Well-Being Parameters and Intention to Leave Current Institution Among Academic Physicians

Ability and utility of the Physician Well-Being Index to identify distress among Chinese physicians

BACKGROUND

Despite the high prevalence of mental stress among physicians, reliable screening tools are scarce. This study aimed to evaluate the capability of the Physician Well-Being Index (PWBI) in identifying distress and adverse consequences among Chinese physicians.

METHODS

This cross-sectional online survey recruited 2803 physicians from Southern Mainland China via snowball sampling between October and December 2020. Data on socio-demographic characteristics, the PWBI, mental distress (including quality of life [QOL], burnout, sleepiness, fatigue and suicidal ideation) and adverse outcomes (medical errors and turnover intention) were collected. Chi-square tests and logistic regression were used for data analysis.

RESULTS

Seven items of the PWBI (emotional exhaustion, depression, stress, poor mental and physical QOL, low work meaning and dissatisfaction with work-life integration) were independently associated with low QOL (all p < 0.05). Physicians with lower QOL were more likely to endorse each item (OR: 1.76-5.86) and less likely to have favourable index scores (all p < 0.001). Assuming a prevalence of 29.2% for low QOL, the PWBI could reduce the post-test probability to 6.9% or increase it to 70.8%. Physicians scoring ≥4 on the PWBI were at increased risk (likelihood ratio >1) for experiencing various mental distress, with sensitivity exceeding 80% in detecting burnout, depression, high stress and anxiety. Additionally, the PWBI score helped stratify physicians' likelihood of reporting medical errors and turnover intention.

CONCLUSIONS

This study provides preliminary insights into the validity and utility of the 9-item PWBI as a screening tool for assessing distress and well-being among Chinese physicians, helping identify those at higher risk of medical errors or turnover. However, these findings should be interpreted with caution due to the limited sample size.

Retaining doctors in organisations in socioeconomically deprived areas in England: a qualitative study

OBJECTIVES

To identify factors that improve retention in under-doctored areas that experience difficulties in maintaining sufficient medical workforce.

DESIGN

Qualitative study based on semi-structured interviews, collected as part of a larger study.

SETTING

Four purposely sampled geographic case study sites in England. Three case study sites were selected as areas that struggled to recruit and retain doctors and one as an area that is oversubscribed. This comprised 27 NHS Trusts, plus 1449 GP practices.

PARTICIPANTS

100 National Health Service (NHS)-employed doctors (including general practitioners, consultant specialists, specialty and specialist doctors, resident doctors/doctors in postgraduate training and locally employed doctors) were interviewed between December 2022 and March 2024.

FINDINGS

Participants shared their experiences of organisational levers that impact on decisions about working life and retention in the workforce. Two key themes explained factors influencing retention. First, participants discussed feeling valued by the organisation, both in terms of material circumstances and in relationships with colleagues. Second, the theme of autonomy and opportunity explored why doctors chose to stay in areas that typically experience difficulties in maintaining sufficient staffing.

CONCLUSIONS

Many studies focusing on workforce examine why staff leave, but by focusing on factors that influence retention, greater understanding of specific facets of organisational culture can be used to inform policy and practice.

TRIAL REGISTRATION NUMBER

ISRCTN95452848.

Female representation in the Canadian physician anesthesia workforce: a historical analysis

PURPOSE

According to an analysis of data from the Canadian Institutes for Health Information (CIHI) National Physician Database, the proportion of female anesthesia physicians is substantially lower than the proportion of female physicians in the total physician population. The goal of this study was to identify trends in female representation in the major subgroups of anesthesia providers, including specialists certified by the Royal College of Physician and Surgeons of Canada (RCPSC), international medical graduates, and family physician anesthetists (FPAs).

METHODS

We examined the sex distribution of the existing physician workforce, including anesthesia providers working in urban and rural Canada, using the CIHI National Physician Database (1996-2018). We also examined the sex distribution of physicians entering the workforce using the Canadian Post-MD Education Registry database and calculated descriptive statistics.

RESULTS

The proportion of female physicians increased steadily over time in all groups; nevertheless, the numbers of female FPAs and rural anesthesia providers continued to lag relative to all Canadian physicians (9.4%, 9.4%, and 26.7%, respectively, in 1996; 18.7%, 21.1%, and 42.1%, respectively, in 2018). Of the graduates from RCPSC training programs in 1996, 28% were female, whereas by 2018, 33.5% of graduates were female.

CONCLUSIONS

Female physicians were underrepresented in all subgroups, but the proportions were lowest among FPAs and rural physicians. Given that greater sex diversity in clinical teams is associated with better outcomes, and in light of ongoing workforce shortages, the barriers that prevent female physicians from entering and/or remaining in the anesthesia workforce need to be understood and ameliorated.

The Practice: A Leadership-Endorsed Workplace Intervention to Improve Well-being in Healthcare Professionals

BACKGROUND

Highly prevalent and worsened by the COVID-19 pandemic, burnout is associated with more frequent self-reported medical errors, suboptimal patient care, staff attrition, and lower professional fulfillment. There is a growing call for "wellness-centered leaders" who model, integrate, and prioritize well-being within the practice environment.  OBJECTIVE: Having piloted a novel intervention called "The Practice" in one work unit with promising outcomes, we set out to implement and prospectively study the intervention more broadly at our institution.

DESIGN

Departmental leaders were offered an opportunity for their team to participate. Within each interested departmental group, participants were trained in the core components of "The Practice": five daily well-being exercises taking less than 15 min. Biweekly facilitated group meetings to share challenges and successes of doing "The Practice" were integrated into departmental meetings for 3 months. Outcome measures included the WHO-5 Well-being Index, the Wong & Law Emotional Intelligence Scale (WLEIS), and the Professional Fulfillment Index (PFI), completed at baseline and months 3, 6, 9, and 12 after enrollment. Changes over time were analyzed using mixed models. Supplemental experience data were collected from a convenience sample and analyzed using the Framework approach.

PARTICIPANTS

From May 2021 through January 2022, 191 physicians and allied health staff from 14 clinical departments were enrolled. Participants were majority female (84%, n = 161) and White (83.2%, n = 159).

KEY RESULTS

We observed significant improvements in scores from baseline compared to month 3 that were sustained at later time points for WHO-5, WLEIS, and three of four PFI scales (p < 0.05). Experience data reflected feelings of gratitude that the institution was invested in their well-being, "humanization" of leaders, and increased awareness of coworker's feelings.

CONCLUSION

"The Practice" may be an effective, integrated, departmental wellness program by which healthcare organizations can support the well-being of their staff.

