The prevalence of burnout in primary care physicians in LMICs: a systematic review and meta-analysis
Burnout is highly prevalent in physicians in high-income countries and many of the risk factors for burnout, such as high workloads and workforce shortages, are also present in low- and middle- income countries (LMICs). Strong primary care in LMICs is critical to achieving the World Health Organisation’s vision of Universal Health Coverage, yet there is a dearth of burnout research in primary care physicians in LMICs. This systematic review aims to determine the prevalence of burnout in primary care physicians in LMICs.
Systematic searches were carried out in nine electronic databases from database inception to November 2020. Observational studies investigating burnout in primary care physicians working in LMICs, were included, with no limitations. Random effects meta-analysis was used to estimate prevalence (as assessed by the Maslach Burnout Inventory subscales), and factors associated with burnout were narratively reported.
Searches returned 1,191 unique studies of which 18 studies (n=18) were included in the review after title, abstract and full text screening. 11 fulfilled criteria for meta-analysis. Overall burnout point prevalence estimates ranged from 2.46% to 75%. Pooled prevalence for a high level of emotional exhaustion (EE) was 26.8% (CI 16.0 – 37.5; 11 studies, n=11); for a high level of depersonalisation (DP) was 9.9% (CI 4.2 – 17.1; 11 studies, n=11); and for a high level of reduced personal accomplishment (PA) was 25.5% (CI 8.5 – 43.3; 11 studies, n=11).
The wide range of prevalence estimates in individual studies is partly due to different definitions of burnout. However, burnout was present in up to 75% of clinicians and pooled results suggest that high levels of EE or reduced PA were experienced by more than a quarter of participants. This has significant implications for patient safety, physician health, and the LMIC workforce as physicians leave the profession or emigrate.