title: Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis.
abstract: 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.
  
  
  
  To evaluate the effectiveness of interventions to reduce burnout in physicians and whether different types of interventions (physician-directed or organization-directed interventions), physician characteristics (length of experience), and health care setting characteristics (primary or secondary care) were associated with improved effects.
  
  
  
  MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Register of Controlled Trials were searched from inception to May 31, 2016. The reference lists of eligible studies and other relevant systematic reviews were hand searched.
  
  
  
  Randomized clinical trials and controlled before-after studies of interventions targeting burnout in physicians.
  
  
  
  Two independent reviewers extracted data and assessed the risk of bias. The main meta-analysis was followed by a number of prespecified subgroup and sensitivity analyses. All analyses were performed using random-effects models and heterogeneity was quantified.
  
  
  
  The core outcome was burnout scores focused on emotional exhaustion, reported as standardized mean differences and their 95% confidence intervals.
  
  
  
  Twenty independent comparisons from 19 studies were included in the meta-analysis (n = 1550 physicians; mean [SD] age, 40.3 [9.5] years; 49% male). Interventions were associated with small significant reductions in burnout (standardized mean difference [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-directed interventions (SMD = -0.45; 95% CI, -0.62 to -0.28) compared with 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 with 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.
  
  
  
  Evidence from this meta-analysis suggests that recent intervention programs for burnout in physicians were associated with small benefits that may be boosted by adoption of organization-directed approaches. This finding provides support for the view that burnout is a problem of the whole health care organization, rather than individuals.
authors.affiliation: National Institute of Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, England.
authors.forename: Maria
authors.initials: M
authors.lastname: Panagioti
authors.affiliation: Laboratory of Hygiene, Aristotle Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Efharis
authors.initials: E
authors.lastname: Panagopoulou
authors.affiliation: National Institute of Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, England.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.affiliation: Complementary and Integrated Medicine Research Unit, Primary Medical Care Aldermoor Health Centre, Southampton, England.
authors.forename: George
authors.initials: G
authors.lastname: Lewith
authors.affiliation: National Institute of Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, England4Farr Institute for Health Informatics Research, Vaughan House, University of Manchester, Manchester, England.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
authors.affiliation: Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, England.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
authors.affiliation: National Institute of Health Research Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, England.
authors.forename: Shoba
authors.initials: S
authors.lastname: Dawson
authors.affiliation: National Institute of Health Research Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, England.
authors.forename: Harm
authors.initials: H
authors.lastname: van Marwijk
authors.affiliation: National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, England.
authors.forename: Keith
authors.initials: K
authors.lastname: Geraghty
authors.affiliation: National Institute of Health Research Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, England.
authors.forename: Aneez
authors.initials: A
authors.lastname: Esmail
mesh_terms: D002055:Burnout, Professional / Q000517:prevention & control*; D006801:Humans; D010820:Physicians / Q000523:psychology*; D012307:Risk Factors