Effectiveness of a Mindfulness- and Compassion-Based Online Intervention for Physician Burnout: A Randomized Controlled Trial with Mediation and Clinical Outcome Analyses

Background: Physician burnout remains a persistent global challenge, yet most mindfulness-based interventions (MBIs) are limited by small samples, short follow-up, and lack of ethical integration. This study evaluated the efficacy of a culturally adapted, ethically grounded mindfulness- and compassion-based program (IBAP) in reducing burnout among physicians. Methods: In a randomized controlled trial, 474 physicians were assigned to an eight-week online IBAP program (n = 120) or a waitlist control (n = 354). Assessments were conducted at baseline, post-intervention, and 6-month follow-up. The primary outcome was burnout (MBI-HSS); secondary outcomes included mindfulness, self-compassion, well-being, and perceived medical errors. Analyses used linear mixed-effects models (LMMs), Bonferroni-adjusted p-values, and Cohen’s d. Sensitivity analyses included multiple imputation, per-protocol, and tipping-point models. Results: IBAP significantly reduced total burnout at post-intervention (B = –9.74, SE = 1.77, p < .001; d = –0.91) and follow-up (B = –11.55, SE = 1.84, p < .001; d = –1.08). Improvements were also observed in emotional exhaustion (p < .001), depersonalization (p = .030), and personal accomplishment (p = .008). Gains in mindfulness, self-compassion, and psychological well-being remained significant after Bonferroni correction. Mediation analyses showed that mindfulness and self-compassion each accounted for ~30% of the burnout reduction. Additionally, reductions in burnout significantly mediated lower self-reported medical errors. Conclusion: IBAP produced large, sustained reductions in physician burnout, with effects confirmed across sensitivity analyses. The program also reduced perceived medical errors via burnout reduction, supporting its clinical relevance and scalability.