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Linzer M, Mallick S, Shah P, Becker A, Nankivil N, Poplau S, Patel SK, Nosal C, Sinsky CA, Goelz E, Stillman M, Alexandrou M, Sullivan EE, Brown R. Resident worklife and wellness through the late phase of the pandemic: a mixed methods national survey study. BMC MEDICAL EDUCATION 2024; 24:484. [PMID: 38698362 PMCID: PMC11064291 DOI: 10.1186/s12909-024-05480-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND System contributors to resident burnout and well-being have been under-studied. We sought to determine factors associated with resident burnout and identify at risk groups. METHODS We performed a US national survey between July 15 2022 and April 21, 2023 of residents in 36 specialties in 14 institutions, using the validated Mini ReZ survey with three 5 item subscales: 1) supportive workplace, 2) work pace/electronic medical record (EMR) stress, and 3) residency-specific factors (sleep, peer support, recognition by program, interruptions and staff relationships). Multilevel regressions and thematic analysis of 497 comments determined factors related to burnout. RESULTS Of 1118 respondents (approximate median response rate 32%), 48% were female, 57% White, 21% Asian, 6% LatinX and 4% Black, with 25% PGY 1 s, 25% PGY 2 s, and 22% PGY 3 s. Programs included internal medicine (15.1%) and family medicine (11.3%) among 36 specialties. Burnout (found in 42%) was higher in females (51% vs 30% in males, p = 0.001) and PGY 2's (48% vs 35% in PGY-1 s, p = 0.029). Challenges included chaotic environments (41%) and sleep impairment (32%); favorable aspects included teamwork (94%), peer support (93%), staff support (87%) and program recognition (68%). Worklife subscales were consistently lower in females while PGY-2's reported the least supportive work environments. Worklife challenges relating to burnout included sleep impairment (adjusted Odds Ratio (aOR) 2.82 (95% CIs 1.94, 4.19), absolute risk difference (ARD) in burnout 15.9%), poor work control (aOR 2.25 (1.42, 3.58), ARD 12.2%) and chaos (aOR 1.73 (1.22, 2.47), ARD 7.9%); program recognition was related to lower burnout (aOR 0.520 (0.356, 0.760), ARD 9.3%). These variables explained 55% of burnout variance. Qualitative data confirmed sleep impairment, lack of schedule control, excess EMR and patient volume as stressors. CONCLUSIONS These data provide a nomenclature and systematic method for addressing well-being during residency. Work conditions for females and PGY 2's may merit attention first.
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Affiliation(s)
- Mark Linzer
- Institute for Professional Worklife, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA.
| | - Sanjoyita Mallick
- Department of Medicine, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Purva Shah
- American Medical Association, 330 N. Wabash Avenue, Chicago, IL, 60611, USA
| | - Anne Becker
- Department of Medicine, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Nancy Nankivil
- American Medical Association, 330 N. Wabash Avenue, Chicago, IL, 60611, USA
| | - Sara Poplau
- Institute for Professional Worklife, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Shivani K Patel
- American Medical Association, 330 N. Wabash Avenue, Chicago, IL, 60611, USA
| | - Caitlin Nosal
- American Medical Association, 330 N. Wabash Avenue, Chicago, IL, 60611, USA
| | - Christine A Sinsky
- American Medical Association, 330 N. Wabash Avenue, Chicago, IL, 60611, USA
| | - Elizabeth Goelz
- Institute for Professional Worklife, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Martin Stillman
- Institute for Professional Worklife, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | | | - Erin E Sullivan
- Sawyer School of Business, Harvard Medical School and Suffolk University, 73 Tremont St, Boston, MA, 02108, USA
| | - Roger Brown
- School of Nursing, University of Wisconsin, 701 Highland Avenue, Madison, WI, 53705, USA
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Stillman M, Sullivan EE, Prasad K, Sinsky C, Deubel J, Jin JO, Brown R, Nankivil N, Linzer M. Understanding what leaders can do to facilitate healthcare workers' feeling valued: improving our knowledge of the strongest burnout mitigator. BMJ LEADER 2024:leader-2023-000921. [PMID: 38649265 DOI: 10.1136/leader-2023-000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/21/2024] [Indexed: 04/25/2024]
Abstract
AIM Feeling valued is a striking mitigator of burnout yet how to facilitate healthcare workers (HCWs) feeling valued has not been adequately studied. This study discovered factors relating to HCWs feeling valued so leaders can mitigate burnout and retain their workforce. METHOD The Coping with COVID-19 survey, initiated in March 2020 by the American Medical Association, was distributed to 208 US healthcare organisations. Of the respondents, 37 685 physicians, advanced practice clinicians, nurses, and other clinical staff answered questions that assessed burnout, intent to leave and whether they felt valued.Quantitative analysis looked at odds of burnout and intent to leave among the highest versus lowest feeling valued (FV) groups. Open-ended comments provided by 5559 respondents with high or low sense of FV were analysed to understand aspects of work life that contributed to FV. RESULTS Of 37 685 respondents, 45% felt valued; HCWs who felt highly valued had 8.3 times lower odds of burnout and 10.2 lower odds of intent to leave than those who did not feel valued at all. Qualitative data identified six themes associated with FV: (1) physical safety, (2) compensation and pandemic-related finances, (3) transparent and frequent communication, (4) effective teamwork, (5) empathetic and respectful leaders, and (6) organisational support. CONCLUSION This US study demonstrates that FV correlates with burnout and intent to leave, yet only 45% of HCWs feel valued. Six themes link to interventions leaders can follow to facilitate HCWs FV and potentially reduce burnout and increase retention for a challenged healthcare workforce.
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Affiliation(s)
- Martin Stillman
- Department of Medicine, Hennepin Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Erin E Sullivan
- Sawyer School of Business, Suffolk University, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kriti Prasad
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Jordyn Deubel
- Sawyer School of Business, Suffolk University, Boston, Massachusetts, USA
| | - Jill O Jin
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Roger Brown
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Mark Linzer
- Department of Medicine, Hennepin Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Tawfik D, Bayati M, Liu J, Nguyen L, Sinha A, Kannampallil T, Shanafelt T, Profit J. Predicting Primary Care Physician Burnout From Electronic Health Record Use Measures. Mayo Clin Proc 2024:S0025-6196(24)00037-5. [PMID: 38573301 DOI: 10.1016/j.mayocp.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To evaluate the ability of routinely collected electronic health record (EHR) use measures to predict clinical work units at increased risk of burnout and potentially most in need of targeted interventions. METHODS In this observational study of primary care physicians, we compiled clinical workload and EHR efficiency measures, then linked these measures to 2 years of well-being surveys (using the Stanford Professional Fulfillment Index) conducted from April 1, 2019, through October 16, 2020. Physicians were grouped into training and confirmation data sets to develop predictive models for burnout. We used gradient boosting classifier and other prediction modeling algorithms to quantify the predictive performance by the area under the receiver operating characteristics curve (AUC). RESULTS Of 278 invited physicians from across 60 clinics, 233 (84%) completed 396 surveys. Physicians were 67% women with a median age category of 45 to 49 years. Aggregate burnout score was in the high range (≥3.325/10) on 111 of 396 (28%) surveys. Gradient boosting classifier of EHR use measures to predict burnout achieved an AUC of 0.59 (95% CI, 0.48 to 0.77) and an area under the precision-recall curve of 0.29 (95% CI, 0.20 to 0.66). Other models' confirmation set AUCs ranged from 0.56 (random forest) to 0.66 (penalized linear regression followed by dichotomization). Among the most predictive features were physician age, team member contributions to notes, and orders placed with user-defined preferences. Clinic-level aggregate measures identified the top quartile of clinics with 56% sensitivity and 85% specificity. CONCLUSION In a sample of primary care physicians, routinely collected EHR use measures demonstrated limited ability to predict individual burnout and moderate ability to identify high-risk clinics.
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Affiliation(s)
- Daniel Tawfik
- Stanford University School of Medicine, Stanford, CA.
| | | | - Jessica Liu
- Stanford University School of Medicine, Stanford, CA
| | - Liem Nguyen
- Stanford University School of Engineering, Stanford, CA
| | | | | | - Tait Shanafelt
- Stanford University School of Medicine, Stanford, CA; Stanford Medicine WellMD & WellPhD Center, Stanford, CA
| | - Jochen Profit
- Stanford University School of Medicine, Stanford, CA
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Savage NM, Santen SA, Rawls M, Marzano DA, Wong JH, Burrows HL, Hicks RA, Aboff BM, Hemphill RR. Understanding resident wellness: A path analysis of the clinical learning environment at three institutions. MEDICAL TEACHER 2024:1-7. [PMID: 38557254 DOI: 10.1080/0142159x.2024.2331038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE The clinical learning environment (CLE) affects resident physician well-being. This study assessed how aspects of the learning environment affected the level of resident job stress and burnout. MATERIALS AND METHODS Three institutions surveyed residents assessing aspects of the CLE and well-being via anonymous survey in fall of 2020 during COVID. Psychological safety (PS) and perceived organizational support (POS) were used to capture the CLE, and the Mini-Z Scale was used to assess resident job stress and burnout. A total of 2,196 residents received a survey link; 889 responded (40% response rate). Path analysis explored both direct and indirect relationships between PS, POS, resident stress, and resident burnout. RESULTS Both POS and PS had significant negative relationships with experiencing a great deal of job stress; the relationship between PS and stress was noticeably stronger than POS and stress (POS: B= -0.12, p=.025; PS: B= -0.37, p<.001). The relationship between stress and residents' level of burnout was also significant (B = 0.38, p<.001). The overall model explained 25% of the variance in resident burnout. CONCLUSIONS Organizational support and psychological safety of the learning environment is associated with resident burnout. It is important for educational leaders to recognize and mitigate these factors.
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Affiliation(s)
- Nastassia M Savage
- FMP Consulting, Arlington, VA, USA
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Sally A Santen
- Dean's Office, Virginia Commonwealth University, Richmond, VA, USA
- Emergency Medicine and Medical Education, University of Cincinnati, Cincinnati, OH, USA
| | - Meagan Rawls
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Bon Secours Mercy Health, Richmond, VA, USA
| | - David A Marzano
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Jean H Wong
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Heather L Burrows
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Ralph A Hicks
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Brian M Aboff
- Graduate Medical Education, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Robin R Hemphill
- Cincinnati Veterans Association Medical Center, Cincinnati, OH, USA
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Hagan G, Okut H, Badgett RG. A Systematic Review of the Single-Item Burnout Question: Its Reliability Depends on Your Purpose. J Gen Intern Med 2024; 39:818-828. [PMID: 38424346 PMCID: PMC11043289 DOI: 10.1007/s11606-024-08685-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Surveillance of burnout by the gold-standard Maslach Burnout Inventory (MBI) is hindered by cost and length. The validity and benchmarking of the commonly recommended and used single-item burnout question (SIBOQ) are unknown. We sought to (1) derive an equation for predicting the gold standard MBI from the SIBOQ and (2) measure the correlation of the SIBOQ with the full MBI and its subscales. METHODS We sought studies in PubMed along with citations by and to included studies. We included studies that either correlated the SIBOQ and the MBI or reported the rates of burnout measured by both instruments. Two reviewers extracted data and CLARITY risk of bias. We used generalized linear mixed regression to separately quantify the predictive (benchmarking) and explanatory (hot-spotting) capabilities of the SIBOQ. We created a regression equation for converting SIBOQ scores to MBI scores. We meta-analyzed correlation coefficients (r) for the SIBOQ and MBI subscales. For all analyses, we considered an r of 0.7 as acceptable reliability for group-level comparisons. RESULTS We included 17 studies reporting 6788 respondents. All studies had a high risk of bias, as no study had a response rate over 75% and no study was able to examine non-responders. The correlations (r) of the SIBOQ with the overall MBI were explanatory r = 0.82 and predictive r = 0.56. Regarding MBI subscales, the correlations of the SIBOQ with emotional exhaustion were adequate with r = 0.71 (95% CI 0.67-0.74; I2 = 89%), and depersonalization was r = 0.44 (95% CI 0.34-0.52; I2 = 90%). However, in 8 of 15 comparisons, the r was less than 0.70. DISCUSSION The SIBOQ's usually adequate explanatory abilities allow "hot-spotting" to identify subgroups with high or low burnout within a single, homogenous survey fielding. However, the predictive ability of the SIBOQ indicates insufficient reliability in comparing local results to external benchmarks.
