Table 1.
Meta-analysis of the association of burnout with outcomes based on the career engagement of physicians and quality of patient care
| Burnout and submeasure | No of studies (No of physicians) | Direction of association | Odds ratio (95% CI); (95% PI) | I2 (95% CI) | Publication bias† |
|---|---|---|---|---|---|
| Career engagement of physicians | |||||
| Career choice regret: | |||||
| Burnout | 16 (33 871) | Favours career choice regret compared with being satisfied with their career choice | 3.49 (2.43 to 5.00); (0.90 to 13.49) | 97 (96 to 98) | P=0.004 |
| Emotional exhaustion* | 4 (2014) | 4.16 (3.34 to 5.19) | 90 (77 to 95) | NA | |
| Depersonalisation* | 2 (274) | 1.54 (0.97 to 2.45) | 65 (0 to 92) | NA | |
| Personal accomplishment* | 1 (147) | 1.12 (0.36 to 3.48) | NA | NA | |
| Career development: | |||||
| Burnout* | 2 (3411) | Favours negative career development compared with positive career development | 3.77 (2.77 to 5.14) | 0 | NA |
| Emotional exhaustion* | 1 (593) | 1.08 (0.80 to 1.44) | NA | NA | |
| Depersonalisation* | 1 (593) | 1.12 (0.83 to 1.49) | NA | NA | |
| Personal accomplishment | No data | No data | No data | NA | |
| Job satisfaction: | |||||
| Burnout | 73 (146 980) | Favours decreased job satisfaction compared with increased job satisfaction | 3.79 (3.24 to 4.43); (1.13 to 12.77) | 97 (96.6 to 98) | P=0.002 |
| Emotional exhaustion | 33 (22 699) | 4.81 (3.67 to 6.30); (1.11 to 20.93) | 98 (97 to 98.3) | P=0.04 | |
| Depersonalisation | 30 (22 002) | 2.89 (2.37 to 3.53); (1.07 to 7.82) | 92 (90 to 94) | P=0.98 | |
| Personal accomplishment | 32 (27 374) | 2.88 (2.28 to 3.63); (0.86 to 9.66) | 93 (91 to 95) | P=0.83 | |
| Productivity loss: | |||||
| Burnout | 7 (9581) | Favours increase in productivity loss compared with sustained productivity | 1.82 (1.08 to 3.07) | 83 (66 to 91) | NA |
| Emotional exhaustion* | 4 (3421) | 1.06 (1.00 to 1.12) | 90 (77 to 96) | NA | |
| Depersonalisation* | 3 (2969) | 1.23 (1.18 to 1.28) | 96 (92 to 98) | NA | |
| Personal accomplishment* | 3 (2969) | 1.53 (1.43 to 1.63) | 97 (94 to 99) | NA | |
| Turnover intention: | |||||
| Burnout | 25 (32 271) | Favours turnover intention compared with retention | 3.10 (2.30 to 4.17); (0.71 to 13.56) | 97 (96 to 97.3) | P<0.001 |
| Emotional exhaustion | 16 (23 625) | 2.81 (1.80 to 4.40); (0.46 to 17.11) | 99 (98.8 to 99.2) | P=0.001 | |
| Depersonalisation | 11 (23 257) | 1.82 (1.26 to 2.62); (0.53, 6.26) | 99 (98.7 to 99.2) | P=0.03 | |
| Personal accomplishment | 5 (11 028) | 1.28 (0.98 to 1.68) | 86 (70 to 94) | NA | |
| Quality of patient care | |||||
| Professionalism: | |||||
| Burnout | 40 (32 321) | Favours low professionalism compared with maintained professionalism | 2.33 (1.96 to 2.70); (0.88 to 6.16) | 96 (95.5 to 97.4) | P<0.001 |
| Emotional exhaustion | 16 (11 861) | 2.45 (1.71 to 3.53); (0.63 to 9.62) | 94 (91.8 to 95.6) | P<0.001 | |
| Depersonalisation | 12 (10 488) | 2.93 (1.93 to 4.46); (0.72 to 11.94) | 93 (89.9 to 95.1) | P=0.03 | |
| Personal accomplishment | 9 (2992) | 2.17 (1.36 to 3.46) | 92 (87 to 95) | NA | |
| Patient safety incidents: | |||||
| Burnout | 35 (41 059) | Favours patient safety incidents compared with no patient safety incidents | 2.04 (1.69 to 2.45); (0.71 to 5.81) | 87 (84 to 90) | P=0.04 |
| Emotional exhaustion | 17 (20 213) | 2.15 (1.82 to 2.53); (1.19 to 3.86) | 73 (56 to 83) | P<0.001 | |
| Depersonalisation | 14 (19 616) | 2.44 (1.84 to 3.23); (0.92 to 6.44) | 90 (85 to 94) | P<0.001 | |
| Personal accomplishment | 14 (19 616) | 1.47 (1.20 to 1.80); (0.78 to 2.76) | 87 (79 to 91) | P<0.001 | |
| Patient satisfaction: | |||||
| Burnout | 8 (1,002) | Favours lower patient satisfaction compared with them being satisfied | 2.22 (1.38 to 3.57) | 75 (53.4 to 86.6) | NA |
| Emotional exhaustion | 5 (527) | 2.79 (0.75 to 10.42) | 77 (44.2 to 90.5) | NA | |
| Depersonalisation | 6 (571) | 3.82 (1.57 to 9.29) | 81 (60 to 91) | NA | |
| Personal accomplishment | 5 (527) | 1.79 (1.14 to 2.81) | 5 (0 to 80) | NA | |
Results pooled using the standardised mean difference are provided in appendix 11. No changes in significance were found when pooling using standardised mean difference. CI=confidence interval; PI=prediction intervals were calculated only for meta-analysis involving 10 or more studies as advised in Cochrane handbook; NA=Estimate not applicable.
Fixed effect results were reported when fewer than five studies were reported and the meta-analysis involved varied sample and effect sizes.
Assessment of publication bias was done using Eggers’s test in all meta-analysis of 10 or more studies as advised in Cochrane handbook, and also checked using trim-and-fill method (see appendix 13 for full results). Forest plots for each analysis are provided in appendix 10, where the log odds ratio estimates are also available within the plots.