By Rebecca Pifer

Despite concerns about widespread provider burnout as the pandemic stretches into its third year, a new study found no evidence that burnout negatively impacts the quality of patient care. Counterintuitively, physicians who report burnout could be contributing to slightly better outcomes instead.

The study, which tied data from more than 1,000 family physicians to Medicare claims, found no statistically significant relationship between seven categories of self-reported burnout and measures of ambulatory care, ER visits, readmissions or costs. Instead, reported burnout seemed to be mildly correlated with slightly better outcomes, compared to doctors who are never burned out.

But this doesn't indicate that physician burnout is beneficial or should be tolerated, researchers said, stressing that the relationship between burnout and outcomes is complex and needs further investigation.

Concerns about burnout have been growing even before COVID-19, with research showing high levels of stress and exhaustion contribute to medical errors, job dissatisfaction and poor patient experiences. But there is little research about the extent to which burnout affects the actual cost or quality of care being delivered, even as the pandemic contributes to drive record burnout and turnover in the field.

In the study published on Monday, researchers from the Weill Cornell Medical College and University of Kentucky hypothesized that patients of family doctors who report frequent burnout would have higher annual Medicare costs and higher rates of ambulatory care-sensitive admissions (defined as hospital admissions that could have been prevented by good outpatient care), along with preventable ED visits and 30-day readmissions.

Doctors who are burned out may give less time or effort, resulting in worse outcomes — especially for dual-eligible patients, researchers theorized.

But the study didn't find any consistent relationship between burnout and outcomes.

"Surprisingly, we found that physicians who reported at least some frequency, or even a high frequency, of burnout had generally lower rates of undesirable outcomes," researchers said, though they noted few of the results were statistically significant, so extrapolating this conclusion may be specious or premature pending further research.

"It may be that physicians who report at least some burnout are highly conscientious and give extra effort to providing good care to their patients," researchers continued. "This effort, and their concern about their patients, may be stressful and produce a feeling of burnout, particularly when physicians experience time pressure or other obstacles to providing care."

The study also analyzed physician callousness toward patients, and found patients of the 2.4% of doctors who reported daily callousness did have worse outcomes.

That implies burnout could be associated with concern for patients (and subsequent better outcomes) as opposed to physicians who report callousness, who may lack this concern, the study said.

Previous research does suggest burnout may have a relationship to self-reported medical errors, and physicians who report more burnout also report making more errors. The study noted there's uncertainty about the accuracy of self-reported errors, as burned-out doctors may be more likely to report perceived errors, or perceived errors may make doctors feel more burned out.

The study stressed that the results in no way mean it's good for doctors to feel burned out, as the phenomenon could contribute to worse care experiences, distress and turnover.