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Affiliation(s)
- Grace Hagan
- Department of Internal Medicine, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Hayrettin Okut
- Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Robert G Badgett
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS, USA.
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Richards SE, Kennel V, Wardian J, Carlson K, Lowndes B. Listening campaigns: engaging clinicians to assess system factors contributing to burnout. BMJ LEADER 2024; 8:79-82. [PMID: 37442569 DOI: 10.1136/leader-2022-000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Even prior to the pandemic, many US physicians experienced burnout affecting patient care quality, safety and experience. Institutions often focus on personal resilience instead of system-level issues. Our leaders developed a novel process to identify and prioritise key system-related solutions and work to mitigate factors that negatively impact clinician well-being through a structured listening campaign. METHODS The listening campaign consists of meeting with each clinician group leader, a group listening session, a follow-up meeting with the leader, a final report and a follow-up session. During the listening session, clinicians engage in open discussion about what is going well, complete individual reflection worksheets and identify one 'wish' to improve their professional satisfaction. Participants rate these wishes to assist with prioritisation. RESULTS As of January 2020, over 200 clinicians participated in 20 listening sessions. One hundred and twenty-two participants completed a survey; 80% stated they benefited from participation and 83% would recommend it to others. CONCLUSION Collecting feedback from clinicians on their experience provides guidance for leaders in prioritising initiatives and opportunities to connect clinicians to organisational resources. A listening campaign is a tool recommended for healthcare systems to elicit clinician perspectives and communicate efforts to address systemic factors.
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Affiliation(s)
- Sarah E Richards
- Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA
| | - Victoria Kennel
- Department of Allied Health Professions Education, Research, and Practice, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jana Wardian
- Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA
| | - Kristy Carlson
- Otolaryngology, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA
| | - Bethany Lowndes
- Department of Allied Health Professions Education, Research, and Practice, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Webber S, Semia S, Nacht CL, Garcia S, Kloster H, Vellardita L, Kieren MQ, Kelly MM. Physician Work-Personal Intersection: A Scoping Review of Terms, Definitions, and Measures. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:331-339. [PMID: 38039978 DOI: 10.1097/acm.0000000000005579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
PURPOSE A substantial body of evidence describes the multidimensional relationship between the intersection of physicians' work and personal lives and health care quality and costs, workforce sustainability, and workplace safety culture. However, there is no clear consensus on the terms, definitions, or measures used in physician work-personal intersection (WPI) research. In this scoping review, the authors aimed to describe the terms and definitions used by researchers to describe physician WPI, summarize the measurement tools used, and formulate a conceptual model of WPI that can inform future research. METHOD The authors searched PubMed, CINAHL, Scopus, and Web of Science for studies that investigated U.S. practicing physicians' WPI and measured WPI as an outcome from January 1990 to March 2022. The authors applied thematic analysis to all WPI terms, definitions, and survey questions or prompts in the included studies to create a conceptual model of physician WPI. RESULTS Ultimately, 102 studies were included in the final analysis. The most commonly used WPI terms were work-life balance, work-life integration, and work-home or work-life conflict(s). There was no consistency in the definition of any terms across studies. There was heterogeneity in the way WPI was measured, and only 8 (7.8%) studies used a validated measurement tool. The authors identified 6 key driver domains of WPI: work and personal demands; colleague and institutional support and resources; personal identity, roles, health, and values; work schedule and flexibility; partner and family support; and personal and professional strategies. CONCLUSIONS The authors found significant variability in the terms, definitions, and measures used to study physician WPI. They offer a conceptual model of the WPI construct that can be used to more consistently study physician WPI in the future. Future work should further investigate the validity of this model and generate consensus around WPI terms, definitions, and measures.
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Satterwhite S, Nguyen MLT, Honcharov V, McDermott AM, Sarkar U. "Good Care Is Slow Enough to Be Able to Pay Attention": Primary Care Time Scarcity and Patient Safety. J Gen Intern Med 2024:10.1007/s11606-024-08658-1. [PMID: 38360962 DOI: 10.1007/s11606-024-08658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND There is growing, widespread recognition that expectations of US primary care vastly exceed the time and resources allocated to it. Little research has directly examined how time scarcity contributes to harm or patient safety incidents not readily capturable by population-based quality metrics. OBJECTIVE To examine near-miss events identified by primary care physicians in which taking additional time improved patient care or prevented harm. DESIGN Qualitative study based on semi-structured interviews. PARTICIPANTS Twenty-five primary care physicians practicing in the USA. APPROACH Participants completed a survey that included demographic questions, the Ballard Organizational Temporality Scale and the Mini-Z scale, followed by a one hour qualitative interview over video-conference (Zoom). Iterative thematic qualitative data analysis was conducted. KEY RESULTS Primary care physicians identified several types of near-miss events in which taking extra time during visits changed their clinical management. These were evident in five types of patient care episodes: high-risk social situations, high-risk medication regimens requiring patient education, high acuity conditions requiring immediate workup or treatment, interactions of physical and mental health, and investigating more subtle clinical suspicions. These near-miss events highlight the ways in which unreasonably large patient panels and packed schedules impede adequate responses to patient care episodes that are time sensitive and intensive or require flexibility. CONCLUSIONS Primary care physicians identify and address patient safety issues and high-risk situations by spending more time than allotted for a given patient encounter. Current quality metrics do not account for this critical aspect of primary care work. Current healthcare policy and organization create time scarcity. Interventions to address time scarcity and to measure its prevalence and implications for care quality and safety are urgently needed.
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Affiliation(s)
- Shannon Satterwhite
- Department of Family and Community Medicine, UC Davis Health, Sacramento, CA, USA
| | - Michelle-Linh T Nguyen
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Vlad Honcharov
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Aoife M McDermott
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Aston University, Birmingham, UK
| | - Urmimala Sarkar
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
- UCSF Pride Hall, San Francisco, CA, USA.
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Garrido-Hermosilla AM, Soto-Sierra M, Díaz-Ruiz MC, Gutiérrez-Sánchez E, Rodríguez-de-la-Rúa-Franch E. Burnout syndrome in Spanish, Portuguese and Latin American ophthalmologists: a cross-sectional analysis. Int Ophthalmol 2024; 44:27. [PMID: 38326583 DOI: 10.1007/s10792-024-02977-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 10/29/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE Despite the well-known consequences of burnout syndrome, there has been little research into this syndrome in the field of ophthalmology. Our objective is to determine the frequency of burnout syndrome between Spanish, Portugal and Latin-American ophthalmologists, as well as to analyse its relationship with different sociodemographic variables. METHODS This is an observational cross-sectional descriptive study including ophthalmologists from Spain, Portugal and 15 Latin American countries. Burnout syndrome was evaluated by the Maslach Burnout Inventory-Human Services Survey. Burnout syndrome was defined as high emotional exhaustion, high depersonalization or low personal accomplishment. In addition, we recorded sociodemographic variables and aspects related to the type of work. A conditional backwards stepwise multivariate binomial logistic regression analysis was run to assess the variables associated with burnout syndrome, expressed as an odds ratio (OR). RESULTS A total of 527 surveys were analysed, the majority from Spain (401; 76.1%), followed by Argentina (45; 8.5%), and Mexico (31; 5.9%). The number of ophthalmologists with burnout syndrome was 351 (66.6%). The results show the profile of a young ophthalmologist (age OR 0.985), carrying out a public activity (OR 2.118) and dedicated to general ophthalmology (OR 1.860). CONCLUSIONS The frequency detected in this study confirms a steady increase in rates of burnout among ophthalmologists. As the consequences of this are well known, it is vital for health centre managers to develop a strategic plan to allow the causes to be understood better and to implement steps to improve the situation in each medical centre.
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Affiliation(s)
- Antonio Manuel Garrido-Hermosilla
- Department of Ophthalmology, Virgen Macarena University Hospital, Av. Dr. Fedriani, 3, 41009, Seville, Spain.
- RETICS OftaRed, Institute of Health Carlos III, Madrid, Spain.
- University of Seville, Seville, Spain.
| | - Marina Soto-Sierra
- Department of Ophthalmology, Virgen Macarena University Hospital, Av. Dr. Fedriani, 3, 41009, Seville, Spain
| | - María Concepción Díaz-Ruiz
- Department of Ophthalmology, Virgen Macarena University Hospital, Av. Dr. Fedriani, 3, 41009, Seville, Spain
| | - Estanislao Gutiérrez-Sánchez
- Department of Ophthalmology, Virgen Macarena University Hospital, Av. Dr. Fedriani, 3, 41009, Seville, Spain
- RETICS OftaRed, Institute of Health Carlos III, Madrid, Spain
- University of Seville, Seville, Spain
| | - Enrique Rodríguez-de-la-Rúa-Franch
- Department of Ophthalmology, Virgen Macarena University Hospital, Av. Dr. Fedriani, 3, 41009, Seville, Spain
- RETICS OftaRed, Institute of Health Carlos III, Madrid, Spain
- University of Seville, Seville, Spain
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Akinleye D, Wu M, Efferen LS, McCauley S, Allen A, Bennett H, Snitkoff LS, Cleary LM, Bliss K, Martiniano R, Wang S, McNutt LA, Osinaga A. Newly Acquired Burnout During the Coronavirus Disease 2019 (COVID-19) Pandemic: A Retrospective Cohort Study on the Experiences of New York State Primary Care Clinicians. J Community Health 2024; 49:34-45. [PMID: 37382837 DOI: 10.1007/s10900-023-01247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
The well-being of primary care clinicians represents an area of increasing interest amid concerns that the COVID-19 pandemic may have exacerbated already high prevalence rates of clinician burnout. This retrospective cohort study was designed to identify demographic, clinical, and work-specific factors that may have contributed to newly acquired burnout after the onset of the COVID-19 pandemic. An anonymous web-based questionnaire distributed in August 2020 to New York State (NYS) primary care clinicians, via email outreach and newsletters, produced 1,499 NYS primary care clinician survey respondents. Burnout assessment was measured pre-pandemic and early in the pandemic using a validated single-item question with a 5-point scale ranging from (1) enjoy work to (5) completely burned out. Demographic and work factors were assessed via the self-reporting questionnaire. Thirty percent of 1,499 survey respondents reported newly acquired burnout during the early pandemic period. This was more often reported by clinicians who were women, were younger than 56 years old, had adult dependents, practiced in New York City, had dual roles (patient care and administration), and were employees. Lack of control in the workplace prior to the pandemic was predictive of burnout early in the pandemic, while work control changes experienced following the pandemic were associated with newly acquired burnout. Low response rate and potential recall bias represent limitations. These findings demonstrate that reporting of burnout increased among primary care clinicians during the pandemic, partially due to varied and numerous work environment and systemic factors.