Empowering Physicians Through Collective Action: A Position Paper From the American College of Physicians

Physicians are increasingly frustrated with the nation's health care system. The erosion of the patient-physician relationship, diminished clinical independence, the mounting burden of administrative tasks, and the growing influence of nonclinicians in the health care system have left many physicians disempowered, demoralized, and burned out. As a result, physicians, most of whom are employed by hospitals, health systems, and other organizations, are exploring collective action to enhance their ability to deliver high-quality care to patients, regain control of their profession, and improve their well-being. In this position paper, the American College of Physicians offers recommendations on how physicians can become effective advocates for their patients and their profession through advocacy, the organized medical staff, responsible collective bargaining, and other means.

Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2023

OBJECTIVE

To evaluate the prevalence of burnout and satisfaction with work-life integration (WLI) among physicians and US workers in 2023 relative to 2011, 2014, 2017, and 2020, as well as physicians in 2021.

PARTICIPANTS AND METHODS

Between October 19, 2023, and March 3rd, 2024, we surveyed US physicians and a probability-based sample of the US working population using methods similar to previous studies. Burnout and WLI were measured using standard tools.

RESULTS

Demographic characteristics of the 7643 survey participants were similar to those of practicing US physicians (N=936,074), although participants were more likely to be women (39.6% vs 37.9%). Nonresponder analysis suggested participants were representative of US physicians with regard to burnout and satisfaction with WLI. Overall, 45.2% of physicians reported at least 1 symptom of burnout in 2023 compared with 62.8% in 2021 (P<.001), 38.2% in 2020 (P<.001), 43.9% in 2017 (P=.16), 54.4% in 2014 (P≤.001), and 45.5% in 2011 (P=.49). Overall, 42.2% of physicians (n=2732) were satisfied with WLI in 2023, compared with 30.3% in 2021 (P<.001), 46.1% in 2020 (P<.001), 42.8% in 2017 (P=.02), 40.9% in 2014 (P<.001), and 48.5% in 2011 (P <.001). On multivariable analysis of 2023 participants, physicians were at increased risk for burnout (odds ratio=1.82; 95% CI, 1.63 to 2.05) and were less likely to be satisfied with WLI (odds ratio=0.59; 95% CI, 0.53 to 0.66) than other US workers.

CONCLUSION

Burnout among US physicians improved between 2021 and 2023 and is currently at levels similar to 2017. However, US physicians remain at higher risk for burnout relative to other US workers.

Actionable Areas of Distress Among Pediatric Cardiology Fellows

OBJECTIVE

To quantify burnout and identify specific stressors among a national sample of pediatric cardiology fellows.

STUDY DESIGN

We invited program directors at all 61 Accreditation Council for Graduate Medical Education-accredited pediatric cardiology training programs to distribute a 40-item survey to their categorical (year 1-3) fellows from February to April 2023. The survey included the Stanford Professional Fulfillment Index and ratings of key stressors to understand levels of burnout and associated stressors.

RESULTS

In total, 67% (261/391) of contacted pediatric cardiology fellows completed the survey, representing 50% of all categorical fellows in the US. Of these, 42% reported symptoms of burnout. Fellows without children were found to have increased odds of experiencing burnout symptoms compared with those with children (OR 2.03). 13 of 15 stressors were associated with increased burnout scores, of which "excessive number of work hours," "challenges to prioritizing self-care," and "mistreatment from supervisors" were the top 3.

CONCLUSION

This national study of pediatric cardiology fellows shows a high prevalence of burnout. The modifiable stressors identified in this study offer opportunities to improve the well-being of this group of trainees.

Implementation of an Organization-Based Couples Health Promotion Program to Improve Physician Well-Being

Importance

Physicians work long, often unpredictable hours and experience multiple work-related stressors, which may adversely affect their personal relationships.

Objective

To assess the associations of a couples' workshop for physicians and their partners with burnout, self-valuation, and impact of work on personal relationships (IWPR).

Design, Setting, and Participants

In this cohort study, participants were grouped into an immediate intervention group and a delayed intervention control group, which were later compared. The participants in the intervention group gathered at a resort near Stanford University in October 2022, whereas the participants in the control group were invited to participate in a May 2023 workshop. Invited participants included Stanford Medicine physicians and their partners. Eligible physicians worked in a department or division considered frontline during the COVID-19 pandemic or had unfavorable IWPR scores on an institution-wide survey. The data were analyzed from June 14, 2024, to October 1, 2024.

Intervention

The intervention group participated in a 2-day workshop for couples and were offered 3 evening sessions. All sessions emphasized positive psychology principles and incorporated didactic, reflection, and unstructured content focused on strengthening relationships.

Main Outcomes and Measures

The main outcome was IWPR score, measured at baseline (immediately preceding the workshop for the intervention group and at registration for the control group) and 6 months later. IWPR was measured with a survey asking 4 questions about how work had affected personal relationships during the past year, and the responses included not at all true, somewhat true, moderately true, very true, and completely true (with scores assigned as 0, 1, 2, 3, and 4, respectively). Other outcome measures included burnout and self-valuation (with a lower score being favorable for burnout and a higher score being favorable for self-valuation).

Results

Of 47 intervention group participants and 69 control group participants, 22 (46.8%) and 40 (57.9%), respectively, were women (P = .32). Paired assessments (at baseline and 6 months) were completed by 38 of 47 (80.9%) physicians in the intervention group and 53 of 69 (76.8%) in the control group. Between baseline and 6-month follow-up, participants in the intervention group showed a mean (SD) improvement of 1.59 (2.66) points (Cohen d = 0.54 [95% CI, 0.23-0.85]; P < .001) in IWPR, 1.22 (1.47) points (Cohen d = 0.68 [95% CI, 0.39-0.98]; P < .001) in burnout, and -1.25 points (2.09) (Cohen d = 0.68 [95% CI, -0.97 to -0.25]; P < .001) in self-valuation. Statistically significant changes in these measures were not observed in the control participants. In mixed-effects modeling comparing the intervention and control groups, being in the intervention group was associated with a 1.25-point improvement in IWPR (Glass d = -0.45 [95% CI, -0.12 to -0.79]; P = .01), a 1.24-point improvement in burnout (Glass d = -0.70 [95% CI, -0.37 to -1.03]; P < .001), and a 0.97-point improvement in self-valuation (Glass d = 0.47 [95% CI, 0.09-0.86]; P = .02).

Conclusions and Relevance

In this cohort study of an organizationally sponsored intervention consisting of a couples' workshop designed to mitigate the adverse IWPR for physicians, participation was associated with statistically significant improvements in IWPR, burnout, and self-valuation. Further development of interventions to mitigate adverse IWPR among physicians is warranted.

