Physician Burnout Jeopardizes Patient Care, Safety

Megan Brooks

September 05, 2018

Burnout among physicians has negative consequences on the quality of care they deliver, results of a large-scale, systematic review and meta-analysis show.

Investigators found that physician burnout is associated with about a twofold increased likelihood of unsafe care, unprofessional behavior, and low satisfaction ratings from patients.

This analysis provides evidence that physician burnout may "jeopardize patient care" and that "reversal of this risk has to be viewed as a fundamental health care policy goal across the globe," the investigators, led by Maria Panagioti, PhD, University of Manchester, United Kingdom, write.

The study was published online September 4 in JAMA Internal Medicine.

An Epidemic

Physician burnout has reached epidemic levels. The Medscape Physician Lifestyle Report 2017 suggests that 50% of physicians in the United States report signs of burnout; this represents a rise of 4% within a year.

"However, the consequences of burnout on patient care are less well known, even though medical errors cost several billions to healthcare systems every year," Panagioti told Medscape Medical News.

Results of the meta-analysis, which included 47 relevant studies and more than 42,000 physicians (59% men; median age, 38 years; range, 27 - 53 years), indicate that physician burnout is significantly associated with an increased risk for patient safety incidents; poorer quality of care, owing to low professionalism; and low satisfaction ratings from patients.

Outcome Odds Ratio (95% CI)
Patient safety incident 1.96 (1.59 - 2.40)
Poorer quality of care 2.31 (1.87 - 2.85)
Low patient satisfaction 2.28 (1.42 - 3.68)
CI, confidence interval

 

A deeper dive into individual components of burnout revealed that symptoms of depression/emotional exhaustion were associated with a greater than twofold increased risk for involvement in patient safety incidents (OR, 2.38; 95% CI, 1.84 - 2.92).

Depersonalization related to burnout was associated with a greater than fourfold increased odds for low patient-reported satisfaction with care (OR, 4.50; 95% CI, 2.34 - 8.64).

"The findings are in general concerning but not surprising," Panagioti told Medscape Medical News. "Current interventions for improving patient safety have mainly focused on identifying and monitoring vulnerable patients and at times vulnerable systems but have overlooked physician burnout," she noted.

"Most Alarming" Finding

"The most alarming finding," she noted, is that, particularly in residents and early career physicians (≤5 years post residency), burnout was associated with close to four times increased risk for unprofessional behaviors (OR 3.39; 95% CI, 2.38 - 4.40).

Overall, these findings demonstrate that physician burnout is associated with a reduction in the efficiency of healthcare systems to deliver high-quality, safe care to patients, the researchers note.

"Our results highlight that healthcare organizations have a duty to invest in large-scale, coordinated strategies to reduce burnout in physicians," said Panagioti. Particular focus should be placed on residents and early career physicians, she said.

"Innovative interventions are needed which will mitigate all three major contributory factors to medical errors: vulnerable patients, vulnerable systems, and burnt-out physicians. Failure to address physician burnout puts patient safety and the wider efficiency of healthcare at risk," she added.

Commenting on the findings for Medscape Medical News, Mark Linzer, MD, University of Minnesota and Hennepin Healthcare Systems, Minneapolis, said this new study "strengthens the connection between burnout and quality of care. It is still hard to tell if the lower quality of care is due to the organizations that burn out the clinicians or the burned out clinicians themselves. Data are conflicting on that point.

"There has been a great rise in interest in addressing burnout," Linzer told Medscape Medical News, "but there are no data yet on whether burnout is decreasing nationally."

He noted that "workflow redesign is effective at reducing burnout, but we still need to test which specific types of workflow redesign are the most effective.

"With close to half of US physicians experiencing symptoms of burnout, more work is needed to understand how to reduce it and what we can expect from doing so," Linzer writes in an accompanying commentary.

The study was funded by the United Kingdom National Institute of Health Research (NIHR) School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Center. The authors have disclosed on relevant financial relationships. Dr Linzer is supported for Wellness Champion training by the American College of Physicians and the Association of Chiefs and Leaders in General Internal Medicine and receives support for research projects in physician wellness from the American Medical Association.

JAMA Intern Med. Published online September 4, 2018. Abstract, Commentary

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