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Physician burnout was associated with career disengagement and poorer patient care, according to a systematic review and meta-analysis of over 200,000 physicians.

Among 170 observational studies, physicians with more burnout were twice as likely to be involved in patient safety incidents (OR 2.04, 95% CI 1.69-2.45), reported Alexander Hodkinson, PhD, MSc, of the U.K.'s National Institute for Health and Care Research, and colleagues in .

Previous studies have focused primarily on linking burnout with patient safety and outcomes, mostly overlooking how burnout's effects on physician career development and attitude plays into the picture, Hodkinson told 番茄社区.

This meta-analysis showed that physicians with more burnout were four times more likely to be dissatisfied with their jobs (OR 3.79, 95% CI 3.24-4.43).

"Things like job satisfaction clearly have an impact on how professional the physician is, and also the quality of patient care. So it's really important to consider both factors in tandem," Hodkinson said.

Burnout and dissatisfaction were highest for jobs in hospital settings, particularly working in emergency medicine or intensive care, and among clinicians between the ages of 31 and 50, though not all of these findings were significant.

The association between burnout and patient safety incidents was strongest in those ages 20 to 30 (OR 1.88, 95% CI 1.07-3.29) and for those working in emergency medicine or intensive care (OR 2.10, 95% CI 1.09-3.56).

The findings on age stand out, Hodkinson noted, pointing out that the length of time doctors can spend with their patients (in the U.K.) has shortened in recent years, which could lower professional standards and leave patients -- and physicians -- feeling dissatisfied.

Moreover, as burnout increased for physicians, they were:

• Over three times more likely to regret their career choice (OR 3.49, 95% CI 2.43-5.00)
• Less likely to maintain "professionalism" (OR 2.33, 95% CI 1.96-2.70) and have less satisfied patients (OR 2.22, 95% CI 1.38-3.57), especially if the "depersonalization" aspect of their burnout was higher (OR 3.82, 95% CI 1.57-9.29)
• More likely to intend to quit (OR 3.10, 95% CI 2.30-4.17), especially if the "emotional exhaustion" aspect of their burnout was higher (OR 2.81, 95% CI 1.80-4.40)

This finding on emotional exhaustion, one of the key aspects of burnout, connects physician burnout to worse patient care in ways that haven't yet been examined in similar analyses, the authors noted. Not only is there a direct connection between burnout and patient safety incidents, but links between burnout, poor career engagement, and physician turnover, which impacts care.

"The mental well-being of physicians is vital for safe healthcare systems," wrote Matthias Weigl, PhD, of University Hospital at Bonn University in Germany, in an . "The pervasive nature of physician burnout indicates a defective work system caused by deep societal problems and structural problems across the sector."

Hodkinson said one of his next research projects is a focus group study on interventions for physician burnout in the U.K.; however, research from his peers has suggested that remedies should be on a case-by-case, organizational level.

"Burnout tends to cluster at practice level," he noted. "So, we find that when a certain number of doctors have high levels of burnout, it will be a high chance that there'll be other doctors in that practice that are also suffering from the same issue."

Any fixes should be tailored to, and come from, healthcare organizations, like hospitals or clinics, he suggested.

For this systematic review and meta-analysis, Hodkinson and colleagues included 170 observational studies of 239,246 physicians mostly from the U.S. or U.K. Burnout was measured with doctor self-reports using the Maslach Burnout Inventory or an abbreviated version of it. Burnout was defined as "a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalization, and a sense of ineffectiveness and little personal accomplishment."

The researchers used data that included burnout measurements and measures of outcomes indicating both career engagement and quality of patient care. Career engagement outcomes included career choice regret, career development, job satisfaction, or turnover intention. Patient care outcomes included not only patient safety incidents, but also patient satisfaction from surveys, productivity, and professionalism (such as adherence to treatment guidelines, provision of information to patients, empathy, and malpractice claims).

Limitations to the meta-analysis included the generally broad range of data collection methods, criteria, and measurements used across studies. A "large heterogeneity for some of the outcomes" like patient safety, professionalism, and job satisfaction could lead to an overestimation of associations between burnout and outcomes, because the definition of something like "job satisfaction" can encompass so many aspects of a job, Hodkinson and team acknowledged. Furthermore, the use of cross-sectional studies made "assessment of direct causality" infeasible, they said.

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