Primary Care Clinician Burnout and Engagement Association With Clinical Quality and Patient Experience

J Am Board Fam Med. 2021 May-Jun;34(3):542-552. doi: 10.3122/jabfm.2021.03.200515.


Background: Burnout and engagement are commonly conceptualized as opposite ends of a spectrum, and there is concern that high clinician burnout and lack of engagement may adversely impact patient care.

Methods: We matched self-reported data on burnout and engagement for 182 primary care clinicians with data on clinical quality (cancer screenings, hypertension and diabetes control) and patient experience (Clinician and Group Survey-Consumer Assessment of Healthcare Providers and Systems [CG-CAHPS] communication scores, overall rating, and likelihood to recommend the clinic). Multivariable linear regression models examined burnout, engagement, or burnout-engagement phenotype (eg, high burnout-low engagement) as predictors of quality and patient experience.

Results: One-third of clinicians in this sample did not fall along the spectrum of low burnout-high engagement to high burnout-low engagement. Neither burnout nor engagement on their own was associated with quality or patient experience measures. However, clinicians with high burnout who also were highly engaged had the highest average ratings for all 3 patient experience domains: clinician communication, overall rating of the clinician, and overall rating of the clinic.

Discussion: The results of our study challenge the assumptions that burnout and engagement are opposite ends of a spectrum and that burnout or low engagement adversely impact quality of care and patient experience. Greater understanding is needed of how best to support dedicated clinicians who may provide quality care at the expense of their personal well-being.

Keywords: Employee Engagement; Linear Models; Mental Health; Occupational Burnout; Patient Care; Primary Health Care; Self Report; Workforce.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Burnout, Professional* / diagnosis
  • Burnout, Professional* / epidemiology
  • Health Personnel
  • Humans
  • Patient Outcome Assessment
  • Primary Health Care
  • Surveys and Questionnaires