Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis

Abstract

Importance: 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. However, this evidence has not been systematically quantified.

Objective: To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction.

Data sources: MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched.

Study selection: Quantitative observational studies.

Data extraction and synthesis: Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed.

Main outcomes and measures: The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs.

Results: Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), 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). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007).

Conclusions and relevance: This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.

Figure 1.. PRISMA Flowchart

Flowchart of the inclusion of studies in the review.

Figure 2.. Association Between Physician Burnout and Patient Safety Incidents

Meta-analysis of individual study and pooled effects. Each line represents 1 study in the meta-analysis, plotted according to the odds ratios (OR). The black box on each line shows the OR for each study and the blue box represents the pooled OR.

Figure 3.. Forest Plot of the Association Between Physician Burnout and Low Professionalism Outcomes

Meta-analysis of individual study and pooled effects. Each line represents 1 study in the meta-analysis, plotted according to the odds ratios (OR). The black box on each line shows the OR for each study and the blue box represents the pooled OR.

Figure 4.. Association Between Physician Burnout and Reduced Patient Satisfaction

Meta-analysis of individual study and pooled effects. Each line represents 1 study in the meta-analysis, plotted according to the odds ratios (OR). The black box on each line shows the OR for each study and the blue box represents the pooled OR.