Associations of Burnout with the Career Engagement of Physicians and the Quality of Patient Care

Problem

Burnout, defined as a work-related syndrome involving emotional exhaustion, depersonalisation, and a sense of reduced personal accomplishment is reaching global levels among physicians, and the Covid-19 pandemic has only further exacerbated this problem. Physicians with burnout often report poor work-life balance and career dissatisfaction. However, past reviews that focused on the potential impacts of physician burnout on healthcare efficiency have overlooked the association of burnout with the career engagement of physicians. Thus, a joint synthesis of the links of physician burnout with the career engagement of physicians and the quality of care is urgently needed. These reciprocal relations are highly important for governments and policy organisations to encourage financial investments and policies to mitigate physician burnout internationally. Therefore, in this systematic review and meta-analysis we examined the association of physician burnout with (a) the career engagement of physicians focusing on job satisfaction, career choice regret, and turnover intention; and (b) the quality of patient care focusing on patient safety incidents, low professionalism, and patient satisfaction.

Approach

Systematic searches of the four databases for observational studies assessing the association of physician burnout (including emotional exhaustion, depersonalisation, and personal accomplishment) with the career engagement and the quality of patient care were carried out up to May 2021. Data were extracted and checked for consistancy by 50% of the authors. Random-effect models were used to calculate the pooled odds ratio. Career engagement outcomes include career choice regret, career development, job satisfaction, productivity loss and turnover intention. Quality of patient care outcomes include low professionalism, patient safety incidents, and patient satisfaction.

Findings

We identified 170 observational studies including 239,246 physicians for meta-analysis. Overall burnout in physicians was associated with almost a four-fold decrease in job satisfaction (odds ratio 3.79, 95% CI 3.24 to 4.43, k=73 studies, n=146,980 physicians), over three-fold increase in career choice regret (3.49, 2.43 to 5.00, k=16, n=33,871), and three-fold increase in turnover intention (3.10, 2.30 to 4.17, k=25, n=32,271). Overall physician burnout was also associated with a two-fold increase in patient safety incidents (2.03, 1.68 to 2.44, k=35, n=41,059), a two-fold decrease in professionalism (2.33, 1.96 to 2.70, k=40, n=32,321) and a two-fold decrease in patient satisfaction (2.22, 1.38 to 3.57, k=8, n=1,002). The link between burnout and poorer job satisfaction was greatest in hospital settings, and in elderly physicians working in emergency medicine. The link between burnout and patient care outcomes was greatest in younger physicians working in emergency medicine.

Consequences

Our systematic review and meta-analysis, provides the most compelling evidence to date that physician burnout jeopardizes the function and sustainability of health care organisations primarily by contributing to the career disengagement and secondarily by reducing the quality of patient care. Moving forward following the Covid-19 pandemic, healthcare organizations urgently need to invest more funds and efforts in implementing evidence-based strategies to help mitigate physician burnout across specialities and particularly in emergency medicine.