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Physician burnout may lead to suboptimal patient care

Editor’s note: The study this article was based on was retracted on May 18, 2020, because of “flaws in the systematic review process,” according to the editors of JAMA Internal Medicine.

Physician burnout was associated with about a twofold increase in unsafe patient care, unprofessionalism and low patient satisfaction, according to research published in JAMA Internal Medicine.

“Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction,” Maria Panagioti, PhD, from the National Institute for Health Research, and colleagues wrote. “However, this evidence has not been systematically quantified.”

Panagioti and colleagues performed a meta-analysis of 47 studies including 42,473 physicians (59% men; median age, 38 years) to investigate the quality and safety of patient care associated with physician burnout.

The researchers found that physicians experiencing burnout were more likely to have patient safety incidents (OR = 1.96; 95% CI, 1.59-2.4), poorer quality of care due to low professionalism (OR = 2.31; 95% CI, 1.87-2.85) and reduced patient satisfaction (OR = 2.28; 95% CI, 1.42-3.68).

There was high heterogeneity and low to moderate study quality, according to the researchers. The association between burnout and unprofessional behavior was stronger among residents and physicians in the early stages of their career (5 or fewer years post-residency) than middle- and late-career physicians.

The results were significantly influenced by whether patient safety incidents and professionalism were reported by physicians or systems, indicating that assessment standards need to be improved, according to the researchers.

“Physician burnout might jeopardize patient care,” Panagioti and colleagues concluded. “Physician wellness and quality of patient care are critical and complementary dimensions of health care organization efficiency. Investments in organizational strategies to jointly monitor and improve physician wellness and patient care outcomes are needed. Interventions aimed at improving the culture of health care organizations as well as interventions focused on individual physicians but supported and funded by health care organizations are beneficial. They should therefore be evaluated at scale and implemented.”

In an accompanying editorial, Mark Linzer, MD, from Hennepin Healthcare Systems, Minneapolis, wrote that the stronger link between burnout and adverse patient outcomes revealed in Panagioti and colleagues’ study are “worrisome.”

Some questions are still left unanswered, according to Linzer.

“Reducing burnout leads to better outcomes for clinicians, but will it do the same for patients?” he wrote. “And how successful can we be at reducing and sustaining burnout at low levels, given that regulations, publicly reported patient outcomes, and complex medical record systems have brought new and enduring challenges to the practice of medicine.”

“New quality improvement studies, including smaller and more-focused but still rigorously performed projects, will help us learn what might work and then allow us to propose the larger funded trials that will test it,” he added. – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures. Linzer reports receiving support from ACP, AMA and the Association of Chiefs and Leaders in General Internal Medicine.