[Representation of respiratory medicine in medical curricula in Germany: an online survey among final-year medical students and chief physicians]

Students' experiences in medical school may have a significant influence on their later choice of medical specialty, but so far, there has been a lack of objective data on how the subject of pneumology is perceived at German medical schools and where there may be potential for improvement.From July to November 2022, we conducted an online survey among final-year students at German medical schools, as well as chief physicians in the field of pneumology. Students were invited to participate by e-mail via their faculties and the survey was further advertised by the Federal Representation of Medical Students in Germany (BVMD). Chief physicians were contacted via the mailing list of the German Respiratory Society (DGP).We received n=279 responses from students (from 95% of German medical faculties) and n=53 responses from chief physicians in pneumology. Both groups considered pneumology to be rather underrepresented or underrepresented compared to other specialties in the medical curricula (62% of students, 89% of chief physicians). Students attributed the greatest influence on their career aspirations by far to theoretical knowledge, practical experience during internships, clinical traineeships and the final (practical) year of medical school (89% of responses), with value being attributed to good and appreciative supervision and the opportunity to work independently. In a regression analysis, practical learning experience in the field of pneumology during the final year of medical school was particularly associated with students' later career choice for pneumology. From the students' perspective, practical teaching (91% of responses) as well as other courses requiring personal attendance (51%) should be strengthened. Chief physicians described difficulties recruiting junior staff into the field of pneumology and highlighted the need to stress the importance of the subject and the financing of teaching at medical schools.Implementation of a more comprehensive, practice-oriented training in respiratory medicine seems essential for promoting the recruitment of the next generation of physicians into the field of pneumology. The results presented in this paper form a basis for giving more weight to pneumology in medical school curricula and serve as an aid for decision-makers at medical faculties and teaching hospitals in Germany.

Sense of Belonging and Intent to Leave Among Medical School Faculty

This cross-sectional study evaluates sense of belonging and intent to leave their medical school among US medical school faculty.

Financial Compensation of Academic Otolaryngologists in the United States: Trends and Distribution

OBJECTIVES

The aim of this study was to assess recent trends in financial compensation in the field of academic otolaryngology, and distribution based on rank, sex, race/ethnicity, and geographical regions in academic medical centers.

METHODS

The AAMC Faculty Salary Survey was used, which collects information for full-time faculty at US academic centers. Financial compensation data for otolaryngology faculty with MD or equivalent degree were collected from 2017 to 2023, stratified by rank, gender, race/ethnicity, and geographical region.

RESULTS

The AAMC Faculty Salary Survey data for 2023 included responses for 1641 faculty members from academic otolaryngology departments. Median faculty compensation increased on an average 0.58%-2.81% per year from 2017 to 2023, with the greatest increase at the senior ranks and smaller increases at the Instructor rank. Male faculty members were consistently compensated more than women at all ranks throughout the study period, and the salary gap increased at the higher academic ranks. Black/African American faculty had a lower median compensation compared to White faculty at all ranks. Faculty members in the northeast region had the highest median compensation at all ranks.

CONCLUSION

This study summarizes the trends of otolaryngology faculty compensation and shows persistent salary inequities at academic medical centers in the United States.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:1367-1371, 2025.

Factors Contributing to Burnout and Professional Fulfillment among AAFPRS Members

Physician wellness is important for physician engagement and reduction of medical errors 1-6, impacting patient care. A recent survey showed that academic otorhinolaryngologists reported low levels of professional fulfillment and high levels of burnout 7,8. This study explores wellness factors in facial plastic and reconstructive surgery (FPRS).To examine factors associated with fulfillment, burnout, and intent to leave within FPRS.Cross-sectional survey.AAFPRS members completed an anonymous and standardized survey to assess professional fulfillment and burnout. Chi-square testing was used for data analysis.Among 75 respondents (5% response rate), 34% lacked professional fulfillment and 18% experienced burnout, lower than reported rates in academic otorhinolaryngology7. Lack of decision-making power in recruitment/purchasing decisions and uncompensated otolaryngology call were driving factors.Decreased autonomy and extra-subspecialty responsibilities drive burnout, lack of fulfillment, and intent to leave and should be considered in employment arrangements.

Results of the 2020-2023 Association of Residents in Radiation Oncology Graduating Resident Survey: Job Search Experience and Satisfaction

PURPOSE

To better understand radiation oncology (RO) resident experiences navigating the job market, responses from the 2020-2023 Association of Residents in Radiation Oncology Graduating Resident Surveys were analyzed and compared.

METHODS AND MATERIALS

All identified postgraduate year 5 RO residents in the United States were sent a 50 to 58 question survey in May of their respective graduating year. Responses were collected in a deidentified database. Descriptive statistics were generated. Univariable and multivariable logistic regression analyses (MVA) were performed to identify predictors of overall satisfaction/dissatisfaction with accepted positions and agreement that the job market was tough.

RESULTS

The aggregate response rate was 86.9%. Very few (0%-1.8%) respondents did not have a signed offer at survey completion. The percentage who strongly agreed or agreed that the job market was "tough" was 39.3% in 2020, 69.9% in 2021, 25.7% in 2022, and 16.2% in 2023. The percentage of respondents who were strongly dissatisfied or dissatisfied with their accepted job position was 6.2% in 2020, 3.6% in 2021, 1.4% in 2022, and 0.6% in 2023. In MVA, significant predictors of feeling that the job search was not tough included the year of job search (2020 [reference]; 2021 [odds ratio {OR}, 0.31; CI, 0.17-0.57; P < .01]; 2022 [OR, 2.68; CI, 1.66-4.33; P < .01]; 2023 [OR, 3.23; CI, 2.02-5.17; P < .01]) and satisfaction with one's residency program's mentorship in the job search (OR, 1.69; CI, 1.08-2.64; P = .02). In MVA, predictors of overall satisfaction with an accepted position included mentorship during the job search (OR, 4.93; CI, 2.45-9.93; P < .01) and practice setting (urban [reference]; rural [OR, 0.29; CI, 0.11-0.74; P < .01]).

CONCLUSIONS

The vast majority of graduating RO residents from 2020 to 2023 were satisfied with their accepted job offer. Perceptions of job market toughness declined precipitously over time after 2021. Residents who have strong mentorship and accepted positions in urban settings were more likely to report accepted position satisfaction.

Experiences of Women Faculty in an Academic Medical Center

Background

Women faculty face different obstacles in academic medical careers than their men counterparts. Women faculty report feeling like "outsiders" and experiencing multiple barriers to career advancement compared with men, especially if they hold a nonmedical degree (e.g., PhD). This study examined aspects of workplace culture that differentially impact women at a large regional academic medical center (AMC) in the Appalachian region of the United States-a geographic area that is largely understudied in this body of literature.

Materials and Methods

Forty-seven women completed a survey that included the Culture Conducive to Women's Academic Success instrument, the Professional Fulfillment Index, the Work and Family Conflict scale, and items measuring burnout, childcare availability, and demographic factors.

Results

Our findings revealed that many women faculty felt that they were being treated differently than men faculty, that work infringed on their home and family life, and that while they were professionally fulfilled at work, childcare problems exacerbated feelings of wanting to leave that AMC. About 60% of our sample indicated some level of burnout.

