Beyond Working Hours: Mental Workload, Burnout, Workplace Violence, and Organizational Support Among Physicians in Sivas, Türkiye: A Multi-Institutional Cross-Sectional Study

The human mind has a limit, much like a muscle that can only carry so much weight before it begins to tremble. In the high-stakes world of medicine, this limit is not just about physical strength but about the sheer volume of thinking, deciding, and remembering a doctor must do in a single day. This mental burden, known as mental workload, is the invisible tax on a physician's attention and memory. When this tax becomes too heavy, it can lead to a state of deep exhaustion called burnout, where a doctor feels drained, cynical, and unable to cope. While it is well known that long hours and too many patients contribute to this problem, the specific mix of factors that pushes a doctor over the edge remains complex. Understanding exactly what creates this pressure is vital, not only for the health of the doctors themselves but for the safety of the patients they treat, as a tired mind is more prone to error.

A team of researchers in Sivas, Türkiye, set out to measure this invisible burden and see how it connects to the emotional state of doctors working in their city. They gathered a group of 409 physicians from various settings, ranging from large university hospitals and state-run facilities to private clinics and local health centers. Instead of just asking how tired the doctors felt, the researchers used two specific tools to get a detailed picture. First, they asked the doctors to rate their mental workload across six different areas: how much thinking was required, how much physical effort was needed, how much time pressure they felt, how well they thought they were performing, how hard they had to try, and how frustrated they felt. Second, they measured burnout in three distinct ways: general personal exhaustion, exhaustion specifically linked to their job, and exhaustion linked to dealing with patients. By combining these detailed ratings with information about the doctors' lives, their work schedules, their financial situations, and their experiences with violence or support at work, the researchers could map out exactly what drives a doctor toward the breaking point.

The results revealed a picture of intense mental strain. On average, the doctors reported a very high level of overall mental workload. The heaviest parts of this burden were not physical labor but the constant demand for thinking and the sheer effort required to keep going. The highest scores were for mental demand and effort, meaning the doctors felt they were constantly using their brains at maximum capacity and working incredibly hard to maintain that level. Frustration was also a significant factor, suggesting that the doctors often felt blocked or hindered in their work. This high level of mental demand was not evenly distributed; it varied depending on the doctor's role and environment. Those who saw patients directly, worked in emergency or surgical fields, and had to be on call for extra shifts reported much higher mental loads than those in administrative roles or basic sciences. The number of patients seen also mattered, with doctors seeing between 51 and 99 patients a day reporting the highest mental demands, perhaps because this volume is high enough to be overwhelming but low enough to prevent the efficiency that comes with extremely standardized, rapid-fire interactions.

Time and money played a major role in this equation. Doctors who worked extremely long weeks, particularly those putting in over 100 hours, reported the highest mental workload scores. Similarly, doctors who felt their economic status was poor, those who carried debt, and those without extra income sources felt a heavier burden. This suggests that financial worry acts as a constant background noise that makes the work itself feel harder. The study also found that doctors who were on call, regardless of how many times a month, felt a significantly higher workload than those who were not. This indicates that the mere state of being available for emergencies adds a layer of cognitive strain that goes beyond the actual hours worked.

The connection between this heavy mental load and burnout was strong and clear. The researchers found that the more frustrated a doctor felt with their work, the more likely they were to feel personally exhausted and burnt out by their job. This link between frustration and burnout was the strongest relationship the study found, suggesting that the feeling of being blocked or unable to do one's job well is a more powerful driver of exhaustion than just the number of tasks completed. Doctors who experienced workplace violence, whether physical or verbal, also reported higher levels of both mental workload and burnout. The fear and vigilance required after such an event seem to consume extra mental energy. Furthermore, doctors who felt they received adequate support from their hospital administration after a violent incident reported lower levels of burnout, while those who felt unsupported felt the strain much more deeply.

The study also looked at the future of the profession by asking doctors if they planned to leave their jobs. About 14 percent said they were definitely considering leaving within the next year, while another 19 percent were undecided. Those who were thinking of leaving, and especially those who were undecided, reported the highest levels of both mental workload and burnout. This suggests that the desire to quit is closely tied to the feeling of being overwhelmed and unsupported. Interestingly, the study found that doctors who had reported a medical error or safety incident in the past year felt more burnt out than those who had not. This does not mean they made more mistakes; rather, the emotional toll of dealing with an incident, or the stress of working in an environment where incidents are reported, seems to contribute to exhaustion.

Ultimately, the research paints a clear picture of a profession under pressure. The doctors in Sivas are not just tired from working long hours; they are mentally taxed by the complexity of their decisions, the frustration of systemic barriers, and the fear of violence. The study shows that burnout is not simply a personal failure of resilience but a reaction to a work environment that demands too much mental effort without providing enough support or control. The findings suggest that to protect doctors and the patients they serve, hospitals and health systems must look beyond individual stress management. They need to address the root causes: reducing excessive work hours, ensuring doctors have control over their schedules, providing strong support after violent incidents, and creating a financial environment where doctors do not have to worry about debt while trying to save lives. The data indicates that when these structural issues are ignored, the cost is paid in the exhaustion and potential departure of the very people the system relies on.