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Affiliation(s)
- Dean Akinleye
- Bureau of Clinical Research and Evaluation, Office of Quality and Patient Safety, New York State Department of Health, Empire State Plaza, Corning Tower, Room 1955, Albany, NY, 12237, USA.
| | - Meng Wu
- Bureau of Clinical Research and Evaluation, Office of Quality and Patient Safety, New York State Department of Health, Empire State Plaza, Corning Tower, Room 1955, Albany, NY, 12237, USA
| | - Linda S Efferen
- Office of Quality and Patient Safety, New York State Department of Health, ESP Corning Tower, Room 2019, Albany, NY, 12237, USA
| | - Susan McCauley
- Office of Quality and Patient Safety, New York State Department of Health, ESP Corning Tower, Room 2019, Albany, NY, 12237, USA
| | - Amanda Allen
- Communications, New York Chapter of the American College of Physicians, PO Box 38237, Albany, NY, 12203, USA
| | - Heather Bennett
- Diversity Equity and Inclusion Task Force, New York Chapter of the American College of Physicians, PO Box 38237, Albany, NY, 12203, USA
| | - Louis S Snitkoff
- Albany Medical College, New York Chapter of the American College of Physicians, PO Box 38237, Albany, NY, 12203, USA
| | - Lynn M Cleary
- Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Kate Bliss
- Office of Health Insurance Programs, New York State Department of Health, ESP Corning Tower, Room, Albany, NY, 12237, USA
| | - Robert Martiniano
- Center for Health Workforce Studies, University at Albany School of Public Health, 1 University Plaza, Pl #220, Rensselaer, NY, 12144, USA
| | - Shen Wang
- Center for Health Workforce Studies, University at Albany School of Public Health, 1 University Plaza, Pl #220, Rensselaer, NY, 12144, USA
| | - Louise-Ann McNutt
- Institute for Health and the Environment, University at Albany, State University of New York, 5 University Place, Room A217, Rensselaer, NY, 12144, USA
| | - Alda Osinaga
- Office of Quality and Patient Safety, New York State Department of Health, ESP Corning Tower, Room 2019, Albany, NY, 12237, USA
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11
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Burt L, Clark L, Park C. Stronger together: learner reactions on a team-based, interprofessional first death simulation experience. J Interprof Care 2024; 38:95-103. [PMID: 37422861 DOI: 10.1080/13561820.2023.2232408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
Patient death is a common experience that may be traumatic for health care providers. Although current rates of burnout are high, evidence supports that interprofessional coping can improve clinician mental health. While health care simulation affords learners freedom of safety to participate in a variety of educational experiences, current application of simulation during patient death is limited to professional duties, without explicitly addressing learner emotional well-being. We designed a patient death simulation scenario within a supportive and reflective interprofessional environment to teach foundational coping and well-being strategies to preclinical nursing, medical, and pharmacy students. Sixty-one students participated in this team-based, First Death simulation experience. Debriefings were analyzed using qualitative inductive content analysis methodology. Students reacted to being part of an interprofessional team after having participated in simulation about the death of a patient as described by five categories: emotional awareness, communication insight, feeling stronger together, with role curiosity, and through reflections on support. Findings suggested that simulation is an effective teaching modality for mentoring interprofessional students on humanistic well-being strategies. Furthermore, the experience fostered reactions transcending interprofessional competencies, which are transferrable to future clinical practice.
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Affiliation(s)
- Leah Burt
- College of Nursing Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lou Clark
- M Simulation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christine Park
- College of Medicine, Simulation and Integrative Learning (SAIL) Institute, University of Illinois, Chicago, Illinois, USA
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12
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Ewens M, Carroll C, Guenther E. Motivations and barriers to exercise among clinicians. PSYCHOL HEALTH MED 2024; 29:277-285. [PMID: 36576254 DOI: 10.1080/13548506.2022.2162938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
According to Kirk & Rhodes (2011), Nooijen et al. (2018), and Saridi et al. (2019), the motivators and barriers to exercise are influenced by one's occupation, especially among those in the healthcare field. We sought to examine the barriers and motivators to physical activity that are distinctive to clinicians. Community hospital clinicians were surveyed regarding motivators and barriers to exercise that they experience, their burnout levels as described by an adaptation of the Mini-Z single item burnout scale, and average weekly exercise habits. The top barriers and motivators were then correlated to burnout levels, levels of physical activity, and demographics. We received 64 total responses from clinicians. The overall average level of burnout was 2.37 and the median level was 2. Approximately 38% of clinicians reported adhering to American Heart Association (AHA) guidelines of 150 minutes of exercise per week, while 33% of clinicians exercise <75 minutes per week. The top general motivator was for one's own well-being and the top clinician-related motivator was reducing stress. The top two barriers to exercise were COVID-19 concerns at an indoor exercise facility and a lack of time. Higher average levels of burnout were experienced by those who marked being too stressed or too burnt out as barriers to exercise. Because of clinicians' roles in propagating healthy practices in their patients from their own habits, wellness programs should be aimed at capitalizing motivators to combat barriers that this group distinctively experiences. Efforts to improve physical and mental wellness among clinicians will translate into better provider and patient health outcomes.
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Affiliation(s)
- M Ewens
- COMP-NW, Western University of Health Sciences, Lebanon, OR, USA
| | - C Carroll
- Woodland Clinic Medical Group, CommonSpirit Health, Woodland, CA, USA
| | - E Guenther
- COMP-NW, Western University of Health Sciences, Lebanon, OR, USA
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13
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Riley TD, Parascando JA, VanDyke E, Stuckey HL, Dong H, Pasha-Razzak O, Kass LE, McCall-Hosenfeld J, Bronson SK. How Does a Junior Faculty Development Program Affect Burnout? A Mixed Methods Assessment. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205231223294. [PMID: 38322705 PMCID: PMC10846043 DOI: 10.1177/23821205231223294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/07/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVES Burnout is common among junior faculty. Professional development has been proposed as a method to improve engagement and reduce burnout among academic physicians. The Penn State College of Medicine Junior Faculty Development Program (JFDP) is a well-established, interdisciplinary program. However, an increase in burnout was noted among participants during the program. The authors sought to quantify the change in burnout seen among JFDP participants across 3 cohorts, and to explore sources of well-being and burnout among participants. METHODS Through a sequential explanatory mixed methods approach, participants in the 2018/19, 2019/20, and 2020/21 cohorts took a survey assessing burnout (Copenhagen Burnout Inventory), quality of life (QoL), job satisfaction, and work-home conflict at the start and end of the course. Descriptive statistics were generated as well as Pearson χ2 test/Fisher exact test for categorical variables and Wilcoxon rank sum tests for continuous variables for group comparisons. To better understand the outcome, past participants were invited to interviews regarding their experience of burnout during the course. Inductive thematic analysis (kappa = 0.86) was used to derive themes. RESULTS Start- and end-of-course surveys were completed by 84 and 75 participants, respectively (response rates: 95.5% and 85.2%). Burnout associated with patient/learner/client/colleague increased (P = .005) and QoL decreased (P = .02) at the end compared with the start. Nonsignificant trends toward worsening in other burnout categories, work-home conflict, and job satisfaction were also observed. Nineteen interviews yielded themes related to risks and protective factors for burnout including competing demands, benefits of networking, professional growth, and challenges related to diverse faculty roles. CONCLUSION Junior Faculty Development Program participants demonstrated worsening of burnout and QoL during the program while benefiting from opportunities including skill building and networking. The impact of Junior Faculty Development Programs on the well-being of participants should be considered as an element of their design, evaluation, and refinement over time.
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Affiliation(s)
- Timothy D Riley
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jessica A Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Erika VanDyke
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Heather L Stuckey
- Division of General Internal Medicine, Department of Medicine, Humanities and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Huamei Dong
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Lawrence E Kass
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Emergency Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer McCall-Hosenfeld
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Sarah K Bronson
- Department of Cellular and Molecular Physiology, Penn State College of Medicine, Hershey, PA, USA
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Boitet LM, Meese KA, Hays MM, Gorman CA, Sweeney KL, Rogers DA. Burnout, Moral Distress, and Compassion Fatigue as Correlates of Posttraumatic Stress Symptoms in Clinical and Nonclinical Healthcare Workers. J Healthc Manag 2023; 68:427-451. [PMID: 37944174 DOI: 10.1097/jhm-d-23-00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
GOAL Research has highlighted psychological distress resulting from the COVID-19 pandemic on healthcare workers (HCWs), including the development of posttraumatic stress symptoms (PTSS). However, the degree to which these conditions have endured beyond the pandemic and the extent to which they affect the entire healthcare team, including both clinical and nonclinical workers, remain unknown. This study aims to identify correlates of PTSS in the entire healthcare workforce with the goal of providing evidence to support the development of trauma-informed leadership strategies. METHODS Data were collected from June to July 2022 using a cross-sectional anonymous survey in a large academic medical center setting. A total of 6,466 clinical and nonclinical employees completed the survey (27.3% response rate). Cases with at least one missing variable were omitted, for a total sample size of 4,806, the evaluation of which enabled us to understand individual, organizational, and work-related and nonwork-related stressors associated with PTSS. Data were analyzed using ordinal logistic regression and dominance analyses to identify predictors of PTSS specific to clinical and nonclinical workers. PRINCIPAL FINDINGS While previous studies have shown that HCWs in different job roles experience unique stressors, our data indicate that the top correlates of PTSS among both clinical and nonclinical HCWs are the same: burnout, moral distress, and compassion fatigue. These three factors alone explained 45% and 44.4% of the variance in PTSS in clinical and nonclinical workers, respectively. PTSS was also associated with a lower sense of recognition and feeling mistreated by other employees at work in the clinical workforce. Concerningly, women and sexual minorities in the clinical sample exhibited a higher incidence of PTSS. In nonclinical workers, social isolation or loneliness and lower trust and confidence in senior leadership were associated with PTSS. Nonwork-related factors, such as exhaustion from caregiving responsibilities and financial strain, were also significantly associated with PTSS. Even after controlling for discrimination at and outside of work in both samples, we found that non-White populations were more likely to experience PTSS, highlighting a deeply concerning issue in the healthcare workforce. PRACTICAL APPLICATIONS The primary objective of this article is to help healthcare leaders understand the correlates of PTSS across the entire healthcare team as organizations recover from the COVID-19 pandemic. Understanding which factors are associated with PTSS will help healthcare leaders develop best practices that aim to reduce HCW distress and strategies to circumvent trauma derived from future crises. Our data indicate that leaders must address the correlates of PTSS in the workforce, focusing attention on both those who work on the frontlines and those who work behind the scenes. We urge leaders to adopt a trauma-informed leadership approach to ensure that the entire healthcare workforce is recognized, supported, and cared for as each HCW plays a unique role in the care of patients.
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Affiliation(s)
| | - Katherine A Meese
- Department of Health Services Administration, University of Alabama at Birmingham (UAB) and UAB Medicine Office of Wellness, Birmingham, Alabama
| | | | - C Allen Gorman
- Department of Management, Information Systems & Quantitative Methods, UAB
| | | | - David A Rogers
- UAB Medicine Office of Wellness and Department of Surgery, UAB
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15
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Tavella G, Hadzi-Pavlovic D, Bayes A, Jebejian A, Manicavasagar V, Walker P, Parker G. Burnout and depression: Points of convergence and divergence. J Affect Disord 2023; 339:561-570. [PMID: 37479038 DOI: 10.1016/j.jad.2023.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Debate is ongoing as to whether burnout can be differentiated from depression. This study evaluated whether burnout and depression could be distinguished using a new burnout measure and other variables. METHODS Scores on the Sydney Burnout Measure (SBM) were compared between participants with self-diagnosed burnout (BO-all group; n = 622) and clinically-diagnosed depression (DEP-all group; n = 90). The latter group was split into melancholic (DEP-mel; n = 56) and non-melancholic (DEP-nonmel; n = 34) depression subgroups for subsequent analyses. Differences in reporting of depressive symptoms and causal attributions were also evaluated. RESULTS While total SBM scores showed poor differentiation, the BO-all group had lower social withdrawal and higher empathy loss subscale scores than the depression groups. Odds ratios were significant for several of the depressive symptoms and causal attribution items when comparing the BO-all group to the DEP-all and DEP-mel groups, while only a few items were significant when comparing the BO-all and DEP-nonmel groups. LIMITATIONS Participants in the depression group were assigned by clinician-based depression diagnoses, rather than by a standardised diagnostic interview, and the group had a relatively small sample size. Participants in the burnout group were self-diagnosed and not assessed for comorbid psychiatric diagnoses. CONCLUSIONS There were some nuanced symptoms differences between burnout and depression, but many of the SBM symptoms were not specific to burnout. Results also suggested that burnout overlaps more with non-melancholic than melancholic depression, and that differentiation of burnout and depression may rely more on weighting causal factors over symptoms.