Conclusions

These findings align with previous findings that women juggle multiple roles that are typically not expected of men, and this juggling may be one reason why women are not staying in academic medicine or being promoted at the same rate as men. We provide incremental validity for the measures used and delineate specific ideas for improvement, such as on-site childcare, standardized leave policies, and formal mentorship and curriculum programs.

Inclusion, belonging, and institutional climate - overlooked factors driving diverse STEM faculty turnover?

Faculty turnover at institutes of higher learning disrupts educational continuity, compromises scholarly activity, has negative impacts on learner experiences, and is costly. As such, understanding the reasons why faculty leave-especially in cases where they plan to stay in academia-is critically important with respect to designing and implementing informed retention initiatives. We conducted a survey of STEM faculty who recently switched institutions to gain insights into factors driving their decision to leave. Across all respondents, we found that factors relating to culture/climate were more important than factors relating to pay/compensation or position title. This relative prioritization was even more apparent among women faculty and faculty from disadvantaged backgrounds. We contextualize and discuss the implications of our findings and provide strategies for cultivating inclusive climates to promote faculty retention.

Anaesthesia practice in Europe: A survey of the National Anaesthesiologists Societies Committee of the European Society of Anaesthesiology and Intensive Care

BACKGROUND

Similar to other continents, Europe is experiencing a shortage of anaesthesia workforce, which profoundly impacts the national healthcare systems of affected countries.

OBJECTIVE

To assess the current landscape of the anaesthesia workforce, organisational practices, rules and responsibilities of anaesthesiologists and other anaesthesia providers in operating rooms.

DESIGN

Survey.

SETTING

Thirty-nine out of 41 European countries were surveyed between April 2022 and April 2023.

PARTICIPANTS

Delegates of the National Anaesthesiologists Societies Committee (NASC) of the European Society of Anaesthesiology and Intensive Care (ESAIC).

INTERVENTION

A faculty of experts from France, Germany and Italy, selected by the Chair of NASC, developed a survey consisting of 16 questions, which was sent to the NASC delegates of all European countries.

MAIN OUTCOME MEASURES

Responses from the NASC delegates.

RESULTS

The anaesthesia workforce, composition, roles and duties of anaesthesia teams vary significantly among European countries. The majority of respondents reported a workforce shortage, with variable trends, exacerbated in some cases by an increased loss of anaesthesiologists following the COVID-19 pandemic. Significant differences in anaesthesiologists' salaries exist across countries. A one-to-one anaesthesiologist-to-patient ratio during general anaesthesia maintenance, neuraxial and peripheral blocks is the most common; however, in a notable number of cases, this ratio decreases to one-to-two or even less. In such instances, residents or nonphysician anaesthesia personnel (NPAs) play a crucial role, enabling anaesthesiologists to supervise more than one patient simultaneously. Differences in the training of anaesthesia team members, as well as rules regulating anaesthesia team composition and the autonomy of its members, were also evident.

CONCLUSION

The survey provides data on the current anaesthesia practice in Europe. The availability, composition and organisation of anaesthesia team members differ among European countries. The study highlights areas for further focus in operating room organisation and anaesthesia team composition, particularly regarding safety, efficacy and cost-effectiveness.

An early evaluation of team consistency and scope optimization in team-based cancer care

BACKGROUND

The British Columbia (BC) government has made significant investments towards the implementation of team-based care (TBC) in its provincial comprehensive cancer control program. TBC implementation involves purposeful efforts towards: (a) establishing/expanding multidisciplinary care teams, (b) optimizing scope of practice, and (c) increasing care team consistency. Study objectives include an early-phase evaluation of (i) the association between TBC elements and team effectiveness and (ii) staff perceptions of barrier and facilitators of team effectiveness.

METHODS

A series of five surveys over a 2-year period will be administered to prospectively evaluate the ongoing implementation of TBC. This study draws on data from the first of the five planned surveys, administered in May 2023. Eligible respondents included 299 program employees-spanning various roles such as physicians, nurses, and unit clerks-working within TBC at the time of survey deployment. The survey included both validated and researcher-developed questions that were either closed or open-ended, including measures of team composition, team consistency, team effectiveness, scope of practice, and demographics. Quantitative data were analyzed using descriptive and regression analysis; qualitative data were analyzed guided by interpretive description methodology.

RESULTS

Collected responses totaled 121, with the majority of respondents being women (76%), full-time employees (90%), and working in direct patient care (77%). Regression analyses indicated that (i) higher frequency of consistently working with the same team members and (ii) lower proportion of shifts practicing below scope are both significant predictors of higher team effectiveness ratings. Qualitative data highlighted staffing levels as a driver of under- and over-utilized scopes of practice. Furthermore, effective communication, enhanced knowledge of each team member's scope of practice, and strong interpersonal relationships were highlighted as contributing factors to effectiveness among multidisciplinary care teams.

CONCLUSIONS

Preliminary findings from the first of five prospective surveys highlight team consistency and role optimization as drivers of effective teamwork in the early implementation of a team-based model of cancer care. Future research should explore contextual factors that influence cancer care staff and clinicians' perceptions of effectiveness.

Psychological safety, job satisfaction, and the intention to leave among German early-career physicians

BACKGROUND

Healthcare systems worldwide experience shortages of healthcare professionals. Retention of physicians is becoming an increasing problem. The psychological safety among physicians affects not only performance but also their emotional well-being and job satisfaction. This study aims to evaluate early career physicians' perception of psychological safety and its influence on job satisfaction and intention to leave.

METHODS

In a cross-sectional study, early career physicians, currently in fellowship programs in Germany were invited to fill in an electronic survey. The instrument consisted of demographic variables and sections from validated and well-established questionnaires. Psychological safety was evaluated on three levels-in relation to the team leader, team as a whole, and peers. Also, job satisfaction was assessed with standardized measures, and participants were asked if they were considering leaving their current employer. Participants were recruited via a nationwide learning platform-an online educational portal for medical students and early career physicians. Data analyses included descriptive, correlation analysis, and regression analyses to determine univariate and multivariate associations with job satisfaction and intention to leave.

RESULTS

The study sample consisted of 432 early career physicians. Most were fulltime employed (85.6%), female (78.2%), and in first 3 years of their postgraduate education (77.5%). A total of 47.2% indicated intention to leave their current employment. On a Likert-10 agreement scale, with high scores indicating greater psychological safety, the mean scores for leader-related, team-related, and peer-related psychological safety were 6.01 [95% confidence interval = 5.81-6.21), 7.30 (7.11-7.49), and 7.95 (7.78-8.12), respectively. In correlation analysis, all dimensions of psychological safety showed significant associations with job satisfaction and the intention to leave. In the multiple regression analyses, female gender (B = -0.10; P = .04) and age group (B = -0.08; P < .01) were associated with lower job satisfaction. High leader and team-related psychological safety were significantly associated with higher job satisfaction (B = 0.18, P < .01; B = 0.10, P < .01), and negatively related to intention to leave (OR = 0.53, P < 0.01; OR = 0.77, P < .01).

