As a doctor working in the Maldives, I have witnessed firsthand how burnout has silently taken a toll on healthcare professionals. Tahe emotional and physical strain of our work, along with the unique challenges of working in an island nation with limited resources, have made burnout an inevitable part of our professional lives. Yet, despite its growing presence, we have no solid data on its prevalence and the conversation around it remains largely absent.

The 11th Revision of the International Classification of Diseases (ICD-11) by the World Health Organization (WHO) defines burnout as "a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed”. Christina Maslach and Susan Jackson (1981)’s model is one of the most influential conceptualizations of burnout that describes burnout as “a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do people work". 

Burnout is being identified more and more globally as a concern among healthcare workers. A 2021 meta-analysis of burnout which analyzed 30 observational studies found an overall prevalence of burnout was 52% among all healthcare workers, and nurses and/or physicians experienced the highest level of burnout at 66%. COVID-19 has increased the rates of burnout among healthcare workers dramatically, with studies done across multiple countries showing nearly 50% experience high levels of burnout, most noticeable among frontline workers. 

Doctors in Maldives face immense demands and deal with everything from routine check-ups to life-threatening emergencies, often with limited resources. The scattered geography of the Maldives adds another layer of difficulty. With about 200 islands, many healthcare workers are isolated from the support and resources available in urban centers. On smaller islands and peripheries, the burden is much higher, as we are expected to manage everything from basic care to complicated procedures with few or no specialists on hand. On top of this, systemic issues like chronic understaffing, lack of training opportunities, and high turnover rates exacerbate the problem. 

Burnout among healthcare workers in the Maldives is likely worsened by inefficiencies in the healthcare system, particularly the absence of an established primary healthcare network and clear referral pathways. This gap encourages a culture where patients seek specialist care directly, the preventive and early-stage management that a strong primary healthcare network could offer. As a result, tertiary care facilities face overwhelming demand, while primary care remains underutilised and underdeveloped. The scarcity of trained professionals only adds to this strain, forming a perfect storm that accelerates burnout among already overburdened staff.

So how does burnout impact us? Is it only us? What about the patients and the healthcare system at large? 

The ripple effect of burnout not only the personal well-being of healthcare workers but also the quality of patient care and the whole healthcare system. Multiple studies show that fatigued healthcare workers are more likely to make errors that can jeopardize patient safety. 

Burnout is not just a personal issue—it’s a systemic one that’s affecting the entire healthcare system. Many of my colleagues, after years of struggling with exhaustion and stress, are leaving the profession or moving abroad in search of better opportunities. This “brain drain” is already underway, as our healthcare system is losing valuable staff who seek relief from a system that undervalues them. 

Burnout also affects productivity, increase absenteeism, and turnover rates. A particularly challenging aspect of burnout in the Maldives is the stigma surrounding sick leave. As healthcare professionals, we understand the importance of prioritizing our physical and mental well-being to provide high-quality patient care. The perception that taking time off for health reasons shows a lack of commitment actually creates this culture to “push through” the exhaustion and illness, often harming both the quality of patient care and own well-being. This approach is not addressing the root cause; which is a systemic one, rather only focuses on the visible symptoms of a bigger issue.

Understanding burnout amongst healthcare workers in Maldives requires acknowledging the lack of existing research and the need for Maldivian context-specific studies. Studies done in multiple countries show the prevalence and impact of burnout, but we lack local data which could potentially help giude our policies and interventions. 

Therefore, research is essential to find the root cause in our context— whether it’s resource limitations, centralisation, scattered geography, cultural norms around work-life balance, hierarchy, or communication styles. The Maldivian healthcare system, with its reliance on island-based clinics, atoll hospitals and central referral hospital likely presents unique stressors for healthcare workers.