Hospitalists no more prone to burnout than outpatient doctors, analysis finds

The common belief that hospitalists are more likely to experience burnout than outpatient physicians doesn't appear to be true, a new meta-analysis suggests.

Researchers searched 5 medical databases and found 54 studies from 1974 to 2012 that measured burnout in inpatient and/or outpatient physicians in the U.S. and countries with a hospitalist-like care model. The studies comprised 5,318 outpatient physicians and 1,301 inpatient physicians, with 15 studies offering direct comparisons between in- and outpatient doctors, and 28 studies using the same measure of burnout. Burnout, as distinguished from depression, stress and job dissatisfaction, was defined as a state in which “emotional exhaustion, depersonalization, and a low sense of personal accomplishment combine to negatively affect work life,” but not personal life, the researchers wrote.

Emotional exhaustion was significantly higher in outpatient than inpatient physicians (mean difference, 3 points; 95% CI, 0.05 to 5.94; P=0.046), but there was no significant difference between doctor types in feelings of depersonalization and low personal accomplishment. Subgroup analysis found that U.S. outpatient physicians had a higher sense of personal accomplishment in double-armed studies than U.S. hospitalists (mean difference, 2.38 points; 95% CI, 1.22 to 3.55; P<0.001), though this difference wasn't evident when single-armed studies were included in the analysis. Results were published online Oct. 25 by the Journal of Hospital Medicine.

The higher prevalence of shift work among hospitalists may allow them to better balance their work and personal lives than outpatient doctors, which could explain why the latter report more emotional exhaustion, the researchers wrote. Inpatient medicine also may provide more opportunity for teamwork and collegiality, which has been correlated with lower burnout, they added. A lack of depersonalization among hospitalists is encouraging, they noted, as some have expressed concern that depersonalization is a byproduct of the hospital medicine model.

The trend toward a greater sense of personal accomplishment among outpatient physicians may be due to the fact that hospital medicine tends to have younger physicians who “may not have had time to develop a sense of accomplishment,” the researchers wrote. The lack of longitudinal patient care, and the higher provision of end-of-life care, may also reduce hospitalists' sense of accomplishment compared to outpatient doctors, they added.