CONCLUSION

This survey enhances our understanding of the nuances of psychological safety among early career physicians. In Germany, they reported low-to-medium levels of psychological safety related to the leader and low job satisfaction. Almost every second participant indicated intention to leave the organization. Leader-related psychological safety had highest effect on job satisfaction and intention to leave. Our findings corroborate the eminent role of leadership, workplace, and safety culture for job satisfaction and retention of early career physicians, what consequently affects quality and safety of healthcare.

Workplace Wellness Support Enhances Health and Mental Well-Being in Optometrists

Purpose

To (1) assess rates of burnout in Fellows of the American Academy of Optometry and (2) assess associations among perceptions of workplace wellness support with lifestyle behaviors and health and wellness indicators (ie, anxiety, depression, stress, burnout, mattering to the workplace, and workplace is not stressful).

Methods

A survey collected sample characteristics and outcomes of interest from 321 Fellows.

Results

Thirty-two percent reported burnout. Females and those working in academia were significantly more likely to report being burned out at work. Compared to Fellows with low perceptions of workplace wellness support, Fellows with high perceptions of support were significantly more likely to report mattering to their workplace, a non-stressful workplace environment, and no burnout.

Conclusion

Promoting workplace wellness support may improve perceptions of mattering, stressful workplace environments, and rates of self-reported burnout in optometrists.

Promoting Reasonable Career Expectations and Maximizing Professional Fulfillment for Academic Oncologists: ASCO Recommendations for Academic Medical Centers

In this statement, ASCO encourages academic medical centers to change their policies and expectations to enhance and promote the professional fulfillment of academic medical oncologists. The statement includes three recommendations directed to academic medical centers to further this goal: (1) establish reasonable clinical workloads for academic medical oncologists, (2) provide resources to enable medical oncologists to participate in and conduct research, and (3) develop and apply their standards for clinical workloads and research support, as well as career advancement and leadership opportunities, fairly and equitably across academic medical oncologists. Overall, improved career satisfaction is likely to result in retention of oncologists in the workforce. This is critical to support high-quality patient care, educate the next generation of cancer-focused professionals, and accelerate research discovering effective strategies for cancer prevention, diagnosis, and treatment.

Recommendations for Clinicians, Technologists, and Healthcare Organizations on the Use of Generative Artificial Intelligence in Medicine: A Position Statement from the Society of General Internal Medicine

Generative artificial intelligence (generative AI) is a new technology with potentially broad applications across important domains of healthcare, but serious questions remain about how to balance the promise of generative AI against unintended consequences from adoption of these tools. In this position statement, we provide recommendations on behalf of the Society of General Internal Medicine on how clinicians, technologists, and healthcare organizations can approach the use of these tools. We focus on three major domains of medical practice where clinicians and technology experts believe generative AI will have substantial immediate and long-term impacts: clinical decision-making, health systems optimization, and the patient-physician relationship. Additionally, we highlight our most important generative AI ethics and equity considerations for these stakeholders. For clinicians, we recommend approaching generative AI similarly to other important biomedical advancements, critically appraising its evidence and utility and incorporating it thoughtfully into practice. For technologists developing generative AI for healthcare applications, we recommend a major frameshift in thinking away from the expectation that clinicians will "supervise" generative AI. Rather, these organizations and individuals should hold themselves and their technologies to the same set of high standards expected of the clinical workforce and strive to design high-performing, well-studied tools that improve care and foster the therapeutic relationship, not simply those that improve efficiency or market share. We further recommend deep and ongoing partnerships with clinicians and patients as necessary collaborators in this work. And for healthcare organizations, we recommend pursuing a combination of both incremental and transformative change with generative AI, directing resources toward both endeavors, and avoiding the urge to rapidly displace the human clinical workforce with generative AI. We affirm that the practice of medicine remains a fundamentally human endeavor which should be enhanced by technology, not displaced by it.

Association of Psychological Safety with Burnout and Intent to Leave Among Physician Faculty in New York City

BACKGROUND

Data on the potential protective effect of psychological safety (PS) on well-being and satisfaction among physicians are lacking.

OBJECTIVE

We sought to examine (1) prevalence of PS; (2) relationship between PS, burnout, and intent to leave one's job (ILJ); and (3) demographic and occupational factors associated with PS within our physician faculty.

DESIGN

Participants: An institution-wide survey was sent to all faculty within our eight-hospital health system, between July and September 2022.

MAIN MEASURES

PS was assessed using the seven-item Fearless Organization Questionnaire and burnout with the Maslach Burnout Inventory-2. Demographics and a measure of ILJ were assessed. Multivariable logistic regression analyses were conducted to determine associations between PS, burnout, ILJ, and demographic and occupational correlates of PS.

KEY RESULTS

A total of 867 out of 3086 total estimated clinical faculty members (28.1%) participated in the survey. The majority were 40 and older (67.4%), female (51.9%), white (60.0%), and married/partnered (80.4%); worked in ambulatory care departments (53.7%); and ranked assistant or associate professors (75.8%). On average, 57.6% of physicians evaluated their workplace as psychologically safe (range across items = 40.9-69.9%), with 35.2% screening positive for burnout and 13.4% reporting ILJ. After adjusting for demographic and occupational characteristics, each standard deviation unit increase in PS scores was associated with 27% lower odds of screening positive for burnout (odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.63-0.84) and 38% lower odds of ILJ (OR = 0.62, 95% CI = 0.52-0.74). Female gender was associated with lower scores of PS.

CONCLUSIONS

A majority of faculty physicians reported working in a psychologically safe environment. Greater PS was associated with lower odds of burnout and ILJ. Investment in gender and diversity equity training may be one concrete step in advancing PS in the workplace.

The Family Anesthesia Experience (FAX): Implementing a Social Support-Focused Wellness Programme Across Multiple Residency Programmes

INTRODUCTION

Lack of social support negatively impacts medical trainees' wellness. Programmes to educate medical trainees and their support persons (SPs) have been developed to improve resident wellness, but implementation of these programmes at other institutions remains unclear. We aimed to demonstrate the feasibility of implementing the Family Anesthesia Experience (FAX) programme across multiple institutions and to assess the programme's utility.

METHODS

FAX includes didactics on wellness, burnout, substance use disorder and institutional resources; a panel of senior residents and their SPs; and small-group simulations of airway management, common procedures and a high-fidelity intraoperative code. We assessed the programme qualitatively using semistructured interviews of 20 first year anaesthesiology residents and 20 SPs. Data analysis was performed via a content analysis approach.

