How does burnout affect physician productivity? A systematic literature review

Carolyn S Dewa, Desmond Loong, Sarah Bonato, Nguyen Xuan Thanh, Philip Jacobs, Carolyn S Dewa, Desmond Loong, Sarah Bonato, Nguyen Xuan Thanh, Philip Jacobs

Abstract

Background: Interest in the well-being of physicians has increased because of their contributions to the healthcare system quality. There is growing recognition that physicians are exposed to workplace factors that increase the risk of work stress. Long-term exposure to high work stress can result in burnout. Reports from around the world suggest that about one-third to one-half of physicians experience burnout. Understanding the outcomes associated with burnout is critical to understanding its affects on the healthcare system. Productivity outcomes are among those that could have the most immediate effects on the healthcare system. This systematic literature review is one of the first to explore the evidence for the types of physician productivity outcomes associated with physician burnout. It answers the question, "How does burnout affect physician productivity?"

Methods: A systematic search was performed of: Medline Current, Medline in process, PsycInfo, Embase and Web of Science. The search period covered 2002 to 2012. The searches identified articles about practicing physicians working in civilian settings. Articles that primarily looked only at residents or medical students were excluded. Productivity was captured by hours worked, patients seen, sick leave, leaving the profession, retirement, workload and presenteeism. Studies also were excluded if: (1) the study sample was not comprised of at least 50% physicians, (2) the study did not examine the relationship between burnout and productivity or (3) a validated measure of burnout was not used.

Results: The search identified 870 unique citations; 5 met the inclusion/exclusion criteria. This review indicates that globally there is recognition of the potential impact of physician burnout on productivity. Productivity was examined using: number of sick leave days, work ability, intent to either continue practicing or change jobs. The majority of the studies indicate there is a negative relationship between burnout and productivity. However, there is variation depending on the type of productivity outcome examined.

Conclusions: There is evidence that burnout is associated with decreased productivity. However, this line of inquiry is still developing. A number of gaps are yet to be filled including understanding how to quantify the changes in productivity related to burnout.

Figures

Figure 1
Figure 1
Flowchart of literature search results and inclusions/exclusions.

