Clinical Context

Physician burnout is not only highly prevalent, but it is increasing, according to Medscape's Annual Lifestyle Report.^[1] The overall rate of physician burnout in 2015 was 46%, a figure that increased by more than 15% from the previous survey in 2013. Critical care and emergency medicine physicians reported the highest rates of burnout, with more than 50% of these specialists feeling emotionally exhausted and unaccomplished. Family physicians, internists, and general surgeons trailed these specialties closely in rates of burnout, and radiologists reported the lowest levels of happiness at work. In contrast, only 38% of psychiatrists reported burnout, as did 37% of dermatologists.

Burnout among healthcare providers is clearly linked with higher rates of mental illness and impairment. However, how does burnout among healthcare providers affect patient care? The current systematic review and meta-analysis by Salyers and colleagues analyzes this issue.

Study Synopsis and Perspective

Across disciplines, healthcare provider burnout is associated with decreased quality of care and patient safety, a comprehensive meta-analytic review confirms.

The review found a "consistent relationship" between higher levels of provider burnout and lower levels of both quality and safety.

"Even though the effect sizes were close to medium range, that provider well-being and their level of burnout could have a relationship with quality of care and safety at even that level I think was surprising," study investigator Michelle P. Salyers, PhD, of the Department of Psychology, Indiana University-Purdue University Indianapolis, told Medscape Medical News.

"We do need to pay attention to our treatment providers not only just for humanity's sake but because it may also relate to other goals of having high quality of care and satisfied patients and reduced errors or safety problems," she said. "This study gives extra rationale for taking care of our care providers. You want your providers to be happy and performing well and to stay and be good employees."

The study was published online October 26 in the Journal of General Internal Medicine.^[2]

Important Implications

Healthcare provider burnout is considered a factor in quality of care, yet little is known about the consistency and magnitude of the relationship, the authors note.

To investigate, they conducted a meta-analysis of 82 studies with 210,669 healthcare providers from different disciplines that examined relationships between provider burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) and quality (perceived quality, patient satisfaction) and safety of health care.

They found statistically significant negative relationships between burnout and quality (r=-0.26; 95% confidence interval [CI], -0.29 to -0.23) and safety (r=-0.23; 95% CI, -0.28 to -0.17). "In both cases, the negative relationship implies that greater burnout among healthcare providers is associated with poorer quality healthcare and decreased safety for patients," they write.

The effect size for perceived quality translates into approximately 7% of variance accounted for by provider burnout. For safety, the effect size translates into approximately 5% of the variance in safety being attributable to provider burnout, they note.

"These relationships were robust to potential publication bias and ratings of study rigor, which increases confidence in the findings," the authors write. "Given the increasing rates of burnout, particularly among physicians, these findings could have important ramifications."

"A meta-analysis allows you to look across multiple studies and test more consistency of findings and provide an overall summary of how strong the relationship is," said Dr Salyers. "Still, this is all correlational, so we don't know whether provider burnout makes quality worse or working in a setting that has more patient safety problems leads providers to feel overwhelmed at work."

Systemic Effect

Commenting on the analysis for Medscape Medical News, Chris Ebberwein, PhD, of the University of Kansas School of Medicine in Wichita, who specializes in provider burnout, said, "I don't know that this article gives anything too novel, but any time you have a meta-analysis confirming some of what we know, that can lend weight to the efforts to turn the tide on the issue."

He noted that the "size of the impact that burnout has on outcomes like quality and safety can appear small to a reader of the study, but in a world where small percentage improvements in safety and quality can drive payments and patient choice, they matter quite a bit -- not to mention the impact that improvement could have on a given patient or professional.

"By confirming that burnout has a system impact, it might motivate decision makers in healthcare to redouble their efforts toward system solutions," Dr Ebberwein said.

"While each professional ought to know what allows him or her to promote health and avoid burnout, the big impact on burnout will have to come from system change, likely by listening to professionals about what is leading to factors such as emotional exhaustion and including their perspectives in solutions."

The study had no funding. The authors have disclosed no relevant financial relationships.

J Gen Intern Med. Published online October 26, 2016.

Clinical Implications

• Rates of burnout among physicians appear to be on the rise, and nearly half of physicians report burnout. Critical care and emergency medicine specialists experience the highest rates of physician burnout.
• The current study by Salyers and colleagues finds that healthcare provider burnout is associated with worse outcomes for both patient care quality and patient safety.
• Implications for the Healthcare Team: The current meta-analysis describes the clinical impact of healthcare provider burnout, and it must be noted that nurses were one of the groups most affected in this regard. The risk for burnout should be addressed for individual providers but also for health systems to facilitate good communication and teamwork.

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