Controlled Interventions to Reduce Burnout in Physicians

Abstract

IMPORTANCE: Burnout is prevalent in physicians and can have a negative influence on performance, career continuation and patient care. Existing evidence does not allow clear recommendations for the management of burnout in physicians. OBJECTIVE: To evaluate the effectiveness of interventions to reduce burnout in physicians. We also examined whether different types of interventions (physician-directed or organization-directed interventions), physician characteristics (length of experience) and healthcare setting characteristics (primary or secondary care) were associated with improved effects. DATA SOURCES: Medline, Embase, PsycINFO, Cinahl, and Central, were searched from inception to May 2016. The reference lists of eligible studies and other relevant systematic reviews were hand-searched. STUDY SELECTION: Randomized controlled trials and controlled before-after studies of interventions targeting burnout in physicians. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed the risk of bias. The main meta-analysis was followed by a number of pre-specified subgroup and sensitivity analyses. All analyses were performed using random-effects models and heterogeneity was quantified using I 2. MAIN OUTCOME AND MEASURES: The core outcome was burnout scores focused on emotional exhaustion, reported as standardized mean differences and their 95% confidence intervals. RESULTS: Twenty independent comparisons from 19 studies were included in the metaanalysis (n=1,550 physicians). Interventions were associated with small significant reductions in burnout (SMD=-0.29, 95% CI=-0.42 to-0.16; equal to a drop of 3-points on the emotional exhaustion domain of the Maslach Burnout Inventory above change in the controls). Subgroup analyses suggested significantly improved effects for organization-5 directed interventions (SMD=-0.45, 95% CI=-0.62 to-0.28) compared to physician-directed interventions (SMD=-0.18, 95% CI=-0.32 to-0.03). Interventions delivered in experienced physicians and in primary care were associated with higher effects compared to interventions delivered in inexperienced physicians and in secondary care, but these differences were not significant. The results were not influenced by the risk of bias ratings. CONCLUSION: Evidence from this meta-analysis suggests that current intervention programs for burnout in physicians are associated with small benefits which may be boosted by adoption of organization-directed approaches. This finding provides support for the view that burnout is a problem of the whole healthcare organization, rather than individuals.

Enhancing Resident Well-being: Illuminating the Path Forward

“…Two recent systematic reviews and meta-analyses reported that few intervention studies on resident burnout have been conducted to date. 8,9 Most published studies have focused on individual strategies, including mindfulness-based stress reduction (MBSR). However, rigorous randomized trials of MBSR among residents have been lacking.…”

The evaluation of a continuing professional development package for primary care dentists designed to reduce stress, build resilience and improve clinical decision-making

“…A recent meta-analysis of burnout interventions in physicians 75 found that organisation-directed interventions were more effective than those which focused on the individual. The authors concluded that burnout is a problem of the whole health care organization, rather than individuals.…”

Current status and attitudes to self-care training in UK medical schools

“…This may account for some of the contradictory results that place an emphasis on personal responsibility for if agreed to it then asks us to consider to what degree we are taking responsibility for our health through our daily choices and consider changing them, whereas disagreeing with it allows us to continue as we are in the belief that other factors may be more important than the way we live every day. Therefore, whilst we fully acknowledge and definitely agree with the need to address toxic systems and environments as part of creating safe, nurturing and healthy workplaces [15], our ability as human beings to both recognise such toxic systems and to address them in an effective way is increased and facilitated when we are more caring for ourselves as we are more aware, present and willing to call out that which is abusive, bullying, harassing or harmful. In addition, even in the most supportive environment a doctor who is not self-caring will be compromising their own health and the quality of care they can give to another.…”