A Two-Level, Multidimensional Framework for Understanding and Treating Clinician Fatigue.

Clinician fatigue is a multifaceted phenomenon implicated in, but distinct from, burnout. It can impair clinician wellbeing and patient care even before burnout develops. Current interventions often treat fatigue as a short-term stress issue, overlooking its multidimensional nature. Rather than a unitary state, it comprises distinct psychological manifestations – emotional and cognitive states – that correspond to different underlying sources. This paper proposes a two-level, multidimensional model that distinguishes these manifestations from their drivers, including organizational pressures and challenges to professional identity. The different dimensions interact and evolve throughout a clinician’s career, positioning fatigue not only as an individual burden but also as a diagnostic signal of systemic misalignment between human capacities and institutional demands. Building on this reframing, the framework emphasizes that clinicians can develop adaptive responses alongside teams and organizations. Management strategies progress from immediate, clinician-led actions to longer-term team and organizational interventions, organized into six pathways: strategic compartmentalization, integrated reconnection, adaptive specialization, collaborative support, systemic engagement, and cyclical renewal. Support for these pathways requires broader institutional and cultural reforms. Reframing clinician fatigue as a signal for individual career choices and institutional transformation underscores the need for more humane and sustainable models of care that respect clinicians’ values and capabilities.