Although reports in the medical literature suggest that physician burnout is associated with poor-quality patient care, this association may be exaggerated, according to a study published in the Annals of Internal Medicine.1
A systematic review of peer-reviewed publications in MEDLINE, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), EMBASE (Elsevier), and Web of Science was performed. Search terms including burnout, emotional exhaustion, depersonalization, reduced personal accomplishment, healthcare providers, and quality-of-care markers were used to query the databases.
Only peer-reviewed publications that reported investigations into the association between clinician burnout and patient care quality were selected from the literature. Studies included both subjectively reported and objectively measured quality metrics. The final meta-analysis included a total of 123 publications with 142 study populations and 241,553 healthcare providers. the published studies, quality of care was categorized into 5 groups: best practices (n=14), communication (n=5), medical errors (n=32), patient outcomes (n=17), and quality and safety (n=74).
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The combination of burnout and quality metrics within the quality categories revealed highly heterogeneous relations (I2 = 93.4%-98.8%). Approximately 51% of the unique burnout-quality combinations correlated to poor-quality care, whereas 5% suggested burnout was associated with high-quality care and 44% correlated with no significant effect. These findings suggest that although physician burnout is frequently reported alongside poor care quality, the variability reported in these publications indicates this association may be exaggerated.
There was excess significance, particularly in studies that reported adherence to best practice guidelines and studies that included metrics for quality and safety (73% of studies observed vs 62% predicted to have significant results; P =.011). According to the researchers, genuine heterogeneity of effects among the studies may be the primary contributing factor for the excess significance. The excess significance may also be an indicator that the true magnitude of effect sizes in the literature may be smaller than reported. Smaller studies did not appear to overestimate effect sizes, according to the Egger test (intercept, −1.32; 95% CI, −3.48 to 0.85).
A limitation of the review and meta-analysis was the use of mostly observational data, which precluded the ability to establish causality or directionality.
In an accompanying editorial, researchers from the University of California, Davis, and the University of Amsterdam, The Netherlands, suggest that variability in the methodology of the included studies in this meta-analysis leave the reader “without clear answers about of the magnitude or clinical significance of the relationship” between physician burnout and lower-quality care.2 Subgroup analyses based on medical errors, they argued, may “shed light on the types of errors associated with burnout and suggest directions for the design of robust psychometric studies about the error metrics.”
References
1. Tawfik DS, Scheid A, Profit J, et al. Evidence relating health care provider burnout and quality of care: a systematic review and meta-analysis. Ann Intern Med. 2019;171(8):555-567.
2. Dewa CS, Nieuwenhuijsen K, Hoch JS, et al. Deciphering the relationship between health care provider burnout and quality of care. Ann Intern Med. 2019;171(8):589-590.
