value. Preliminary findings of this study found that only approximately one-half of healthcare workers were willing to pay for a booster dose of inactivated severe acute respiratory syndrome coronavirus 2 (i.e., SARS-CoV-2) vaccine in China, with most only willing to pay <100 CHY ($15.04 USD) (15). This is significantly lower than that of healthcare workers from some other countries with comparable economic levels (34–36). This is a reflection of the salaries of physicians in China. Combined with the study by Zhu (33), we have reason to believe that the deviation of the overall salary level of physicians from the labor value may be related to the high incidence of job fatigue among Chinese physicians.