References

    1. Wallace JE, Lemaire J. Physician well being and quality of patient care: an exploratory study of the missing link. Psychol Health Med. 2009;14(5):545–552. doi: 10.1080/13548500903012871.
    1. Martin S. More hours, more tired, more to do: results from the CMA’s 2002 Physician Resource Questionnaire. Can Med Assoc J. 2002;14(5):521–522.
    1. Virtanen P, Oksanen T, Kivimaki M, Virtanen M, Pentti J, Vahtera J. Work stress and health in primary health care physicians and hospital physicians. Occup Environ Med. 2008;14(5):364–366. doi: 10.1136/oem.2007.034793.
    1. Richter A, Kostova P, Baur X, Wegner R. Less work: more burnout? A comparison of working conditions and the risk of burnout by German physicians before and after the implementation of the EU Working Time Directive. Int Arch Occup Environ Health. 2014;14(2):205–215. doi: 10.1007/s00420-013-0849-x.
    1. Alarcon GM. A meta-analysis of burnout with job demands, resources, and attitudes. J Vocat Behav. 2011;14(2011):549–562.
    1. Maslach C, Leiter MP. The truth about burnout. San Francisco, CA: Jossey-Bass; 1997.
    1. Allegra CJ, Hall R, Yothers G. Prevalence of burnout in the U.S. Oncology community: results of a 2003 survey. J Oncol Pharm Pract/Am Soc Clin Oncol. 2005;14(4):140–147. doi: 10.1200/JOP.1.4.140.
    1. Arigoni F, Bovier PA, Sappino AP. Trend of burnout among Swiss doctors. Swiss Med Wkly. 2010;14:w13070.
    1. Elit L, Trim K, Mand-Bains IH, Sussman J, Grunfeld E. Society of Gynecologic Oncology C. Job satisfaction, stress, and burnout among Canadian gynecologic oncologists. Gynecol Oncol. 2004;14(1):134–139. doi: 10.1016/j.ygyno.2004.04.014.
    1. Embriaco N, Azoulay E, Barrau K, Kentish N, Pochard F, Loundou A, Papazian L. High level of burnout in intensivists: prevalence and associated factors.[Erratum appears in Am J Respir Crit Care Med. 2007 Jun 1;175(11):1209–10] Am J Respir Crit Care Med. 2007;14(7):686–692. doi: 10.1164/rccm.200608-1184OC.
    1. Klein J, Grosse Frie K, Blum K, von dem Knesebeck O. Burnout and perceived quality of care among German clinicians in surgery. International J Qual Health Care. 2010;14(6):525–530. doi: 10.1093/intqhc/mzq056.
    1. Maslach C, Jackson SE. The measurement of experienced burnout. J Occup Behav. 1981;14:99–113. doi: 10.1002/job.4030020205.
    1. Sharma A, Sharp DM, Walker LG, Monson JRT. Stress and burnout in colorectal and vascular surgical consultants working in the UK National Health Service. Psychooncology. 2008;14(6):570–576. doi: 10.1002/pon.1269.
    1. Siu CFY, Yuen SK, Cheung A. Burnout among public doctors in Hong Kong: cross-sectional survey. Hong Kong Med J. 2012;14(3):186–192.
    1. Asai M, Morita T, Akechi T, Sugawara Y, Fujimori M, Akizuki N, Nakano T, Uchitomi Y. Burnout and psychiatric morbidity among physicians engaged in end-of-life care for cancer patients: a cross-sectional nationwide survey in Japan. Psychooncology. 2007;14(5):421–428. doi: 10.1002/pon.1066.
    1. Williams ES, Konrad TR, Scheckler WE, Pathman DE, Linzer M, McMurray JE, Gerrity M, Schwartz M. Understanding physicians’ intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health. 2001. Health Care Manag Rev. 2010;14(2):105–115. doi: 10.1097/01.HMR.0000304509.58297.6f.
    1. Henkens K, Leenders M. Burnout and older workers’ intentions to retire. Int J Manpow. 2010;14(3):306–321. doi: 10.1108/01437721011050594.
    1. Dewa CS, Jacobs P, Thanh NX, Loong D. An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada. BMC Health Serv Res. 2014;14:254. doi: 10.1186/1472-6963-14-254.
    1. Lagerveld SE, Bultmann U, Franche RL, van Dijk FJ, Vlasveld MC, van der Feltz-Cornelis CM, Bruinvels DJ, Huijs JJ, Blonk RW, van der Klink JJ, Nieuwenhuijsen K. Factors associated with work participation and work functioning in depressed workers: a systematic review. J Occup Rehabil. 2010;14(3):275–292. doi: 10.1007/s10926-009-9224-x.
    1. Pines AM, Aronson E, Kafry D. Burn Out: From Tedium to Personal Growth. New York: Free Press; 1981.
    1. Ruitenburg MM, Frings-Dresen MHW, Sluiter JK. The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study. BMC Health Serv Res. 2012;14:292. doi: 10.1186/1472-6963-12-292.
    1. Soler JK, Yaman H, Esteva M, Dobbs F, Asenova RS, Katic M, Ozvacic Z, Desgranges JP, Moreau A, Lionis C, Kotanyi P, Carelli F, Nowak PR, de Aguiar Sa Azeredo Z, Marklund E, Churchill D, Ungan M. European General Practice Research Network Burnout Study Group. Burnout in European family doctors: the EGPRN study. Fam Pract. 2008;14(4):245–265. doi: 10.1093/fampra/cmn038.
    1. Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Soc Behav. 2002;14(1):72–91. doi: 10.2307/3090246.
    1. Zhang Y, Feng X. The relationship between job satisfaction, burnout, and turnover intention among physicians from urban state-owned medical institutions in Hubei China: a cross-sectional study. BMC Health Serv Res. 2011;14:235. doi: 10.1186/1472-6963-11-235.

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