Impact of Burnout on Self-reported Patient Care Among Emergency Physicians

Dave W. Lu, MD, MBE; Scott Dresden, MD, MS; Colin McCloskey, MD; Jeremy Branzetti, MD; Michael A. Gisondi, MD


Western J Emerg Med. 2015;16(7):996-1001. 

In This Article

Abstract and Introduction


Introduction: Burnout is a syndrome of depersonalization, emotional exhaustion and sense of low personal accomplishment. Emergency physicians (EPs) experience the highest levels of burnout among all physicians. Burnout is associated with greater rates of self-reported suboptimal care among surgeons and internists. The association between burnout and suboptimal care among EPs is unknown. The objective of the study was to evaluate burnout rates among attending and resident EPs and examine their relationship with self-reported patient care practices.

Methods: In this cross-sectional study burnout was measured at two university-based emergency medicine residency programs with the Maslach Burnout Inventory. We also measured depression, quality of life (QOL) and career satisfaction using validated questionnaires. Six items assessed suboptimal care and the frequency with which they were performed.

Results: We included 77 out of 155 (49.7%) responses. The EP burnout rate was 57.1%, with no difference between attending and resident physicians. Residents were more likely to screen positive for depression (47.8% vs 18.5%, p=0.012) and report lower QOL scores (6.7 vs 7.4 out of 10, p=0.036) than attendings. Attendings and residents reported similar rates of career satisfaction (85.2% vs 87.0%, p=0.744). Burnout was associated with a positive screen for depression (38.6% vs 12.1%, p=0.011) and lower career satisfaction (77.3% vs 97.0%, p=0.02). EPs with high burnout were significantly more likely to report performing all six acts of suboptimal care.

Conclusion: A majority of EPs demonstrated high burnout. EP burnout was significantly associated with higher frequencies of self-reported suboptimal care. Future efforts to determine if provider burnout is associated with negative changes in actual patient care are necessary.


Burnout is a triad of emotional exhaustion, depersonalization and reduced sense of personal accomplishment that produces decreased effectiveness at work.[1] Physician burnout is widespread, with almost half of all physicians reporting high levels of burnout.[2] Among all specialties, emergency medicine (EM) experiences the highest levels of physician burnout at over 60%.[2,3]

High levels of burnout may negatively impact the quality of care physicians provide to patients. Prior work in select medical specialties suggests that burnout is associated with self-reported medical error (e.g., medication errors) and suboptimal care (e.g., failure to adhere to practice standards, lower patient satisfaction).[4–14] Burnout may also contribute to job turnover, absenteeism, low morale, and deterioration of provider health.[3,15–26] Although emergency physicians (EPs) report some of the highest levels of burnout, to our knowledge the relationship between EP burnout and patient care has not been studied. Our study evaluated rates of burnout among attending and resident EPs and examined the relationship between their levels of burnout and self-reported patient care practices.