Does physician burnout affect the quality of patient care?

Despite the heavy emotional and psychological toll burnout exacts on physicians, it doesn’t appear to affect the quality of care they provide, according to results of a new study.

The study in Health Affairs looks at the extent to which physician’s feelings of burnout and callousness are tied to patient outcomes and costs of care. The authors hypothesized that as the frequency of burnout and callousness increased, patient outcomes would worsen, particularly among patients dually eligible for Medicare and Medicaid.

To test their theory, the authors linked Medicare claims data to self-reported feelings of burnout and callousness among more than a thousand family physicians seeking to renew their board certifications. They used responses to the statements, “I feel burned out from my work,” and “I have become more callous towards people to gauge feelings of burnout and callousness, respectively.

Quality of outcomes was measured according to numbers of ambulatory care-sensitive hospital and emergency department admissions, and 30-day hospital readmissions, and costs by total annual per-beneficiary costs.

The results showed no consistent relationship between burnout or callousness and outcomes among either the general population of patients or the dually eligible. Moreover, doctors reporting at least some, or even a high frequency of burnout had generally lower rates of undesirable outcomes.

The authors offer several possible explanations for the study’s findings, which they describe as “counterintuitive.” One is that doctors reporting at least some burnout are also highly conscientious and put more effort into providing their patients with good care. “This effort, and their concerns about their patients, may be stressful and produce a feeling of burnout,” they write, “particularly when physicians experience time pressure or other obstacles to providing care.”

A second possibility is that some doctors reporting burnout are sufficiently resilient that they are not overwhelmed by their feelings and thus still able to make the effort to get good results for their patients.

The results for patients of doctors self-reporting callousness showed a slightly stronger connection with outcomes, in that 2.4% of doctors reporting daily feelings of callousness had worse outcomes. The authors hypothesize that whereas burnout is at least partially associated with concern for patients, doctors reporting daily callousness lack such concern.

The authors caution that their findings shouldn’t be interpreted to mean that it’s good for physicans to experience burnout, noting that, among other consequences. Patients of burned-out doctors may have worse experience of care even if the actual outcomes are not worse. Burnout can also lead to higher rates of physician turnover thereby upsetting patients, disrupting continuity of care, and generating high replacement costs for practices and hospitals.

The study, “Relationship Between Physician Burnout And The Quality And Cost Of Care For Medicare Beneficiaries Is Complex,” appears in the April issue of Health Affairs.