RESULTS

Twelve anaesthesiology programmes of varying size and geographic locations implemented FAX with minor adaptations. Minimal direct costs were incurred for the virtual programme. Participants enjoyed the event overall. Content analysis showed that FAX improved SPs' understanding of residency and communication between SPs and residents, had minimal impact on SPs' stress, reduced residents' interpersonal stress with SPs and modified perceptions on wellness and burnout. We developed a conceptual model in which we propose SPs' understanding and empathy for their residents would improve through FAX, which may improve communication with and support for residents.

CONCLUSION

We demonstrated that FAX can be implemented at varying anaesthesiology residency programmes. Family-oriented educational events like FAX may be an effective approach to improve SPs' understanding of a resident's role, thereby increasing social support for residents.

VA physicians intent to leave and correlations to drivers of burnout: a cross-sectional study

BACKGROUND

Physician well-being and workforce retention within the healthcare system is of critical importance. Understanding physicians' intent to leave the organization will inform efforts on optimizing the physician workforce. In this study, we examine the association of burnout and specific drivers of burnout on turnover intentions.

METHODS

The study was a cross-sectional design using data collected from an organization-wide workforce survey. The sample included 16,363 respondents from the Veterans Health Administration (VA). A multinomial model was run to compare physicians indicating turnover intent because they were: a.) changing internal jobs; b.) leaving the organization for another job; or c.) retiring, against physicians indicating they had no plans to turnover. Explanatory variables in the model included burnout, drivers of burnout, and demographics. We also asked about the primary reason behind turnover intent.

RESULTS

Most physicians responding to the survey (n = 13,083, 80%) indicated they would stay within their current job, while 5.8% indicated they would look for another VA job, 5% indicated planning to retire, and 9.3% said they would leave the VA workforce altogether. Burnout and less favorable senior leadership perceptions were associated with greater odds of turnover intent specific to finding another VA job, leaving VA, or retire. Experiencing discrimination was related to turnover intent for another VA job and leaving VA, while satisfaction with workload and recognition were related to lower odds of finding another VA job or leaving VA. Culture of well-being was associated with lower odds of leaving VA.

CONCLUSIONS

The study highlights how burnout is associated with turnover intentions with physicians have differing rationales for leaving. Several drivers of burnout were related to turnover intentions for both finding another VA job and leaving VA altogether. Efforts to improve workforce well-being and drivers of burnout may help address the different rationales physicians may have for considering leaving.

Should I Stay, or Should I Go? Emotional Exhaustion's Association with Intent to Leave in a National Sample of Female Physician Trainees

Background: Physician burnout disproportionately affects women and contributes to attrition from the workforce, a costly problem that likely begins in training. Female physicians leave the workforce significantly earlier than male counterparts. The association between burnout and attrition intent in women physician trainees is unknown. Methods: This is a cross-sectional analysis of baseline data from a national sample of female physician trainees in a randomized controlled trial testing a well-being program in 2022. Participants completed surveys on burnout and intent to leave. Associations were analyzed using chi-square testing and univariable linear regression. Results: A total of 1,017 trainees responded. The average standard deviation (SD) age was 30.8 (4.0) years, 959 (94.3%) self-identified as a woman, and 540 (53.1%) as White. One-fifth (207, 20.7%) were in postgraduate year (PGY)-1, 198 (19.8%) PGY-2, and 595 (59.5%) ≥ PGY-3. Most scored positively for burnout; 77.5% experienced high emotional exhaustion (EE). One-fifth (20.6%) reported some intent to leave their program before graduation, and 32.7% reported intent to leave their specialty within 2 years. There was a strong association between EE scores and intent to leave: trainees reporting a high likelihood to leave before graduation had a 22.27 higher EE point average than those reporting no likelihood (95% confidence interval [CI]: 7.80, 36.74, p = 0.003). Conclusions: Attrition intent was associated with burnout. Addressing burnout during training will not only benefit trainees but could impact the retention of women physicians.

Big brother or big opportunity? Utilization of EHR use metadata in the inpatient setting: A mixed methods study at 16 organizations

BACKGROUND

Clinician electronic actions within the electronic health record (EHR) are captured seamlessly in real-time during regular work activities in all major EHRs. Analysis of this EHR use metadata, such as audit log data, is increasingly used to understand the impact of work design on critical patient, workforce, and organizational outcomes.

OBJECTIVE

Understand experiences and perspectives influencing the use and implementation of audit log data into practice.

METHODS

Mixed methods design utilizing focus groups and embedded survey with hospitalist group leaders attending a national society special interest group. Themes and subthemes were identified.

RESULTS

Seven semistructured virtual focus groups were held with 16 individuals from 16 different organizations on December 12, 2023, with a 100% survey response rate. Survey results highlighted the lack of familiarity with audit log data, the lack of tools and training for use, and the lack of established protocols to respond to insights, with some concerns for the accuracy of the data. Four themes and multiple subthemes were identified and included: (1) Limited, but widely variable use of audit log data driven by a lack of access, resources, skills, and knowledge, (2) mistrust and skepticism about the data, including concerns about potential misuse and a lack of best practices and standards, (3) perspectives around audit log data are culture and context driven, and (4) excitement for the many potential use cases.

CONCLUSION

Despite all major EHRs having audit log data, participants had limited access, training, and knowledge. Although there was mistrust, many opportunities were identified.

The electronic health record: does it enhance or distract from patient safety?

PURPOSE OF REVIEW

The electronic health record (EHR) is an invaluable tool that may be used to improve patient safety. With a variety of different features, such as clinical decision support and computerized physician order entry, it has enabled improvement of patient care throughout medicine. EHR allows for built-in reminders for such items as antibiotic dosing and venous thromboembolism prophylaxis.

RECENT FINDINGS

In anesthesiology, EHR often improves patient safety by eliminating the need for reliance on manual documentation, by facilitating information transfer and incorporating predictive models for such items as postoperative nausea and vomiting. The use of EHR has been shown to improve patient safety in specific metrics such as using checklists or information transfer amongst clinicians; however, limited data supports that it reduces morbidity and mortality.

SUMMARY

There are numerous potential pitfalls associated with EHR use to improve patient safety, as well as great potential for future improvement.

Emotional Intelligence in Medicine: An Investigation of the Significance for Physicians, Residents, and Medical Students - A Systematic Review

OBJECTIVE

Physicians, residents, and medical students consistently report higher levels of stress, anxiety, depression, burnout, and suicide compared to the general population. Emotional intelligence is a trait 1 possesses that has been shown to have associations with aspects of mental health specifically in the medical field. It has also been studied in business literature demonstrating multiple performance benefits. The purpose of this review is to investigate the relationship of emotional intelligence and mental health and well-being, clinical performance, and academic success with physicians, residents, and medical students.

METHODS

A systematic review was conducted of studies investigating the associations of emotional intelligence on physicians, residents, or medical students between 2013 and 2023. Studies investigating the association of empathy within the study population were also included. Studies must have used a validated measure or reported a reliable method of measuring emotional intelligence or empathy.