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Affiliation(s)
- Gabriela Tavella
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Australia
| | - Dusan Hadzi-Pavlovic
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Australia
| | - Adam Bayes
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Australia; Black Dog Institute, Hospital Rd, Randwick, New South Wales, Australia
| | - Artin Jebejian
- Gordon Private Hospital, Sydney, New South Wales, Australia
| | - Vijaya Manicavasagar
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Australia; Black Dog Institute, Hospital Rd, Randwick, New South Wales, Australia
| | - Peter Walker
- Lumiere Clinical Psychology, Sydney, New South Wales, Australia
| | - Gordon Parker
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Australia; Gordon Private Hospital, Sydney, New South Wales, Australia.
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16
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Sullivan EE, Khazen M, Arabadjis SD, Mirica M, Ramos JM, Olson APJ, Linzer M, Schiff GD. Exploring relationships between physician stress, burnout, and diagnostic elements in clinician notes. Diagnosis (Berl) 2023; 10:309-312. [PMID: 36877149 DOI: 10.1515/dx-2022-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/13/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To understand the relationship between stressful work environments and patient care by assessing work conditions, burnout, and elements of the diagnostic process. METHODS Notes and transcripts of audiotaped encounters were assessed for verbal and written documentation related to psychosocial data, differential diagnosis, acknowledgement of uncertainty, and other diagnosis-relevant contextual elements using 5-point Likert scales in seven primary care physicians (PCPs) and 28 patients in urgent care settings. Encounter time spent vs time needed (time pressure) was collected from time stamps and clinician surveys. Study physicians completed surveys on stress, burnout, and work conditions using the Mini-Z survey. RESULTS Physicians with high stress or burnout were less likely to record psychosocial information in transcripts and notes (psychosocial information noted in 0% of encounters in 4 high stress/burned-out physicians), whereas low stress physicians (n=3) recorded psychosocial information consistently in 67% of encounters. Burned-out physicians discussed a differential diagnosis in only 31% of encounters (low counts concentrated in two physicians) vs. in 73% of non-burned-out doctors' encounters. Burned-out and non-burned-out doctors spent comparable amounts of time with patients (about 25 min). CONCLUSIONS Key diagnostic elements were seen less often in encounter transcripts and notes in burned-out urgent care physicians.
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Affiliation(s)
- Erin E Sullivan
- Sawyer School of Business, Suffolk University, Boston, MA, USA
- Harvard Medical School, Center for Primary Care, Harvard University, Boston, MA, USA
| | - Maram Khazen
- Harvard Medical School, Center for Primary Care, Harvard University, Boston, MA, USA
- Center for Patient Safety Research and Practice, Brigham and Women's Hospital, Boston, MA, USA
- School of Public Health, Haifa University, Haifa, Israel
| | | | - Maria Mirica
- Center for Patient Safety Research and Practice, Brigham and Women's Hospital, Boston, MA, USA
| | - Jason M Ramos
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Mark Linzer
- University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Medicine and Institute for Professional Worklife, Hennepin Healthcare System, Minneapolis, MN, USA
| | - Gordon D Schiff
- Harvard Medical School, Center for Primary Care, Harvard University, Boston, MA, USA
- Center for Patient Safety Research and Practice, Brigham and Women's Hospital, Boston, MA, USA
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17
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Steffey MA, Griffon DJ, Risselada M, Scharf VF, Buote NJ, Zamprogno H, Winter AL. Veterinarian burnout demographics and organizational impacts: a narrative review. Front Vet Sci 2023; 10:1184526. [PMID: 37470072 PMCID: PMC10352684 DOI: 10.3389/fvets.2023.1184526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.
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Affiliation(s)
- Michele A. Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Dominique J. Griffon
- Western University of Health Sciences, College of Veterinary Medicine, Pomona, CA, United States
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West-Lafayette, IN, United States
| | - Valery F. Scharf
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
| | - Nicole J. Buote
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
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Breton M, Gaboury I, Martin E, Green ME, Kiran T, Laberge M, Kaczorowski J, Ivers N, Deville-Stoetzel N, Bordeleau F, Beaulieu C, Descoteaux S. Impact of externally facilitated continuous quality improvement cohorts on Advanced Access to support primary healthcare teams: protocol for a quasi-randomized cluster trial. BMC PRIMARY CARE 2023; 24:97. [PMID: 37038126 PMCID: PMC10088119 DOI: 10.1186/s12875-023-02048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Improving access to primary health care is among top priorities for many countries. Advanced Access (AA) is one of the most recommended models to improve timely access to care. Over the past 15 years, the AA model has been implemented in Canada, but the implementation of AA varies substantially among providers and clinics. Continuous quality improvement (CQI) approaches can be used to promote organizational change like AA implementation. While CQI fosters the adoption of evidence-based practices, knowledge gaps remain, about the mechanisms by which QI happens and the sustainability of the results. The general aim of the study is to analyse the implementation and effects of CQI cohorts on AA for primary care clinics. Specific objectives are: 1) Analyse the process of implementing CQI cohorts to support PHC clinics in their improvement of AA. 2) Document and compare structural organisational changes and processes of care with respect to AA within study groups (intervention and control). 3) Assess the effectiveness of CQI cohorts on AA outcomes. 4) Appreciate the sustainability of the intervention for AA processes, organisational changes and outcomes. METHODS Cluster-controlled trial allowing for a comprehensive and rigorous evaluation of the proposed intervention 48 multidisciplinary primary care clinics will be recruited to participate. 24 Clinics from the intervention regions will receive the CQI intervention for 18 months including three activities carried out iteratively until the clinic's improvement objectives are achieved: 1) reflective sessions and problem priorisation; 2) plan-do-study-act cycles; and 3) group mentoring. Clinics located in the control regions will receive an audit-feedback report on access. Complementary qualitative and quantitative data reflecting the quintuple aim will be collected over a period of 36 months. RESULTS This research will contribute to filling the gap in the generalizability of CQI interventions and accelerate the spread of effective AA improvement strategies while strengthening local QI culture within clinics. This research will have a direct impact on patients' experiences of care. CONCLUSION This mixed-method approach offers a unique opportunity to contribute to the scientific literature on large-scale CQI cohorts to improve AA in primary care teams and to better understand the processes of CQI. TRIAL REGISTRATION Clinical Trials: NCT05715151.
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Affiliation(s)
- Mylaine Breton
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada.
| | - Isabelle Gaboury
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Elisabeth Martin
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | | | - Tara Kiran
- University of Toronto, Toronto, ON, Canada
| | | | | | - Noah Ivers
- University of Toronto, Toronto, ON, Canada
| | - Nadia Deville-Stoetzel
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Francois Bordeleau
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Christine Beaulieu
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Sarah Descoteaux
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
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Asfaw ZK, Schupper AJ, Durbin J, Kellner C, Shrivastava R. Black clouds in surgery: A study of surgical resident workload and burnout. Surgeon 2023; 21:71-77. [PMID: 36858912 DOI: 10.1016/j.surge.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/16/2022] [Accepted: 01/23/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND The concept of a 'black cloud' is a common unfounded perception in the healthcare workforce that attributes a heavier workload to specific individuals or teams. Prior studies in non-surgical disciplines have demonstrated that 'black cloud' perceptions are not associated with workload, albeit such perceptions may influence behavior. The influence of 'black cloud' perceptions on surgical resident workload and burnout remains to be investigated. This study assesses the associations between 'black cloud' self-perception with actual workload and burnout among surgical residents in different specialties. METHODS A cross-sectional survey study of postgraduate year (PGY) 2 and 3 residents enrolled in different surgical residencies at the Icahn School of Medicine at Mount Sinai was conducted between September-November 2021. RESULTS The survey response rate was 62.1% (41/66). 46.3% of respondents were female. The majority of subjects were single (61%) and PGY2 trainees (56.1%). In a multivariate regression analysis demographic factors and workload variables, such as the number of pages responded, notes, and amount of sleep, were not significant predictors of a 'black cloud'-self-perception. A significantly lower Burnout Index Score (BIS) was observed among females (p< .001). A significantly higher BIS was observed among residents who are single (p = .003), training in general surgery (p = .02), and orthopedic surgery (p = .03). There was no significant association between 'black cloud' self-perception and BIS. DISCUSSION The findings demonstrate that a 'black cloud' self-perception is not associated with a high workload and burnout among surgical residents. Gender, marriage/domestic partnership, and certain surgical specialties influenced burnout among the study cohort.
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Affiliation(s)
- Zerubabbel K Asfaw
- Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Durbin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raj Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Kase J, Doolittle B. Job and life satisfaction among emergency physicians: A qualitative study. PLoS One 2023; 18:e0279425. [PMID: 36827313 PMCID: PMC9955602 DOI: 10.1371/journal.pone.0279425] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 12/07/2022] [Indexed: 02/25/2023] Open
Abstract
The prevalence of burnout among emergency physicians is among the highest of any specialty. Multiple studies have described factors that contribute to physician burnout, such as age, institutional support, and the electronic medical record (EMR). However, there have been few studies that investigate those physicians who are satisfied with their career and their personal lives. This qualitative study evaluated emergency physicians who were satisfied with both their career and personal lives to propose a model for physician well-being. Physicians were recruited using email solicitation and referral by their peers from June-September 2020. Inclusion criteria involved those physicians who were satisfied with their life and their job and did not meet the criteria for burnout. A qualitative, non-structured interview with open-ended questions was performed with each participant. Emergent themes were identified using standard practice for qualitative studies. Twenty-three physicians participated with a mean age of 45.4 years old (range 32-65), 17 (73.9%) were men, 13 (56.5%) were Caucasian, 6 (26.0%) were Asian/South Asian, 1 (4.3%) were Latino, and 3 (13.0%) were another ethnicity. Several important themes emerged. Physicians satisfied with their lives and their jobs tended to be personally resilient, socially connected, with significant outside interests. These physicians self-identified their personality type as having both introverted and extroverted features. Threats to thriving included ineffective leadership and the EMR. This project proposes a model for job and life satisfaction among emergency physicians. Encouraging these qualities, while fostering supportive leadership, and optimizing the EMR, may improve satisfaction among physicians experiencing burnout.
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Affiliation(s)
- Jesse Kase
- Yale Program for Medicine, Spirituality and Religion, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Benjamin Doolittle
- Internal Medicine & Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
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Lu MA, O'Toole J, Shneyderman M, Brockman S, Cumpsty-Fowler C, Dang D, Herzke C, Rand CS, Sateia HF, Van Dyke E, Eakin MN, Daugherty Biddison EL. "Where You Feel Like a Family Instead of Co-workers": a Mixed Methods Study on Care Teams and Burnout. J Gen Intern Med 2023; 38:341-350. [PMID: 36038756 PMCID: PMC9422940 DOI: 10.1007/s11606-022-07756-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Physicians and nurses face high levels of burnout. The role of care teams may be protective against burnout and provide a potential target for future interventions. OBJECTIVE To explore levels of burnout among physicians and nurses and differences in burnout between physicians and nurses, to understand physician and nurse perspectives of their healthcare teams, and to explore the association of the role of care teams and burnout. DESIGN A mixed methods study in two school of medicine affiliated teaching hospitals in an urban medical center in Baltimore, Maryland. PARTICIPANTS Participants included 724 physicians and 971 nurses providing direct clinical care to patients. MAIN MEASURES AND APPROACH Measures included survey participant characteristics, a single-item burnout measure, and survey questions on care teams and provision of clinical care. Thematic analysis was used to analyze qualitative survey responses from physicians and nurses. KEY RESULTS Forty-three percent of physicians and nurses screened positive for burnout. Physicians reported more isolation at work than nurses (p<0.001), and nurses reported their care teams worked efficiently together more than physicians did (p<0.001). Team efficiency was associated with decreased likelihood of burnout (p<0.01), and isolation at work was associated with increased likelihood of burnout (p<0.001). Free-text responses revealed themes related to care teams, including emphasis on team functioning, team membership, and care coordination and follow-up. Respondents provided recommendations about optimizing care teams including creating consistent care teams, expanding interdisciplinary team members, and increasing clinical support staffing. CONCLUSIONS More team efficiency and less isolation at work were associated with decreased likelihood of burnout. Free-text responses emphasized viewpoints on care teams, suggesting that better understanding care teams may provide insight into physician and nurse burnout.
