Burnout is described in the literature as a combination of emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment, all of which are the result of sustained work demands that exceed available resources. In healthcare, burnout is often entwined with moral distress: the psychological strain that arises when a physician knows what a patient needs but is constrained by the system from providing it. A national survey of Canadian physicians found that 57% of family physicians reported burnout during the COVID-19 pandemic, and 21% reported moral distress 'very often' or 'always' since the pandemic began (1). These numbers are not primarily a consequence of individual physician vulnerability, but a product of working conditions that would produce similar outcomes in most professionals.
A 2024 qualitative study of 68 Canadian family physicians across four provinces identified four system-level factors that either amplified or buffered burnout during the pandemic: workload, payment model, locum coverage, and team and peer support (1). These are system-level variables, not individual ones.
Patient complexity has increased, wait times for specialist support have lengthened, and the administrative burden of documentation and system navigation has grown substantially with the adoption of EMRs. The time required to provide comprehensive primary care has increased without a corresponding reduction in patient panel sizes or clinical session lengths.
Fee-for-service models provide no income replacement during leave and no protection against the financial consequences of illness or sustained overwork. Physicians who need time to rest are often forced to choose between protecting their own well-being and protecting their income. That tension reflects a structural consequence of the payment model, rather than an individual shortcoming.
Without reliable locum coverage, physicians who recognize the need for time away are often left carrying a difficult tradeoff between stepping back and maintaining continuity of care for their patients. The study documents physicians who continued working for months past the point of sustainable function because finding coverage was impossible, not because they chose to ignore the warning signs (1).
Physicians with access to interprofessional teams - nursing, social work, pharmacy - and with collegial peer relationships reported better well-being than those practising in professional isolation. Team-based care distributes the cognitive and emotional load of primary care, whereas isolation concentrates it.
The research is clear that interventions targeted at individual physician resilience, including mindfulness programmes, wellness initiatives, and self-care guidance, do not address the structural drivers of burnout (1). Individual interventions have their place in a comprehensive approach to physician well-being. But they address consequences rather than causes, and should not be presented as equivalent to the structural interventions the evidence supports.
The 2024 Mathews et al. study recommends several system-level interventions, specifically: expansion of interprofessional team-based models of care, implementation of alternate payment models that provide income security during leave, organized locum tenens programmes, and short-term insurance mechanisms to cover fixed practice costs during physician absences (1). These are not new recommendations. They appear in different forms across a decade of burnout research and physician workforce literature. The challenge lies less in identifying the interventions than in putting them into practice consistently and at scale, which requires sustained system-level commitment and investment.
Physician burnout in primary care is a system-level problem that requires system-level responses. Locum coverage infrastructure is one of the documented components of those responses - identified in the peer-reviewed literature as a structural factor in physician well-being, not a convenience. The evidence supports organized locum programmes as part of a multi-component approach alongside payment reform and team-based care expansion.
1. Mathews M, Idrees S, Ryan D, Hedden L, Lukewich J, Marshall EG, et al. System-based interventions to address physician burnout: a qualitative study of Canadian family physicians’ experiences during the COVID-19 pandemic. Int J Health Policy Manag. 2024;13:8166.