RESULTS

Thirty-nine articles were included. The trait emotional intelligence questionnaire short form was the most frequently used assessment tool (28%). Mental health and well-being was the most common study outcome (67%). Twenty articles reported lower levels of burnout in those with higher emotional intelligence levels. (p < 0.05). Other protective associations of emotional intelligence included decreased levels of anxiety, stress, and depression (p < 0.05). Emotional intelligence was associated with multiple clinical performance metrics including patient satisfaction, perceived communication ratings, patient information recall, and improved decision making under operational stress (p < 0.05).

CONCLUSIONS

Emotional intelligence has beneficial associations for physicians at all levels of training. Those entering with higher levels of emotional intelligence may be better suited to handle the psychological effects described within the healthcare field. Emotional intelligence can also be improved through training. Using emotional intelligence as part of a holistic screening process may help predict and enhance the success of doctors, residents, and medical students, which can contribute to improving the healthcare system.

Incidence and Factors Associated With Burnout Among Cardiac Anesthesiologists in India

OBJECTIVE

Many previous surveys have demonstrated a high incidence of burnout among anesthesiologists. The current survey was designed to estimate the incidence and understand the factors associated with burnout among cardiac anesthesiologists in India.

DESIGN

Members of the Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA) were invited to participate. The survey consisted of two sections: the initial section collected demographic data, work patterns, and factors associated with burnout perception. The second part assessed emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (LPA) using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS).

SETTING

Web-based survey.

PARTICIPANTS

Members of IACTA.

INTERVENTIONS

None.

MEASUREMENT AND RESULTS

A high score on EE (≥27 and/or DP ≥10) identified those at high risk for burnout. A high risk of burnout in addition to LPA ≤33 was defined as burnout syndrome. Of the 2,262 IACTA members surveyed, 325 (14.35%) responded. Among them, 162 (49.8%) were classified as at high risk of burnout, and 91 (28%) met the criteria for burnout syndrome. Logistic regression analysis identified factors associated with a high risk of burnout, including <5 years of experience (odds ratio [OR] = 3.53), insufficient external support (OR = 2.87), limited personal time (OR = 1.96), and considering leaving cardiac anesthesia (OR = 3.61). Factors contributing to burnout syndrome were <5 years of experience (OR = 3.83), inadequate workplace colleague support (OR = 1.84), and considering leaving cardiac anesthesia (OR = 2.43).

CONCLUSIONS

The burden of burnout syndrome is high among Indian anesthesiologists. Risk factors included younger age, inadequate workplace and external support, limited personal time, and contemplation of leaving cardiac anesthesia. There is a need for various stakeholders to be sensitized and institute necessary measures to reduce the burden and impact of burnout.

Respiratory Specialist Visits Before Admissions with COPD Exacerbation are Linked to Improved Management and Outcomes

Purpose

Exacerbations of COPD (ECOPD) significantly impact disease progression and mortality. Visiting a respiratory specialist (RS) in proximity to the exacerbation may lead to prompt treatment and improved outcomes. We aimed to evaluate the association between an RS visit 30-days before admission and exacerbation outcomes.

Patients and methods

The prospective study included subjects that were hospitalized with ECOPD between 2017 and 2019 in 13 medical centers. Pre-admission, in-hospital, and 30-day outcomes were assessed and compared between patients with and without a 30-day RS visit, using propensity score matching. A sub-group analysis was performed based on the reason for the RS visit (emergent vs regular follow-up).

Results

Three hundred and forty-four subjects were included, and 105 (31%) had pre-admission RS visit (RS group). Before matching, indicators of severe COPD were prevalent in the RS group, while after matching there were no differences. RS visits were associated with pre-hospital initiation of short acting bronchodilators (50% vs 36%), antibiotics (30% vs 17%), and systemic steroids (38% vs 22%). The RS group had longer duration between first symptoms to hospital arrival (median 5 vs 3 days, p < 0.01) and shorter hospital length-of-stay (median 4 vs 5 days, p = 0.04). In-hospital and 30-days outcomes were similar between the groups. However, a non-emergent pre-hospital RS visit was associated with improved in-hospital and 30-day outcomes.

Conclusion

Routine RS visits could lead to correct and early treatment for ECOPD with a potential for improved outcomes. These findings highlight the need for available specialists and higher awareness.

Academic Physician and Trainee Occupational Well-Being by Sexual and Gender Minority Status

Importance

Few studies have explored the association between sexual and gender minority (SGM) status and occupational well-being among health care workers.

Objectives

To assess the prevalence of burnout, professional fulfillment, intent to leave, anxiety, and depression by self-reported SGM status.

Design, Setting, and Participants

This cross-sectional survey study collected data from October 2019 to July 2021, from 8 academic medical institutions participating in the Healthcare Professional Well-Being Academic Consortium. The survey, including questions on SGM status, was administered to attending physicians and trainees. Statistical analyses were performed from June 1, 2023, to February 29, 2024.

Exposure

SGM status was determined via self-reported sexual orientation and gender identity.

Main Outcomes and Measures

Primary outcomes measured were the Professional Fulfillment Index (burnout and professional fulfillment), intent to leave, and self-reported anxiety and depression using the Patient-Reported Outcomes Measurement Information System short-form 4-item measure.

Results

Of 20 541 attendings and 6900 trainees, 8376 attendings and 2564 trainees responded and provided SGM status. Of these respondents, 386 attendings (4.6%) and 212 trainees (8.3%) identified as SGM. Compared with their non-SGM peers, SGM attendings had a lower prevalence of professional fulfillment (133 of 386 [34.5%] vs 3200 of 7922 [40.4%]) and a higher prevalence of burnout (181 of 382 [47.4%] vs 2791 of 7883 [35.4%]) and intent to leave (125 of 376 [33.2%] vs 2433 of 7873 [30.9%]) (all P < .001). Compared with their non-SGM peers, SGM trainees had a lower prevalence of professional fulfillment (63 of 211 [29.9%] vs 833 of 2333 [35.7%]) and a higher prevalence of burnout (108 of 211 [51.2%] vs 954 of 2332 [40.9%]) (both P < .001). After adjusting for age and race and ethnicity, SGM attendings had higher odds of burnout than their non-SGM peers (adjusted odds ratio, 1.57 [95% CI, 1.27-1.94]; P < .001). Results for burnout were similar among the SGM trainees compared with their non-SGM peers (adjusted odds ratio, 1.47 [1.10-1.96]; P = .01).

Conclusions and Relevance

In this cross-sectional survey study of academic physicians and trainees, SGM attendings and trainees had higher levels of burnout and lower levels of professional fulfillment. SGM attendings had greater intent to leave than their non-SGM peers, but trainees did not. These disparities represent an opportunity for further exploration to retain SGM health care workers.