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Affiliation(s)
- Monica A Lu
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jacqueline O'Toole
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | - Matthew Shneyderman
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | | | - Carolyn Cumpsty-Fowler
- Johns Hopkins Health System, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Carrie Herzke
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | - Cynthia S Rand
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | - Heather F Sateia
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | | | - Michelle N Eakin
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | - E Lee Daugherty Biddison
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA.
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Moving Away from Chaos: Intentional and Adaptive Management of the Non-visit Care River. J Gen Intern Med 2023; 38:784-788. [PMID: 36443630 PMCID: PMC9707193 DOI: 10.1007/s11606-022-07959-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
In modern primary care practice, clinicians face increasing volumes of asynchronous, electronic, non-visit care (NVC). Systems for completing this work, however, remain under-developed and often lack definition around patient and practice expectations for work completion and team member contributions. The resulting reactive, unstructured, and unscheduled NVC workflows cause and exacerbate physicians' cognitive overload, distraction, and dissatisfaction. Herein, we propose that primary care practices take an intentional, holistic approach to managing systems of NVC and offer a conceptual model for managing NVC work, analogizing the flow of these tasks to the flow of water through a river system: (1) by carefully controlling the inputs into the NVC system (the tributaries entering the river system); (2) by carefully defining the workflows, roles and responsibilities for completion of common tasks (the direction of river flow); (3) by improving the interface of the electronic health record (obstacles encountered in the river); and (4) by optimizing effectiveness of primary care teams (the contours of the river determining rate of flow). This framework for managing NVC, viewed from a broader system perspective, has the potential to improve productivity, quality of care, and clinician work experience.
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23
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Chen F, Isaak R, Afroze F, Mulaikal TA, Licatino LK, Ladlie B, Jain A, Willie C, Bairde E, Hayes BH, Carter T, Zisblatt L, Diachun C, Martin TW, Marshall JM, Huffmyer J, Hindle AK, Stahl DL, Liu Y, Martinelli SM. A Multi-Site Survey Study on the Association Between the COVID-19 Pandemic and United States Anesthesiology Residents' Mental Health. Cureus 2023; 15:e34782. [PMID: 36915835 PMCID: PMC10005895 DOI: 10.7759/cureus.34782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND At the onset of the coronavirus disease 2019 (COVID-19) pandemic, anesthesiology residency programs were impacted differently due to various factors such as the local severity of COVID-19, exposure to patient suffering, and inability to complete rotations. We sought to investigate the impact of local-level pandemic severity on the well-being of anesthesiology residents. METHODS This multi-site study surveyed postgraduate year two residents from 15 United States (US) anesthesiology programs using the Perceived Stress Scale, Mini-Z, Patient Health Questionnaire-9,WHO-5 Well-Being Index,and the Multidimensional Scale of Perceived Social Support before the pandemic (baseline survey) and during the first COVID-19 surge (post survey). RESULTS A total of 144 (65%) residents responded to the initial baseline survey; 73 (33%) responded to the post survey, and 49 (22%) completed both surveys. There was not a statistically significant difference in any well-being outcomes of participants between the surveys, nor was there a significant difference based on the severity of COVID-19 impact at the program's hospital. Male participants had higher perceived stress scores (β = 4.05, 95%CI: 0.42, 7.67, P = 0.03) and lower social support from family (β = -6.57, 95%CI: -11.64, -1.51, P = 0.01) at the post survey compared to female participants after controlling for baseline scores. Additionally, married participants or those with domestic partners reported higher perceived social support in the post survey (β = 5.79, 95%CI: -0.65, 12.23, P = 0.03). CONCLUSION The local COVID-19 severity at a residency program did not disproportionately impact well-being scores among anesthesiology residents. Those most vulnerable to diminished well-being appeared to be male and single participants. As a result, targeted well-being interventions, including those aiming to increase social support, to higher-risk resident groups may be indicated. Future work is needed to assess the longstanding COVID-19 pandemic impacts on resident well-being.
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Affiliation(s)
- Fei Chen
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Robert Isaak
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Farzana Afroze
- Department of Anesthesiology, Albany Medical Center, Albany, USA
| | - Teresa A Mulaikal
- Department of Anesthesiology, Columbia University, New York City, USA
| | - Lauren K Licatino
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, USA
| | - Beth Ladlie
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA
| | - Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, USA
| | - Chelsea Willie
- Department of Anesthesiology and Pediatrics, Medical College of Wisconsin, Milwaukee, USA
| | - Emily Bairde
- Department of Anesthesiology, Oregon Health & Science University, Portland, USA
| | - Blair H Hayes
- Department of Anesthesiology, The Ohio State University, Columbus, USA
| | - Tekuila Carter
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Lara Zisblatt
- Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - Carol Diachun
- Department of Anesthesiology, University of Florida College of Medicine, Jacksonville, USA
| | - Timothy W Martin
- Department of Anesthesiology, University of Florida, Gainesville, USA
| | - Julie M Marshall
- Department of Anesthesiology, University of Missouri, Columbia, USA
| | - Julie Huffmyer
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, USA
| | - Anna K Hindle
- Department of Anesthesiology, The George Washington University, Washington, D.C., USA
| | - David L Stahl
- Department of Anesthesiology, The Ohio State University, Columbus, USA
| | - Yutong Liu
- Department of Biostatistics, University of North Carolina, Chapel Hill, USA
| | - Susan M Martinelli
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel HIll, USA
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Abstract
OBJECTIVE There is currently little consensus as to how burnout is best defined and measured, and whether the syndrome should be afforded clinical status. The latter issue would be advanced by determining whether burnout is a singular dimensional construct varying only by severity (and with some level of severity perhaps indicating clinical status), or whether a categorical model is superior, presumably reflecting differing 'sub-clinical' versus 'clinical' or 'burning out' vs 'burnt out' sub-groups. This study sought to determine whether self-diagnosed burnout was best modelled dimensionally or categorically. METHODS We recently developed a new measure of burnout which includes symptoms of exhaustion, cognitive impairment, social withdrawal, insularity, and other psychological symptoms. Mixture modelling was utilised to determine if scores from 622 participants on the measure were best modelled dimensionally or categorically. RESULTS A categorical model was supported, with the suggestion of a sub-syndromal class and, after excluding such putative members of that class, two other classes. Analyses indicated that the latter bimodal pattern was not likely related to current working status or differences in depression symptomatology between participants, but reflected subsets of participants with and without a previous diagnosis of a mental health condition. CONCLUSION Findings indicated that sub-categories of self-identified burnout experienced by the lay population may exist. A previous diagnosis of a mental illness from a mental health professional, and therefore potentially a psychological vulnerability factor, was the most likely determinant of the bimodal data, a finding which has theoretical implications relating to how best to model burnout.
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25
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Godby Vail S, Dierst-Davies R, Kogut D, Degiorgi Winslow L, Kolb D, Weckenman A, Almeida S, King HB, Chessen E, Strickland M, Logan E, Gliner M, Koeppl P, Marshall-Aiyelawo K. Teamwork Is Associated with Reduced Hospital Staff Burnout at Military Treatment Facilities: Findings from the 2019 Department of Defense Patient Safety Culture Survey. Jt Comm J Qual Patient Saf 2023; 49:79-88. [PMID: 36543658 DOI: 10.1016/j.jcjq.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND A National Academy of Medicine report emphasizes the importance of creating positive work environments to address the negative effects of burnout on health care workers. The purpose of this investigation was to determine the scope of burnout among military hospital personnel and explore the relationship between teamwork, burnout, and patient safety culture. METHODS A logistic regression analysis investigated the relationship between teamwork and burnout using the 2019 US Department of Defense Patient Safety Culture Survey data from 15,838 military hospital workers. Additional regressions investigated teamwork/burnout relationships among individual work areas and staff positions. RESULTS About one third of respondents (34.4%) reported experiencing burnout. Work areas most likely to report burnout included many different/other work areas (43.4%), pharmacy (41.8%), and labor and delivery/obstetrics (41.8%). Staff positions most likely to report burnout included pharmacy/pharmacists (39.7%), assistants/technicians/therapists (38.1%), and nurses/nursing (37.6%). Analysis revealed an association between lower burnout and high teamwork, both within (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.48-0.60) and across (OR 0.64, 95% CI 0.57-0.72) units. Within-unit teamwork was associated with reduced odds of burnout across almost all work areas and staff positions, with the greatest odds reduction among personnel working in emergency (OR 0.25, 95% CI 0.14-0.43), radiology (OR 0.41, 95% CI 0.20-0.83), and labor and delivery/obstetrics (OR 0.42, 95% CI 0.27-0.65); and physicians/medical staff (OR = 0.44, 95% CI: 0.28-0.69), other staff positions (OR 0.48, 95% CI 0.28-0.81), and assistants/technicians/therapists (OR 0.58, 95% CI 0.46-0.73). CONCLUSION Effective teamwork may reduce burnout in hospital workers. This association between teamwork (particularly teamwork within units) and burnout was found in all work areas, even in those with the highest levels of self-reported workplace chaos. Greater adoption of workplace interventions focused on improving teamwork, such as TeamSTEPPS, is warranted.
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Alobayli F, O’Connor S, Holloway A, Cresswell K. Electronic Health Record Stress and Burnout Among Clinicians in Hospital Settings: A Systematic Review. Digit Health 2023; 9:20552076231220241. [PMID: 38130797 PMCID: PMC10734365 DOI: 10.1177/20552076231220241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Background There is growing evidence to suggest that EHRs may be associated with clinician stress and burnout, which could hamper their effective use and introduce risks to patient safety. Objective This systematic review aimed to examine the association between EHR use and clinicians' stress and burnout in hospital settings, and to identify the contributing factors influencing this relationship. Methods The search included peer-reviewed published studies between 2000 and 2023 in English in CINAHL, Ovid Medline, Embase, and PsychINFO. Studies that provided specific data regarding clinicians' stress and/or burnout related to EHRs in hospitals were included. A quality assessment of included studies was conducted. Results Twenty-nine studies were included (25 cross-sectional surveys, one qualitative study, and three mixed methods), which focused on physicians (n = 18), nurses (n = 10) and mixed professions (n = 3). Usability issues and the amount of time spent on the EHR were the most significant predictors, but intensity of the working environment influenced high EHR-related workload and thereby also contributed to stress and burnout. The differences in clinicians' specialties influenced the levels of stress and burnout related to EHRs. Conclusions This systematic review showed that EHR use was a perceived contributor to clinicians' stress and burnout in hospitals, primarily driven by poor usability and excessive time spent on EHRs. Addressing these issues requires tailored EHR systems, rigorous usability testing, support for the needs of different specialities, qualitative research on EHR stressors, and expanded research in Non-Western contexts.
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Affiliation(s)
- Fatimah Alobayli
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Siobhan O’Connor
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Aisha Holloway
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Kathrin Cresswell
- College of Medicine and Veterinary Medicine, Usher Institute, The University of Edinburgh, Edinburgh, UK
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Lopez K, Li H, Paek H, Williams B, Nath B, Melnick ER, Loza AJ. Predicting physician departure with machine learning on EHR use patterns: A longitudinal cohort from a large multi-specialty ambulatory practice. PLoS One 2023; 18:e0280251. [PMID: 36724149 PMCID: PMC9891518 DOI: 10.1371/journal.pone.0280251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/22/2022] [Indexed: 02/02/2023] Open
Abstract
Physician turnover places a heavy burden on the healthcare industry, patients, physicians, and their families. Having a mechanism in place to identify physicians at risk for departure could help target appropriate interventions that prevent departure. We have collected physician characteristics, electronic health record (EHR) use patterns, and clinical productivity data from a large ambulatory based practice of non-teaching physicians to build a predictive model. We use several techniques to identify possible intervenable variables. Specifically, we used gradient boosted trees to predict the probability of a physician departing within an interval of 6 months. Several variables significantly contributed to predicting physician departure including tenure (time since hiring date), panel complexity, physician demand, physician age, inbox, and documentation time. These variables were identified by training, validating, and testing the model followed by computing SHAP (SHapley Additive exPlanation) values to investigate which variables influence the model's prediction the most. We found these top variables to have large interactions with other variables indicating their importance. Since these variables may be predictive of physician departure, they could prove useful to identify at risk physicians such who would benefit from targeted interventions.
