Physician Burnout Has Major Consequences for Patient Health

Physician burnout is a clear and present danger to patient health, according to a major new meta-analysis of 47 studies involving some 42,000 physicians.

“We found that physicians with burnout are twice as likely to be involved in patient safety incidents, twice as likely to deliver suboptimal care to patients owing to low professionalism, and 3 times more likely to receive low satisfaction ratings from patients,” wrote lead author Maria Panagioti, PhD, of the University of Manchester.

Panagioti and colleagues say it is imperative that health care organizations do a better job of capturing burnout data and intervening as necessary and as possible.

There’s long been anecdotal evidence, and some studies, suggesting that stress and burnout among physicians leads to diminished care for patients. However, the authors sought to systematically quantify the evidence by reviewing all available and appropriate literature.

To gather the data, they searched academic databases for any study on physicians, burnout, and patient outcomes published through October of 2017. Any physician working in any health care setting was considered eligible for conclusion, though they limited the meta-analysis to physicians, rather than including other health care providers.

After eliminating duplicates and using screening criteria, 47 studies were selected for inclusion in the analysis. Of those, about half (49%) were conducted in the United States. Another one-third of the studies (32%) took place in Europe.

The investigators found that “depersonalization”—adopting an impersonal approach toward patients—was the symptom of burnout that had the largest impact on patient safety, correlating with increased patient safety incidents and lower professionalism.

“Depersonalization was also associated with lower patient satisfaction, suggesting that its results can be perceived by patients,” Panagioti and colleagues wrote. “These findings are consistent with existing evidence showing that depersonalization is related to low professionalism.”

The authors noted that the correlations in the studies were generally based on self-reports by physicians, rather than by institutional data by health care systems. They suggest that existing methods by which health care organizations record and assess for metrics like burnout may be incomplete or insufficient.

The study called out residents and early career physicians as showing the strongest links between burnout and low professionalism. They say the data suggest these physicians might also have lower levels of satisfaction with their work, and might feel estranged from their professional values and integrity.

They argue that health care organizations have a duty to better support these providers as they transition into the life of a full-time physician.

“Residents will be responsible for the health care delivery for over 2 decades in the future,” Panagioti and colleagues wrote. “Investments in their wellness and professional values, which are largely shaped during early-career years, are perhaps the most efficient strategy for building organizational immunity against workforce shortages and patient harm/mistrust.”

However, the authors said that interventions need to extend beyond identifying and helping specific physicians facing burnout. They write that health care organizations also need to do a better job of improving their workplace cultures, so as to foster a more supportive—and ultimately, safer—environments.

The study, “Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis,” was published in JAMA Internal Medicine.