Healthcare provider burnout is commonly associated with a decrease in the quality of patient care; however, the effect size may be smaller than once thought, according to study results published in the Annals of Internal Medicine.

A team of investigators conducted a systematic review and meta-analysis to collect summary estimations of the association between healthcare provider burnout and patient quality of care, study heterogeneity, and any possible bias in previous findings.

Investigators identified 11,703 citations and included 123 publications from 1994 through 2019, covering 142 study populations. The study populations included physicians (n=71), nurses (n=84), and other providers (n=18), for a total of 241,553 healthcare providers.

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The 142 study populations were grouped by quality-of-care outcomes, including best practices (n=14), communication (n=5), medical errors (n=32), patient outcomes (n=17), and quality and safety (n=74). Meta-analysis combining burnout (burnout, emotional exhaustion, and depersonalization) and quality-of-care metrics within quality categories suggested significant heterogeneity (I2 =93.4%-98.8%).

Of the 114 burnout-quality combinations, 46 had a primary effect size; 24 indicated burnout related to poor quality of care, 1 indicated that burnout was related to higher quality of care, and 21 reported no significant difference. Secondary effect sizes resulted in similar outcomes.

The researchers noted that the most precise study with low risk for bias also has a small effect size. In addition, there was an excess of observed vs predicted statistically significant studies (73% vs 62%, respectively).

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“[B]urnout among health care providers is frequently associated with reduced quality of care in the published literature,” the investigators wrote. “However, few rigorous studies exist, and the effect size may be smaller than reported — and may be particularly smaller for objective quality measures. Whether curtailing burnout improves quality of care, or whether improving quality of care reduces burnout, is not yet known, and adequately powered and designed randomized trials will be indispensable in answering these questions.”


Tawfik DS, Scheid A, Profit J, et al. Evidence relating health care provider burnout and quality of care: a systematic review and meta-analysis [published online October 8, 2019]. Ann Intern Med. doi:10.7326/M19-1152