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Affiliation(s)
- Kevin Lopez
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Huan Li
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Computational Biology and Bioinformatics, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Hyung Paek
- Information Technology Services, Yale New Haven Health, Stratford, Connecticut, United States of America
- Northeast Medical Group, Yale New Haven Health, New London, Connecticut, United States of America
| | - Brian Williams
- Northeast Medical Group, Yale New Haven Health, New London, Connecticut, United States of America
| | - Bidisha Nath
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Edward R. Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
| | - Andrew J. Loza
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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The effect of remote scribes on primary care physicians’ wellness, EHR satisfaction, and EHR use. Healthcare (Basel) 2022; 10:100663. [DOI: 10.1016/j.hjdsi.2022.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
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Trombello JM, David NS, Robbins MA, Ruchinskas RA. Burnout During the COVID-19 Pandemic: Descriptive and Predictive Data from a Survey of Psychologists at a Single Academic Medical Center. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:718-722. [PMID: 34845707 PMCID: PMC8628836 DOI: 10.1007/s40596-021-01562-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Burnout in academic medicine has been widely studied, but most work has been conducted among physicians. Psychologists in academic medicine have unique burnout factors. Therefore, investigating the prevalence and predictors of burnout among psychologists in academic medicine during the COVID-19 pandemic represents an important addition to the literature. METHODS Sixty-two psychologists responded to burnout-related items in a larger, 40-item Psychiatry Department climate survey conducted from October to November 2020. Five items from the MINI-Z survey were administered to examine control over workload and sufficiency of documentation time as predictors of both continuous and dichotomously defined burnout. Linear and logistic regression was employed with years as a faculty member entered as a covariate. RESULTS Slightly less than half (48.4%) of respondents met dichotomous criteria for burnout. Faculty with fewer years of experience scored higher on their level of continuous burnout. Both control over workload and sufficiency of time for documentation were independent predictors of continuous burnout, but only control over workload remained a statistically significant predictor in a simultaneous model. Control over workload was a significant predictor in dichotomous models but did not remain so once sufficiency of documentation time was also added. CONCLUSION Burnout prevalence among psychologists was comparable to rates among physicians at other institutions, even when examined during the COVID-19 pandemic. Academic medicine administrators and organizational leaders should consider policies and programming to increase control over workload, especially among junior psychologist faculty.
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Affiliation(s)
| | - Natalia S David
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mona A Robbins
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kavanaugh J, Hardison ME, Rogers HH, White C, Gross J. Assessing the Impact of a Shinrin-Yoku (Forest Bathing) Intervention on Physician/Healthcare Professional Burnout: A Randomized, Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14505. [PMID: 36361384 PMCID: PMC9658142 DOI: 10.3390/ijerph192114505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Professional healthcare worker burnout is a crisis in the United States healthcare system. This crisis can be viewed at any level, from the national to local communities, but ultimately, must be understood at the level of the individual who is caring for patients. Thus, interventions to reduce burnout symptoms must prioritize the mental health of these individuals by alleviating some of the symptoms of depression, grief, and anxiety that accompany burnout. The practice of Shinrin-Yoku (Forest Bathing) is a specific evidence-based practice which research has shown can improve an individual's mental health and, when performed in a group, can support a sense of social connection. We investigated the impact of a three-hour, guided Shinrin-Yoku (Forest Bathing) nature-based intervention on burnout symptoms among physicians and other healthcare workers by using a randomized, controlled trial. The Oldenburg Burnout Inventory (OLBI) and Mini-Z assessments were used to collect baseline burnout scores and participants were randomized into the intervention group, which completed the assessment again after the Shinrin-Yoku walk, or into a control group, which completed the assessments again after a day off from any clinical duties. A total of 34 participants were enrolled in the intervention group and a total of 22 participants were enrolled in the control group. Ultimately, no statistically significant differences were detected between the pre-test and post-test scores for the intervention group or between the post-test scores of the intervention group compared to the control group. However, the subjective responses collected from participants after participating in the Shinrin-Yoku walk overwhelmingly reported decreased feelings of stress and increased mental wellbeing. This raises important questions about the difference between symptoms of burnout and other aspects of mental health, as well as the limitations of a one-time nature-based intervention on levels of chronic burnout symptoms. Thus, further research on the effects of engaging healthcare providers in an ongoing practice of Shinrin-Yoku is warranted.
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Affiliation(s)
- John Kavanaugh
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Hospital, University of New Mexico School of Medicine, Albuquerque, NM 87106, USA
| | - Mark E. Hardison
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM 87131, USA
| | - Heidi Honegger Rogers
- College of Nursing, University of New Mexico College of Nursing, Albuquerque, NM 87131, USA
| | - Crystal White
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM 87131, USA
| | - Jessica Gross
- Clinical and Translational Science Center, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
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31
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Shaikh CF, Palmer Kelly E, Paro A, Cloyd J, Ejaz A, Beal EW, Pawlik TM. Burnout Assessment Among Surgeons and Surgical Trainees During the COVID-19 Pandemic: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2022; 79:1206-1220. [PMID: 35659443 PMCID: PMC9091165 DOI: 10.1016/j.jsurg.2022.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/22/2022] [Accepted: 04/30/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND The objective of the current study was to summarize current research on burnout among surgical trainees and surgeons during the COVID-19 pandemic. METHODS PubMed, SCOPUS, Embase, and Psych INFO were systematically searched for studies that evaluated burnout during the COVID-19 pandemic among surgical trainees and surgeons. RESULTS A total of 29 articles met inclusion criteria, most of which originated from the United States (n = 18, 62.1%). Rates of burnout ranged from 6.0% to 86.0%. Personal factors responsible for burnout were fear of contracting/transmitting COVID-19 (8 studies, 27.6%), female gender (8, 27.6%), and younger age (5, 17.2%). Professional factors contributing to burnout included increased COVID-19 patient clinical load (6, 20.7%), limited work experience (6, 20.7%), reduction in operative cases (5, 17.2%) and redeployment to COVID-19 wards (4, 13.8%). The COVID-19 pandemic negatively impacted surgical education due to reduced number of operative cases (11, 37.9%), decreased hands-on experience (4, 13.8%), and not being able to complete case requirements (3, 10.34%). The shift of didactics to virtual formats (3, 10.3%), increased use of telemedicine (2, 6.9%), and improved camaraderie among residents (1, 3.4%) were viewed as positive consequences. CONCLUSION COVID-19 related burnout was reported in as many as 1 in 2 surgical trainees and attending surgeons. Intrinsic- (i.e., gender, age), family- (i.e., family/being married/having children or being single/not having children), as well as work-related extrinsic- (i.e., work-force deployment, risk of infection/spread, changes in educational format) factors were strongly associated with risk of burnout. These factors should be considered when designing interventions to ameliorate burnout among surgical trainees and surgeons.
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Affiliation(s)
- Chanza Fahim Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Elizabeth Palmer Kelly
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Alessandro Paro
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Eliza W Beal
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio.
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32
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Li C, Parpia C, Sriharan A, Keefe DT. Electronic medical record-related burnout in healthcare providers: a scoping review of outcomes and interventions. BMJ Open 2022; 12:e060865. [PMID: 35985785 PMCID: PMC9396159 DOI: 10.1136/bmjopen-2022-060865] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Healthcare provider (HCP) burnout is on the rise with electronic medical record (EMR) use being cited as a factor, particularly with the rise of the COVID-19 pandemic. Burnout in HCPs is associated with negative patient outcomes, and, therefore, it is crucial to understand and address each factor that affects HCP burnout. This study aims to (a) assess the relationship between EMR use and burnout and (b) explore interventions to reduce EMR-related burnout. METHODS We searched MEDLINE (Ovid), CINAHL and SCOPUS on 29 July 2021. We selected all studies in English from any publication year and country that discussed burnout in HCPs (physicians, nurse practitioners and registered nurses) related to EMR use. Studies must have reported a quantitative relationship to be included. Studies that implemented an intervention to address this burnout were also included. All titles and abstracts were screened by two reviewers, and all full-text articles were reviewed by two reviewers. Any conflicts were addressed with a third reviewer and resolved through discussion. Quality of evidence of all included articles was assessed using the Quality Rating Scheme for Studies and Other Evidence. FINDINGS The search identified 563 citations with 416 citations remaining after duplicate removal. A review of abstracts led to 59 studies available for full-text assessment, resulting in 25 studies included in the scoping review. Commonly identified associations between EMR-related burnout in HCPs included: message and alert load, time spent on EMRs, organisational support, EMR functionality and usability and general use of EMRs. Two articles employed team-based interventions to improve burnout symptoms without significant improvement in burnout scores. CONCLUSIONS AND RELEVANCE Current literature supports an association between EMR use and provider burnout. Very limited evidence exists for burnout-reducing interventions that address factors such as time spent on EMRs, organisational support or EMR design.
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Affiliation(s)
- Calandra Li
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Parpia
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abi Sriharan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Krembil Centre for Healthcare Management and Leadership, Schulich School of Business, Toronto, ON, Canada
| | - Daniel T Keefe
- University of Toronto, Toronto, Ontario, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
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Shreffler J, Shreffler M, Thomas A, Huecker M. Wise Exertion: Associating Stoic Thought with Stress, Well-Being, and Life Satisfaction in Physicians. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221120785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recognition of how physicians contemplate and approach their activities, positive or negative, may shed light into a more holistic depiction of physician well-being. The purpose of this work was to develop items to measure wise cognitive exertion, constructed with Stoic thought, and determine its association with physician stress, well-being, and life satisfaction. A survey was sent to physicians and university staff members. This pilot investigation found a relationship among focusing on a purposeful life, acknowledging locus of control, avoiding wasteful cognition, and taking (good or bad) life experiences for personal growth and superior life satisfaction, well-being and lower stress. A 13-Item Wise Exertion Scale was developed and had significant associations with stress, well-being, and life satisfaction. Each of the four factors from the 13-Item Wise Exertion Scale were significantly associated with each measure with the exception of Control Consciousness and life satisfaction. Within physicians (N = 59), the 13-Item Wise Exertion Scale was a significant predictor, after adjusting for demographics with stress, well-being, and life satisfaction. Physicians had significantly lower 13-Item Wise Exertion Scale scores compared to non-physicians (N = 126). Future inquiries are required to determine if physicians with a mindset assembled with these beliefs have superior well-being.