Implementation and delivery of electronic health records training programs for nurses working in inpatient settings: a scoping review

OBJECTIVES

Well-designed electronic health records (EHRs) training programs for clinical practice are known to be valuable. Training programs should be role-specific and there is a need to identify key implementation factors of EHR training programs for nurses. This scoping review (1) characterizes the EHR training programs used and (2) identifies their implementation facilitators and barriers.

MATERIALS AND METHODS

We searched MEDLINE, CINAHL, PsycINFO, and Web of Science on September 3, 2023, for peer-reviewed articles that described EHR training program implementation or delivery to nurses in inpatient settings without any date restrictions. We mapped implementation factors to the Consolidated Framework for Implementation Research. Additional themes were inductively identified by reviewing these findings.

RESULTS

This review included 30 articles. Healthcare systems' approaches to implementing and delivering EHR training programs were highly varied. For implementation factors, we observed themes in innovation (eg, ability to practice EHR skills after training is over, personalizing training, training pace), inner setting (eg, availability of computers, clear documentation requirements and expectations), individual (eg, computer literacy, learning preferences), and implementation process (eg, trainers and support staff hold nursing backgrounds, establishing process for dissemination of EHR updates). No themes in the outer setting were observed.

DISCUSSION

We found that multilevel factors can influence the implementation and delivery of EHR training programs for inpatient nurses. Several areas for future research were identified, such as evaluating nurse preceptorship models and developing training programs for ongoing EHR training (eg, in response to new EHR workflows or features).

CONCLUSIONS

This scoping review highlighted numerous factors pertaining to training interventions, healthcare systems, and implementation approaches. Meanwhile, it is unclear how external factors outside of a healthcare system influence EHR training programs. Additional studies are needed that focus on EHR retraining programs, comparing outcomes of different training models, and how to effectively disseminate updates with the EHR to nurses.

Impact of Work on Personal Relationships and Physician Well-being

OBJECTIVE

To assess the impact of work on personal relationships (IWPR) by specialty and demographic variables in a national sample of physicians, to assess the association between the IWPR and burnout, and to determine the effect of adjusting for IWPR on the risk of burnout associated with being a physician.

METHODS

Analysis was conducted of data from a representative sample of US physicians surveyed between November 20, 2020, and March 23, 2021, and from a probability-based sample of other US workers. IWPR and burnout were measured with published assessments.

RESULTS

Of the 7360 physicians who responded to the survey, 6271 (85.2%) completed the IWPR assessment. In multivariable analysis, moderate or higher IWPR was associated with female sex (odds ratio [OR], 1.26; 95% CI, 1.11 to 1.43), married vs single (OR, 0.59; 95% CI, 0.48 to 0.71), and emergency medicine (OR, 1.93; 95% CI, 1.43 to 2.60) or physical and rehabilitative medicine (OR, 1.67; 95% CI, 1.12 to 2.50) vs internal medicine subspecialty. Physicians were more likely than workers in other fields (OR, 2.65; 95% CI, 2.33 to 3.02) to endorse the statement "In the past year, my job contributed to me feeling more isolated or detached from the people who are important to me" as at least moderately true. After adjustment for responses to this statement, work hours, and demographic characteristics, being a physician was not associated with the risk of burnout.

CONCLUSION

IWPR is associated with burnout. Adjustment for IWPR eliminated the observed difference in burnout between physicians and workers in other fields. Interventions that identify and mitigate work practices that have a negative impact on physicians' personal relationships and interventions that support affected individual physicians are warranted.

Accounting for taste: preferences mediate the relationship between documentation time and ambulatory physician burnout

OBJECTIVES

Physician burnout in the US has reached crisis levels, with one source identified as extensive after-hours documentation work in the electronic health record (EHR). Evidence has illustrated that physician preferences for after-hours work vary, such that after-hours work may not be universally burdensome. Our objectives were to analyze variation in preferences for after-hours documentation and assess if preferences mediate the relationship between after-hours documentation time and burnout.

MATERIALS AND METHODS

We combined EHR active use data capturing physicians' hourly documentation work with survey data capturing documentation preferences and burnout. Our sample included 318 ambulatory physicians at MedStar Health. We conducted a mediation analysis to estimate if and how preferences mediated the relationship between after-hours documentation time and burnout. Our primary outcome was physician-reported burnout. We measured preferences for after-hours documentation work via a novel survey instrument (Burden Scenarios Assessment). We measured after-hours documentation time in the EHR as the total active time respondents spent documenting between 7 pm and 3 am.

RESULTS

Physician preferences varied, with completing clinical documentation after clinic hours while at home the scenario rated most burdensome (52.8% of physicians), followed by dealing with prior authorization (49.5% of physicians). In mediation analyses, preferences partially mediated the relationship between after-hours documentation time and burnout.

DISCUSSION

Physician preferences regarding EHR-based work play an important role in the relationship between after-hours documentation time and burnout.

CONCLUSION

Studies of EHR work and burnout should incorporate preferences, and operational leaders should assess preferences to better target interventions aimed at EHR-based contributors to burnout.

Provider perception of presentations with nonspecific back pain in the emergency department and primary care practices: a semi-structured interview study

BACKGROUND

Increasing numbers of patients treated in the emergency departments pose challenges to delivering timely and high-quality care. Particularly, the presentation of patients with low-urgency complaints consumes resources needed for patients with higher urgency. In this context, patients with non-specific back pain (NSBP) often present to emergency departments instead of primary care providers. While patient perspectives are well understood, this study aims to add a provider perspective on the diagnostic and therapeutic approach for NSBP in emergency and primary care settings.

METHODS

In a qualitative content analysis, we interviewed seven Emergency Physicians (EP) and nine General Practitioners (GP) using a semi-structured interview to assess the diagnostic and therapeutic approach to patients with NSBP in emergency departments and primary care practices. A hypothetical case of NSBP was presented to the interviewees, followed by questions on their diagnostic and therapeutic approaches. Recruitment was stopped after reaching saturation of the qualitative content analysis. Reporting this work follows the consolidated criteria for reporting qualitative research (COREQ) checklist.

RESULTS

EPs applied two different strategies for the workup of NSBP. A subset pursued a guideline-compliant diagnostic approach, ruling out critical conditions and managing pain without extensive diagnostics. Another group of EPs applied a more extensive approach, including extensive diagnostic resources and specialist consultations. GPs emphasized physical examinations and stepwise treatment, including scheduled follow-ups and a better knowledge of the patient history to guide diagnostics and therapy. Both groups attribute ED visits for NSBP to patient related and healthcare system related factors: lack of understanding of healthcare structures, convenience, demand for immediate diagnostics, and fear of serious conditions. Furthermore, both groups reported an ill-suited healthcare infrastructure with insufficiently available primary care services as a contributing factor.

CONCLUSIONS

The study highlights a need for improving guideline adherence in younger EPs and better patient education on the healthcare infrastructure. Furthermore, improving access and availability of primary care services could reduce ED visits of patients with NSBP.

TRIAL REGISTRATION

No trial registration needed.