Burnout in inpatient‐based versus outpatient‐based physicians: A systematic review and meta‐analysis

Abstract

BACKGROUND Burnout is a syndrome affecting the entirety of work life and characterized by cynicism, detachment, and inefficacy. Despite longstanding concerns about burnout in hospital medicine, few data about burnout in hospitalists have been published. PURPOSE A systematic review of the literature on burnout in inpatient‐based and outpatient‐based physicians worldwide was undertaken to determine whether inpatient physicians experience more burnout than outpatient physicians. DATA SOURCES Five medical databases were searched for relevant terms with no language restrictions. Authors were contacted for unpublished data and clarification of the practice location of study subjects. STUDY SELECTION Two investigators independently reviewed each article. Included studies provided a measure of burnout in inpatient and/or outpatient nontrainee physicians. DATA EXTRACTION Fifty‐four studies met inclusion criteria, 15 of which provided direct comparisons of inpatient and outpatient physicians. Twenty‐eight studies used the same burnout measure and therefore were amenable to statistical analysis. DATA SYNTHESIS Outpatient physicians reported more emotional exhaustion than inpatient physicians. No statistically significant differences in depersonalization or personal accomplishment were found. Further comparisons were limited by the heterogeneity of instruments used to measure burnout and the lack of available information about practice location in many studies. CONCLUSIONS The existing literature does not support the widely held belief that burnout is more frequent in hospitalists than outpatient physicians. Better comparative studies of hospitalist burnout are needed. Journal of Hospital Medicine 2013;8:653–664. © 2013 Society of Hospital Medicine

A national comparison of burnout and work‐life balance among internal medicine hospitalists and outpatient general internists

“…Burnout has been demonstrated to affect a sizable proportion of hospitalists, with prevalence estimates from prior studies varying from 12.9% to 27.2%, although nearly all studies of US hospitalists have relied on single‐item instruments . Hospital‐based physicians have represented a rapidly expanding segment of the internist workforce for more than a decade, but studies of the impact of inpatient vs outpatient practice location on burnout and career satisfaction are limited.…”

“…Hospital‐based physicians have represented a rapidly expanding segment of the internist workforce for more than a decade, but studies of the impact of inpatient vs outpatient practice location on burnout and career satisfaction are limited. A meta‐analysis of the impact of practice location on burnout relied almost exclusively on noncomparative studies from outside the United States . A recent study of US physician burnout and satisfaction with work‐life balance showed that general internists expressed below average satisfaction with work‐life balance and had the second highest rate of burnout among 24 specialties .…”

Medical Students’ Perspectives on Careers in Hospital Medicine: A National Study

“…However, increasing concerns of physician burnout are emerging. [1][2][3][4] It would be valuable to be able to identify trainees at early stages of their careers to help them prepare for successful careers in hospital medicine. Our study looked to identify correlative factors among medical students who report interest in hospital medicine.…”

“…2,3 In spite of this, hospitalists do report satisfaction with their work-life balance. 4 Medical student specialty choice is a complex issue, and one that has been studied extensively. However, factors that influence why students pursue hospital medicine as a career are less well studied.…”

Long-term Plans for Those Selecting Hospital Medicine as an Initial Career Choice

“…These studies have mostly been survey studies with limited response rates that may affect their fi ndings. [11][12][13][14] Future studies addressing this important issue may seek to focus on those who plan for hospital medicine to be a long-term career rather than all of those who are currently employed in the profession. Likely such studies will be more germane to these physicians, and response rates among this segment of the hospitalist workforce may be higher.…”