Burned-out physicians twice as likely to compromise patient safety

A new review published in JAMA Internal Medicine adds to the growing body of evidence that physician burnout negatively impacts clinical outcomes, as burned-out doctors were twice as likely to be involved in patient safety incidents, provide suboptimal care as a result of low professionalism and garner low patient satisfaction ratings.

Another notable finding was that burned-out residents and early-career physicians were 3.4 times more likely than their more experienced colleagues to deliver poor care attributed to low professionalism—defined as suboptimal adherence to guidelines, reduced professional integrity, poor communication to patients and low empathy.

“Health care organizations have a duty to support physicians in the demanding transition from training to professional life,” wrote lead author Maria Panagioti, PhD, with the University of Manchester in the U.K., and colleagues. “Residents will be responsible for the health care delivery for over two decades in the future. Investments in their wellness and professional values, which are largely shaped during early-career years, are perhaps the most efficient strategy for building organizational immunity against workforce shortages and patient harm/mistrust.”

After reviewing more than 5,200 records, Panagioti et al. included 47 studies on 42,473 physicians. All studies used validated measures of physician burnout, most commonly the Maslach Burnout Inventory.

When pooling the results, the researchers found physicians meeting criteria for burnout were about twice as likely to be involved in patient safety incidents and demonstrate low professionalism. They were also 2.3 times more likely to have low patient-reported satisfaction measures.

A recent report suggests about half of physicians in the U.S. report signs of burnout, which has been linked to shorter life expectancy, depression, problematic alcohol use and even suicide, the authors wrote.   

Investing in fighting physician burnout may be an ethical decision, but it might also be cost-saving for hospitals. As Panagioti and colleagues note, poor care from a burned-out doctor could lead to a patient requiring additional treatment in the future.

“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,” they wrote. “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.”

In a related editorial, Mark Linzer, MD, with the University of Minnesota, pointed to the need for well-designed studies (with control groups) to evaluate patient outcomes and costs associated with different quality improvement measures. Some potential questions that could be addressed, he noted, are which workflow designs best improve efficiency, limit chaos and reduce burnout; what efforts can reduce burnout among female clinicians; which elements of electronic health records could be addressed to reduce burnout; and whether improving burnout among physicians trickles down to other members of the care team.

“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,” Linzer wrote.