Table 3 Summary of included studies

Tam [23]

Longitudinal Survey

Chiropractic students at Parker University (n = 108)

Professional Fulfillment Index (PFI); Maslach Burnout Inventory- Human Services Survey (MBI-HSS)

• Burnout identified through MBI in conjunction with PFI to determine impact on EE

• No differences between age or gender

• While the percentage of students with burnout increased during statistically significant time points, absolute numbers of students with burnout decreased

• Identified as similar rates to other healthcare professions

Ward [28]

Survey

Life Chiropractic College of Chiropractic college faculty (n = 43)

Maslach Burnout Inventory (MBI);

Epidemic-Pandemic Impacts Inventory (EPII)

• Faculty scored lower on EE and DP subscales and higher on PA subscales compared to other health professional faculties

• No significant differences identified between full and part-time faculty

• EE was four times higher among faculty who had recently departed the college compared to current faculty

Rigney [30]

Narrative Review

Articles relevant to chiropractic profession attrition

Not applicable

• Burnout listed as a possible cause of attrition within the chiropractic profession

• List of causes also included financial burden and questionable business ethics in the profession

• Mentions that a provider may continue to stay in the profession regardless of burnout

Etxeberria [21]

Cross sectional and comparative study

Chiropractic students at Barcelona College of Chiropractic (n = 69)

Maslach Burnout Inventory-Student Survey (MBI-SS); Perceived Stress Scale (PSS)

• Students in the 2020 COVID-19 lockdown cohort reported lower stress and higher amounts cynicism, compared to the 2018 cohort

• Chiropractic students reportedly have higher stress and cynicism compared to the general population

• Women reported higher rates of stress and exhaustion, compared to their male peers

• Younger students reported higher rates of stress and lower cynicism, compared to their older peer (age 35+)

Alcantara [24]

Cross Sectional Survey

Licensed chiropractors with International Chiropractic Pediatrics Association Membership (n = 154)

Safety, Communication, Operational Reliability, and Engagement (SCORE) questionnaire

• Chiropractors reported lower burnout and higher safety rating than the general population

• Factors contributing to higher burnout rates included: higher workload, lack of growth opportunities, lack of teamwork climate, poor safety climate, and poor work-life balance

• No significant differences were found between genders or age groups

Rank [22]

Cross Sectional Survey

Chiropractic students from 9 European chiropractic institutions (n = 121)

Perceived Stress Scale (PSS); Maslach Burnout Inventory (MBI)

• Chiropractic students reported high levels of emotional exhaustion and cynicism, low levels of academic efficacy, and moderate levels of stress

• Significant differences in stress and burnout were reported by students at different institutions

• No significant differences in burnout were shown based on gender or working status

• A positive correlation was reported for rates of cynicism and exhaustion among chiropractic students.

• Chiropractic students report higher levels of stress, compared to the general population

• Chiropractic students present with burnout scores similar to those of medical, physical therapy, and pharmacy students

• Recently accredited schools demonstrated higher levels of burnout and stress compared to older institutions

Williams [27]

Qualitative Survey

Licensed chiropractors identified from a chiropractic marketing agency’s database (n = 970)

Non-validated questionnaire involving open-ended questions related to perceived factors related to occupational stressors and emotional exhaustion within the chiropractic profession

• Chiropractors reported the following themes as sources of occupational stress and emotional exhaustion:

• Regulations from managed care organizations (MCOs)

• Reimbursement from MCOs

• Scope of practice issues

• Business and administrative

• Poor public perception / acceptance

Williams [25]

Cross Sectional Survey

Licensed chiropractors identified from a chiropractic marketing agency’s database (n = 1162)

Maslach Burnout Inventory (MBI)

• Burnout among chiropractors was significantly lower than rates reported for medical, nursing, and physical therapy providers.

• Factors associated with aspects of burnout include the following:

• Dealing with insurance companies

• Greater administrative duties

• Less time spent providing clinical care

• Owning a practice/business

• Practice focused on workers’ compensation/personal injury

• Musculoskeletal-focused practice

• Exposure to opposing chiropractic practice philosophies

• Inconsistent public opinion of the chiropractic profession

Williams [26]

Cross Sectional Survey

Chiropractors licensed in New York, New Jersey, and Pennsylvania with contact information in a membership directory (n = 90)

Maslach Burnout Inventory-Human Services Survey (MBI-HSS)

• Rates of burnout lower among chiropractors when compared to other professions (i.e., medicine, nursing, physical therapy, occupational therapy, and dentistry)

• Factors associated with greater aspects of burnout include the following:

• Working in an acute/chronic care setting, compared to a wellness-based setting

• History of work-related injury

• Poor public perception of the profession

• Varying philosophical approach

Williams [29]

Narrative Literature Review

Articles relevant to physical therapy, occupational therapy, dentistry, manual therapy

Not applicable

• Author speculated on potential factors that may contribute to burnout within the chiropractic profession, including:

• Physical workload

• Role stress

Mental and emotional demands