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Affiliation(s)
- Jacob Shreffler
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (JS, AT, MH); and Department of Health and Sports Sciences, University of Louisville, Louisville, KY, USA (MS)
| | - Megan Shreffler
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (JS, AT, MH); and Department of Health and Sports Sciences, University of Louisville, Louisville, KY, USA (MS)
| | - Alyssa Thomas
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (JS, AT, MH); and Department of Health and Sports Sciences, University of Louisville, Louisville, KY, USA (MS)
| | - Martin Huecker
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (JS, AT, MH); and Department of Health and Sports Sciences, University of Louisville, Louisville, KY, USA (MS)
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Linzer M, McLoughlin C, Poplau S, Goelz E, Brown R, Sinsky C. The Mini Z Worklife and Burnout Reduction Instrument: Psychometrics and Clinical Implications. J Gen Intern Med 2022; 37:2876-2878. [PMID: 35048290 PMCID: PMC9411313 DOI: 10.1007/s11606-021-07278-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/10/2021] [Indexed: 01/07/2023]
Affiliation(s)
- Mark Linzer
- Department of Medicine and Institute for Professional Worklife, Hennepin Healthcare System, 701 Park Avenue (G5), Minneapolis, MN, 55415, USA.
| | | | - Sara Poplau
- Department of Medicine and Institute for Professional Worklife, Hennepin Healthcare System, 701 Park Avenue (G5), Minneapolis, MN, 55415, USA
| | - Elizabeth Goelz
- Department of Medicine and Institute for Professional Worklife, Hennepin Healthcare System, 701 Park Avenue (G5), Minneapolis, MN, 55415, USA
| | - Roger Brown
- University of Wisconsin School of Nursing, Madison, WI, USA
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Yassin A, Al-Mistarehi AH, Qarqash AA, Soudah O, Karasneh RA, Al-Azzam S, Khasawneh AG, El-Salem K, Kheirallah KA, Khassawneh BY. Trends in Insomnia, Burnout, and Functional Impairment among Health Care Providers over the First Year of the COVID-19 Pandemic. Clin Pract Epidemiol Ment Health 2022; 18:e174501792206200. [PMID: 37274859 PMCID: PMC10156054 DOI: 10.2174/17450179-v18-e2206200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/14/2022] [Accepted: 05/26/2022] [Indexed: 06/07/2023]
Abstract
Background COVID-19 pandemic has negatively impacted the psychological well-being and quality of life of health care providers (HCPs). Objectives This study assessed the trends in prevalence and predictors of insomnia, burnout, and functional impairment among HCPs over the first year of the pandemic. Methods An online survey was conducted one month after the pandemic's onset (onset group) and a year later (one-year group). The demographic features of participants were collected. Insomnia, burnout, and functional impairment were assessed using Insomnia Severity Index (ISI), Mini-Z survey, and Sheehan Disability Scale (SDS), respectively. Results The onset group included 211 HCPs (mean (SD) age 34.7 (9.3) years and 73% men), while 212 HCPs participated in the one-year survey (mean (SD) age 35.9 (10.5) years and 69% men). High prevalence estimates were found in both onset and one-year groups of symptoms of insomnia (52% vs. 49%), of diagnosis of clinical insomnia (15% vs. 18%), with a high mean ISI score (8.4 vs. 8.7), but with no significant difference between the onset and one-year groups. Risk factors for clinical insomnia included age in both groups, lower income and contact level with COVID-19 patients/samples in the onset group, and lower Mini-Z scores and higher SDS scores in the one-year group. Approximately one-third of respondents reported at least one or more burnout symptoms, with a higher percentage in the one-year group (35.4%) than in the onset group (24.2%) (p=0.012). Younger age, lower monthly income, and higher ISI and SDS scores were risk factors for burnout in both groups. Greater perceived changes in social life were associated with burnout in the onset group. In contrast, higher weekly working hours, worse participants' evaluation of their institution's preparation, and more changes in workload were risk factors for burnout in the one-year group. The SDS score and its subscales scores were higher in the one-year group than in the onset group. Changes in workload and social life predicted higher SDS scores among both groups. Living with older people predicted higher SDS scores among the onset group, while contact level and estimated number of COVID-19 patients that participants engaged in during caring predicted higher SDS scores among the one-year group. ISI scores were significantly correlated with the Mini-Z scores and SDS scores in both groups, while the Mini-Z and SDS scores were significantly correlated only in the one-year group. Conclusion This study demonstrated high rates of insomnia, burnout, and functional impairment among HCPs during the pandemic. It reveals a significant rise in job burnout and functional impairment of HCPs overtime during the pandemic. Furthermore, high-risk subgroups are also highlighted for whom comprehensive psychosocial and occupational interventions might be warranted.
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Affiliation(s)
- Ahmed Yassin
- Department of Neurology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Aref A. Qarqash
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ola Soudah
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Reema A. Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Sayer Al-Azzam
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Aws G. Khasawneh
- Department of Psychiatry, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid El-Salem
- Department of Neurology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid A. Kheirallah
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Basheer Y. Khassawneh
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Kamali M, Azizi M, Moosazadeh M, Mehravaran H, Ghasemian R, Reskati MH, Elyasi F. Occupational burnout in Iranian health care workers during the COVID-19 pandemic. BMC Psychiatry 2022; 22:365. [PMID: 35643438 PMCID: PMC9143709 DOI: 10.1186/s12888-022-04014-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIM Health care workers (HCWs), mostly frontliners, are encountering numerous physical and psychosocial stressors, and even managing some conflicts over the course of the novel coronavirus disease 2019 (COVID-19). In this respect, the present study was to investigate the prevalence rate of occupational burnout (OB) in such workers during this pandemic. MATERIALS AND METHODS This cross-sectional study was conducted between April 6 and May 30, 2020, via an online survey in 31 provinces of Iran, on HCWs selected based on convenience sampling method. For data collection, a socio-demographic information form and the Maslach Burnout Inventory (MBI) was utilized. Descriptive statistics, Chi-square test, and multivariate regression analysis were also applied to test the research hypotheses. RESULTS In total, 7626 HCWs participated in the present study. Accordingly, 73.2 and 26.8% of the workers were female and male, respectively. As well, 57.8% of the respondents were nurses and 14.4% of the cases were clinicians. Moreover, 44.8% of the participants had thus far worked in isolation wards and 40.3% of these individuals reported working for 4-8 hours with COVID-19 patients. The prevalence rate of OB was 18.3%. Besides, 34.2, 48.7, and 56.1% of the respondents had severe levels of emotional exhaustion (EE), higher depersonalization (DP), and decreased sense of personal accomplishment (PA), respectively. Besides, the HCWs at the age range of 20 to 30, having female gender, no children, and a bachelor's degree, and working in isolation wards showed the higher levels of OB with reference to the Chi-square test results (p < 0.001). Accordingly, the statistical test outcomes demonstrated that a history of physical illnesses (p = 0.001) and psychiatric disorders (p = 0.044) could be the best predictor of OB throughout the first peak of the COVID-19 pandemic. CONCLUSION Regarding the high prevalence rate of OB among the HCWs and the remaining COVID-19 journey in Iran, health care managers are recommended to orient the required management and coping strategies toward improving mental health in these individuals.
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Affiliation(s)
- Mahsa Kamali
- grid.411623.30000 0001 2227 0923Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Marzieh Azizi
- grid.411705.60000 0001 0166 0922Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Tehran university of Medical Sciences, Tehran, Iran ,grid.411623.30000 0001 2227 0923Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- grid.411623.30000 0001 2227 0923Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Mehravaran
- grid.411623.30000 0001 2227 0923Department of Internal Medicine, Pulmonary and Critical Care Division, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Ghasemian
- grid.411623.30000 0001 2227 0923Antimicrobial Resistance Research Center, Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Hasannezhad Reskati
- grid.411623.30000 0001 2227 0923Educational Psychology, Research Ethics Committee, Imam khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Sexual and Reproductive Health Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran. .,Department of Psychiatry, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. .,Psychosomatic Ward, Imam Khomeini General Hospital, Razi Ave, Sari, Mazandaran, Iran.
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Symptoms of Burnout Syndrome among Physicians during the Outbreak of COVID-19 Pandemic—A Systematic Literature Review. Healthcare (Basel) 2022; 10:healthcare10060979. [PMID: 35742031 PMCID: PMC9223230 DOI: 10.3390/healthcare10060979] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Studies in the recent decades show that the medical profession has a high risk to develop burnout due to constant exposure to mental and physical suffering or death. The pandemic period induced additional stress for healthcare professionals due to the likelihood of a high rate of infection, long working shifts, using protective equipment, staying away from family, implementing new medical procedures. The present study is focusing on assessing the prevalence of burnout among physicians working in the healthcare system during the COVID-19 pandemic, and discovering the main factors associated with burnout syndrome among the population of physicians. Material and methods: A systematic review was conducted by searching PubMed, Wiley, and Google Scholar in November 2021. A total of 35 studies were eligible for the evaluation. Results: The samples ranged from 39 to 3071 physicians, and the overall burnout ranged from 14.7% to 90.4%. Sociodemographic characteristics associated with a high prevalence of burnout were the female gender, less experienced, not having children, and single marital status, associated with high levels of anxiety, depression, and stress in the female gender. The highest level of burnout among all the studies was 90.4% on a sample of physicians from the Republic of Korea, 80.2% among psychiatrists in Saudi Arabia, followed by a study in Ireland with a 77% level of burnout among senior and specialist physicians, and 74.7% prevalence of burnout for emergency physicians in USA. Conclusions: During the pandemic, the factors that contribute to burnout are the lack of personal protective equipment and the violence of issues related to organizational health; the high prevalence of burnout symptoms is associated with anxiety, depression, and stress.
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Lawlor SK, Low CM, Carlson ML, Rajasekaran K, Choby G. Burnout and well‐being in otolaryngology trainees: A systematic review. World J Otorhinolaryngol Head Neck Surg 2022; 8:118-125. [PMID: 35782400 PMCID: PMC9242424 DOI: 10.1002/wjo2.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To comprehensively review the recent published literature to characterize current trends of burnout and well‐being among otolaryngology trainees. Methods Study design: systematic review and meta‐analysis. A comprehensive literature review from 2000 to 2021 of studies related to otolaryngology resident burnout and well‐being, as well as the general topic of well‐being among surgical residents was completed. All included studies were summarized qualitatively. For the quantitative analysis, only articles reporting a Maslach burnout inventory (MBI), modified MBI or Mini‐Z‐ Burnout assessment were included. Results Twenty‐five articles were included in the qualitative summary and nine articles in the quantitative analysis. In the qualitative summary, trainees were reported to have increased levels of distress and emotional hardening compared to attending otolaryngologists. Total hours worked per week and female gender were associated with worsened well‐being. Residency program strategies to improve trainee well‐being include program‐sponsored wellness activities, dedicated wellness champions, and assistance with clerical burden. Implementation of protected nonclinical time has been shown to decrease burnout and increase well‐being among trainees. Moreover, formal trainee mentorship programs have also been shown to reduce trainee burnout and stress. In the quantitative analysis, rates of trainee burnout ranged from 29.7% to 86% with an overall trend towards reduced rates of burnout from 2006 to 2021. Utilizing a weighted average, the overall burnout among otolaryngology residents was 58.6%. Conclusions Rates of burnout remain high among otolaryngology trainees. Implementing formal mentorship programs and providing protected time during regular work hours appear to be effective tools to improve resident well‐being. Question: What is the current state of the literature in regard to otolaryngology trainee well‐being and burnout? Findings: In this systematic review of 34 articles, otolaryngology trainees were reported to have increased levels of distress and emotional hardening compared to attending otolaryngologists. Total hours worked per week and female gender were associated with worsened well‐being. Utilizing a weighted average, the overall burnout rate among otolaryngology residents was 58.6%. Implementation of protected nonclinical time has been shown to decrease burnout and increase well‐being among trainees. Meaning: Rates of burnout among otolaryngology trainees remains high but have improved over time. Formal mentorship programs and introduction of protected non‐clinical time may help to improve well‐being.
