Objective To examine the association of physician burnout with the career engagement and the quality of patient care globally. Design Systematic review and meta-analysis. Data sources Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021. Eligibility criteria for selecting studies Observational studies assessing the association of physician burnout (including a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalisation, and a sense of ineffectiveness and little personal accomplishment) with career engagement (job satisfaction, career choice regret, turnover intention, career development, and productivity loss) and the quality of patient care (patient safety incidents, low professionalism, and patient satisfaction). Data were double extracted by independent reviewers and checked through contacting all authors, 84 (49%) of 170 of whom confirmed their data. Random-effect models were used to calculate the pooled odds ratio, prediction intervals expressed the amount of heterogeneity, and meta-regressions assessed for potential moderators with significance set using a conservative level of P<0.10. Results 4732 articles were identified, of which 170 observational studies of 239 246 physicians were included in the meta-analysis. Overall burnout in physicians was associated with an almost four times decrease in job satisfaction compared with increased job satisfaction (odds ratio 3.79, 95% confidence interval 3.24 to 4.43, I2=97%, k=73 studies, n=146 980 physicians). Career choice regret increased by more than threefold compared with being satisfied with their career choice (3.49, 2.43 to 5.00, I2=97%, k=16, n=33 871). Turnover intention also increased by more than threefold compared with retention (3.10, 2.30 to 4.17, I2=97%, k=25, n=32 271). Productivity had a small but significant effect (1.82, 1.08 to 3.07, I2=83%, k=7, n=9581) and burnout also affected career development from a pooled association of two studies (3.77, 2.77 to 5.14, I2=0%, n=3411). Overall physician burnout doubled patient safety incidents compared with no patient safety incidents (2.04, 1.69 to 2.45, I2=87%, k=35, n=41 059). Low professionalism was twice as likely compared with maintained professionalism (2.33, 1.96 to 2.70, I2=96%, k=40, n=32 321), as was patient dissatisfaction compared with patient satisfaction (2.22, 1.38 to 3.57, I2=75%, k=8, n=1002). Burnout and poorer job satisfaction was greatest in hospital settings (1.88, 0.91 to 3.86, P=0.09), physicians aged 31-50 years (2.41, 1.02 to 5.64, P=0.04), and working in emergency medicine and intensive care (2.16, 0.98 to 4.76, P=0.06); burnout was lowest in general practitioners (0.16, 0.03 to 0.88, P=0.04). However, these associations did not remain significant in the multivariable regressions. Burnout and patient safety incidents were greatest in physicians aged 20-30 years (1.88, 1.07 to 3.29, P=0.03), and people working in emergency medicine (2.10, 1.09 to 3.56, P=0.02). The association of burnout with low professionalism was smallest in physicians older than 50 years (0.36, 0.19 to 0.69, P=0.003) and greatest in physicians still in training or residency (2.27, 1.45 to 3.60, P=0.001), in those who worked in a hospital (2.16, 1.46 to 3.19, P<0.001), specifically in emergency medicine specialty (1.48, 1.01 to 2.34, P=0.042), or situated in a low to middle income country (1.68, 0.94 to 2.97, P=0.08). Conclusions This meta-analysis provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care. Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency. Systematic review registration PROSPERO number CRD42021249492. Because this meta-analysis was based on data extracted from previously published research, most of the data and study materials are available in the public domain. However, the raw data extractions, transformed data sheets and author emails confirming the data will be made available and will be published on Mendeley.

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医生职业倦怠与职业投入和患者护理质量的关联：系统评价和荟萃分析

目的 研究全球医生职业倦怠与职业投入和患者护理质量的关系。设计系统回顾和荟萃分析。数据来源 Medline、PsycINFO、Embase 和 CINAHL 从数据库开始到 2021 年 5 月进行了搜索。选择研究的资格标准人格解体、无效感和个人成就感）与职业投入（工作满意度、职业选择后悔、离职意向、职业发展和生产力损失）和患者护理质量（患者安全事件、低专业性和患者满意度） ）。数据由独立评审员双重提取，并通过联系所有作者进行检查，其中 170 名作者中有 84 名（49%）确认了他们的数据。随机效应模型用于计算汇总优势比，预测区间表示异质性的量，以及使用 P <0.10 的保守水平设置显着性的潜在调节因子评估的元回归。结果 4732 篇文章被确定，其中 239 246 名医生的 170 项观察性研究被纳入荟萃分析。与增加的工作满意度相比，医生的总体倦怠与工作满意度的下降几乎相关（优势比 3.79，95% 置信区间 3.24 至 4.43，I2=97%，k=73 项研究，n=146 980 名医生）。与对职业选择感到满意相比，职业选择后悔增加了三倍以上（3.49，2.43 至 5.00，I2=97%，k=16，n=33 871）。与保留率相比，营业额意愿也增加了三倍以上（3.10，2.30 至 4.17，I2=97%，k=25，n=32271）。生产力有一个小而显着的影响（1.82, 1.08 到 3.07, I2=83%, k=7, n=9581），倦怠也影响职业发展，从两项研究的汇总关联来看（3.77, 2.77 到 5.14, I2=0 %，n=3411)。与没有患者安全事件相比，总体医生倦怠使患者安全事件翻了一番（2.04，1.69 至 2.45，I2=87%，k=35，n=41 059）。与保持专业水平相比，低专业水平的可能性是维持专业水平的两倍（2.33, 1.96 至 2.70, I2=96%, k=40, n=32 321），与患者满意度相比，患者不满意（2.22, 1.38 至 3.57, I2=75%，k=8，n=1002)。职业倦怠和较差的工作满意度在医院环境（1.88，0.91 至 3.86，P=0.09）、31-50 岁的医生（2.41、1.02 至 5.64，P=0.04）以及从事急诊医学和重症监护（2.16 , 0.98 至 4.76, P=0.06); 全科医生的倦怠最低（0.16, 0.03 至 0.88, P=0.04）。然而，这些关联在多变量回归中并不显着。职业倦怠和患者安全事件在 20-30 岁的医生（1.88，1.07 至 3.29，P=0.03）和急诊科工作人员（2.10，1.09 至 3.56，P=0.02）中最多。在 50 岁以上的医生中，职业倦怠与低专业水平的关联最小（0.36，0.19 至 0.69，P=0.003），而在仍在培训或住院医师中的医生中，职业倦怠的关联最大（2.27，1.45 至 3.60，P=0.001），在医院工作（2.16，1.46 至 3.19，P<0.001），特别是急诊医学专业（1.48，1.01 至 2.34，P=0.042）或位于中低收入国家（1.68，0.94 至2.97，P=0.08）。结论这项荟萃分析提供了令人信服的证据，表明医生倦怠与医疗保健组织的功能和可持续性不佳有关，这主要是通过导致医生的职业脱离和更替，其次是降低患者护理质量。医疗机构应该投入更多的时间和精力来实施循证策略，以减轻跨专业医师的倦怠，特别是在急诊医学和培训或住院医师方面。系统评价注册PROSPERO编号CRD42021249492。因为这项荟萃分析是基于从先前发表的研究中提取的数据，所以大部分数据和研究材料都可以在公共领域获得。但是，将提供原始数据提取、转换后的数据表和确认数据的作者电子邮件，并将在 Mendeley 上发布。