Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Clinician Burnout Can Impact Quality of Care

Key clinical point: Burnout among health care professionals is associated with lower quality of care, but this effect may be smaller than reported because of study limitations.

Major finding: In an analysis of 114 unique burnout-quality combinations, 58 showed burnout related to poor-quality care.

Study details: The data come from a meta-analysis of 123 publications from 1994 to 2019 including 142 study populations.

Disclosures: The study was supported by the Stanford Maternal and Child Health Research Institute. Dr. Tawfik disclosed grants from Stanford Maternal and Child Health Research Institute during the study period.


Tawfik DS et al. Ann Intern Med. 2019 Oct 8. doi: 10.7326/M19-1152


The current meta-analysis is consistent with previous research, but offers nothing new on the relationship between clinician burnout and quality of care, wrote Carolyn S. Dewa, MPH, PhD, Karen Nieuwenhuijsen, PhD, and Jeffrey S. Hoch, PhD, in an accompanying editorial.

Some of the concerns they expressed included variability in the methods used to measure provider burnout, as well as variability in measuring and defining medical error. They suggested that the researchers could have conducted a subgroup analysis based on error definition. “Such analyses might shed light on the types of errors associated with burnout and suggest directions for the design of robust psychometric studies about the error metrics,” they wrote.

The editorialists also expressed concerns about the heterogeneity of the studies included in the review and the potential for confounding. Finally, they noted that the use of observational studies in a meta-analysis can be challenging because “the assessment of observational studies is not straightforward.” They added that knowing the limitations of the studies is important in allowing readers to be confident in the estimates from any meta-analyses.

“Considering the limitations of the available literature, prior reviews, and Tawfik and colleagues’ current meta-analysis, we conclude that higher burnout is associated with lower quality, but we are left without clear answers about the magnitude or clinical significance of the relationship,” they wrote (Ann Intern Med. 2019 Oct 8. doi: 10.7326/M19-2760).

Dr. Dewa and Dr. Hoch are affiliated with the University of California, Davis. Dr. Nieuwenhuijsen is affiliated with the University of Amsterdam. The editorialists had no financial conflicts to disclose.