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Affiliation(s)
- Skye K. Lawlor
- Department of Otolaryngology‐Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
| | - Christopher M. Low
- Department of Otolaryngology‐Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
| | - Matthew L. Carlson
- Department of Otolaryngology‐Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
- Department of Neurologic Surgery Mayo Clinic Rochester Minnesota USA
| | - Karthik Rajasekaran
- Department of Otolaryngology‐Head and Neck Surgery University of Pennsylvania Pennsylvania USA
| | - Garret Choby
- Department of Otolaryngology‐Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
- Department of Neurologic Surgery Mayo Clinic Rochester Minnesota USA
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Fong A, Iscoe M, Sinsky CA, Haimovich A, Williams B, O'Connell RT, Goldstein R, Melnick E. Exploration of Primary Care Physician Phenotypes for Electronic Health Record Use. JMIR Med Inform 2022; 10:e34954. [PMID: 35275070 PMCID: PMC9055474 DOI: 10.2196/34954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/03/2022] [Accepted: 03/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background Electronic health records (EHRs) have become ubiquitous in US office-based physician practices. However, the different ways in which users engage with EHRs remain poorly characterized. Objective The aim of this study is to explore EHR use phenotypes among ambulatory care physicians. Methods In this retrospective cohort analysis, we applied affinity propagation, an unsupervised clustering machine learning technique, to identify EHR user types among primary care physicians. Results We identified 4 distinct phenotype clusters generalized across internal medicine, family medicine, and pediatrics specialties. Total EHR use varied for physicians in 2 clusters with above-average ratios of work outside of scheduled hours. This finding suggested that one cluster of physicians may have worked outside of scheduled hours out of necessity, whereas the other preferred ad hoc work hours. The two remaining clusters represented physicians with below-average EHR time and physicians who spend the largest proportion of their EHR time on documentation. Conclusions These findings demonstrate the utility of cluster analysis for exploring EHR use phenotypes and may offer opportunities for interventions to improve interface design to better support users’ needs.
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Affiliation(s)
- Allan Fong
- MedStar Health, 3007 Tilden St NW, Washington, US
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Carlson KJ, Matthias TH, Birge JR, Bulian BP, Richards SE, Shiffermiller JF. The effect of geographic rounding on hospitalist work experience: A mixed-methods study. Hosp Pract (1995) 2022; 50:124-131. [PMID: 35253585 DOI: 10.1080/21548331.2022.2050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe the structure and implementation of a model in which hospitalists focus on a particular hospital unit or area, referred to as "geographic rounding," and to analyze its effect on hospitalist efficiency, interruptions, after-hours work, and satisfaction. METHODS The leadership of our academic hospital medicine group designed a geographic rounding intervention with the goal of improving provider satisfaction and mitigating burnout. Our quantitative analysis compared the pre-intervention and post-intervention time periods with regard to progress note completion time, after-hours progress note completion, secure messaging communication volume, and Mini-Z survey results. A post-intervention qualitative analysis was performed to further explore the relationship between geographic rounding and the drivers of burnout. RESULTS Following the intervention, 97% of geographic rounders were localized to one or two geographic areas and 77% were localized to a single geographic area. Following the implementation of geographic rounding, progress notes were completed an average of 29 minutes earlier (p<0.001). The proportion of progress notes completed after-hours decreased from 25.1% to 20% (p<0.001). The volume of secure messages received by hospitalists decreased from 1.95 to 1.8 per patient per day (p<0.001). The proportion of hospitalists reporting no burnout increased from 77.8% to 93% after implementing geographic rounding, a change that did not reach statistical significance (p=0.1). Qualitative analysis revealed mixed effects on work environment but improvements in efficiency, patient-centeredness, communication with nurses, and job satisfaction. CONCLUSION Geographic rounding represents an organization-level change that has the potential to improve hospitalist career satisfaction.
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Affiliation(s)
- Kristy J Carlson
- Univeristy of Nebraska Medical Center, Department of Otolaryngology Head and Neck Surgery, 981225 Nebraska Medical Center, Omaha, NE 68198-1225
| | - Tabatha H Matthias
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Justin R Birge
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Brady P Bulian
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Sarah E Richards
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Jason F Shiffermiller
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
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Kulhawy-Wibe SC, Widdifield J, Lee JJY, Thorne JC, Yacyshyn EA, Batthish M, Jerome D, Shupak R, Jilkine K, Purvis J, Shamis J, Roberts J, Kur J, Burt JE, Johnson NA, Barnabe C, Spencer N, Harrison M, Pope J, Barber CE. Results from the 2020 Canadian Rheumatology Association's Workforce and Wellness Survey. J Rheumatol 2022; 49:635-643. [DOI: 10.3899/jrheum.210990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/22/2022]
Abstract
Objective The Canadian Rheumatology Association (CRA) launched the Workforce and Wellness Survey to update the Canadian rheumatology workforce characteristics. Methods The survey included demographic and practice information, pandemic impacts, and the Mini-Z questionnaire to assess burnout. French and English survey versions were distributed to CRA members electronically between 10/14/2020-3/5/2021. The number of full-time equivalent (FTE) rheumatologists per 75,000 population was estimated from the median proportion of time in clinical practice multiplied by provincial rheumatologist numbers from the Canadian Medical Association (CMA). Results Forty-four percent (183/417) of the estimated practicing rheumatologists (149 adult; 34 pediatric) completed the survey. The median age was 47 years, 62% were female, and 28% planned to retire within the next 5-10 years. Respondents spent a median of 65% of their time in clinical practice. FTE rheumatologists per 75,000 ranged between 0 and 0.70 in each province/territory and 0.62 per 75,000 nationally. This represents a deficit of 1 to 78 FTE rheumatologists per province/territory and 194 FTE rheumatologists nationally to meet the CRA's workforce benchmark. Approximately half of survey respondents reported burnout (51%). Women were more likely to report burnout (OR 2.86, 95%CI: 1.42-5.93). Older age was protective against burnout (OR 0.95, 95%CI: 0.92, 0.99). As a result of the pandemic, 97% of rheumatologists reported spending more time engaged in virtual care. Conclusion There is a shortage of rheumatologists in Canada. This shortage may be compounded by the threat of burnout to workforce retention and productivity. Strategies to address these workforce issues are urgently needed.
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English EF, Holmstrom H, Kwan BW, Suresh K, Rotholz S, Lin CT, Sieja A. Virtual Sprint Outpatient Electronic Health Record Training and Optimization Effect on Provider Burnout. Appl Clin Inform 2022; 13:10-18. [PMID: 34986492 PMCID: PMC8731238 DOI: 10.1055/s-0041-1740482] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES This study aimed to develop a virtual electronic health record (EHR) training and optimization program and evaluate the impact of the virtual model on provider and staff burnout and electronic health record (EHR) experience. METHODS UCHealth created and supported a multidisciplinary EHR optimization and training program, known as the Epic Sprint Program. The Sprint Team conducted dozens of onsite Sprint events over the course of several years prior to the pandemic but transitioned to a fully virtual program and successfully "sprinted" 21 outpatient clinics from May to December 2020. Core program components of group and 1:1 training, workflow analysis, and new or adjusted EHR build were unchanged from the onsite model. Pre- and post-Sprint surveys provided detailed, objective data about EHR usability, EHR proficiency, job satisfaction, and burnout. RESULTS The EHR Net Promoter Score (NPS), a likelihood to recommend metric, increased by 39 points (-3 pre and 36 post; p < 0.001) for providers and 29 points (8 pre and 37 post; p = 0.001) for staff post-Sprint. Positive provider (NPS = +53) and staff (NPS = +47) NPS scores indicated a high likelihood to recommend the Sprint Program. Post-Sprint surveys also reflect an increase in providers (10%; p = 0.04) and staff (9%; 0.13) who indicated "no burnout" or "did not feel burned out." DISCUSSION The UCHealth Sprint Team transitioned this comprehensive, enterprise level initiative from an onsite model to a fully virtual EHR training and optimization program during the first few months of the novel coronavirus disease (COVID-19) pandemic. Despite this change in program delivery, survey data clearly demonstrated improved EHR satisfaction, a high likelihood to recommend a sprint to a friend or colleague, and a trend toward burnout reduction in providers and staff. CONCLUSION Changing an existing on-site EHR optimization program to a purely virtual format can be successful, and this study showed improved provider and staff EHR satisfaction with reduced burnout.
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Affiliation(s)
- Eden F. English
- University of Colorado Anschutz School of Medicine, Aurora, Colorado, United States,Address for correspondence Eden F. English, MD University of Colorado School of Medicine, General Internal MedicineCU Anschutz, Academic Office One, 12631 East 17th Avenue, Aurora, CO 80045United States
| | - Heather Holmstrom
- University of Colorado Anschutz School of Medicine, Aurora, Colorado, United States
| | - Bethany W. Kwan
- University of Colorado Anschutz School of Medicine, Aurora, Colorado, United States
| | - Krithika Suresh
- University of Colorado Anschutz School of Medicine, Aurora, Colorado, United States
| | - Stephen Rotholz
- University of Colorado Anschutz School of Medicine, Aurora, Colorado, United States
| | - Chen-Tan Lin
- University of Colorado Anschutz School of Medicine, Aurora, Colorado, United States
| | - Amber Sieja
- University of Colorado Anschutz School of Medicine, Aurora, Colorado, United States
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Mendelsohn D. Self in medicine: Determinants of physician well-being and future directions in improving wellness. MEDICAL EDUCATION 2022; 56:48-55. [PMID: 34559421 DOI: 10.1111/medu.14671] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Medicine, a profession dedicated to the wellness of patients, is struggling with a crisis of physician and trainee wellness. Physicians and trainees are burning out at alarming rates. Historically, medicine has been characterised by challenging working conditions and inattention to physician wellness and self-care. Healthy physicians are better at promoting wellness to their patients, and physicians who are suffering from burnout can deliver compromised patient care. DISCUSSION In recent years, research has increasingly focused on the causes of unwellness among doctors, and a broad range of health determinants have been identified. Studies of interventions for improving trainee and physician wellness have identified individual-focused and organisational approaches that can address the root causes of burnout. Insights from the corporate workplace may help guide interventions. Strategies for addressing physician burnout and improving wellness will involve innovative and multifaceted approaches. Despite a growing emphasis of physician wellness in the literature, implementation of wellness interventions is lagging, and quality improvement methods can address these challenges. CONCLUSION Physician wellness is a shared responsibility among doctors, health care organisations and governing bodies. Addressing burnout and improving physician wellness will require transformational change and the embracement of a culture of wellness in medicine. Quality improvement methods are the next step in identifying effective wellness interventions and the targeted groups of physicians and trainees who will most benefit.
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Affiliation(s)
- Daniel Mendelsohn
- Lions Gate Hospital, Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
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Sampei M, Okubo R, Sado M, Piedvache A, Mizoue T, Yamaguchi K, Morisaki N. Emotional Exhaustion of Burnout Among Medical Staff and Its Association With Mindfulness and Social Support: A Single Center Study During the COVID-19 Pandemic in Japan. Front Psychiatry 2022; 13:774919. [PMID: 35370822 PMCID: PMC8965002 DOI: 10.3389/fpsyt.2022.774919] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although higher rates of burnout have been reported during the COVID-19 pandemic, the contribution of the modifiable factors is lesser-known. We investigated how the risk of emotional exhaustion was associated with mindfulness skills and social support in a single medical center in Japan. METHODS We conducted a cross-sectional web survey on mental health for all staff of a national medical hospital from February to March 2021. We examined the association between self-rated emotional exhaustion and levels of mindfulness and social support using multivariate logistic regression. RESULTS Of the 830 participants, signs of emotional exhaustion were observed in 261 (31%) individuals. Among those highly exposed to the virus at work, individuals with low levels of mindfulness and social support had significantly higher odds of emotional exhaustion [OR 3.46 (95% CI; 1.48-8.09), OR; 3.08 (95% CI; 1.33-7.13), respectively] compared to those with high levels. However, among those not highly exposed to the virus, individuals with both low and moderate levels of mindfulness had significantly higher odds of emotional exhaustion. [OR 3.33 (95% CI; 2.22-5.00), OR; 2.61 (95% CI; 1.73-3.94), respectively]. CONCLUSION We found that factors associated with emotional exhaustion differed by exposure to SARS-CoV-2. Building mindfulness skills can help reduce the high burden placed on the staff. Additionally, increasing social support may be useful especially for workers highly exposed to SARS-CoV-2.
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Affiliation(s)
- Makiko Sampei
- Department of Health Science, Health Promotion, Nippon Sport Science University, Tokyo, Japan.,Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Ryo Okubo
- Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Aurelie Piedvache
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koushi Yamaguchi
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
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de Hoop T, Neumuth T. Evaluating Electronic Health Record Limitations and Time Expenditure in a German Medical Center. Appl Clin Inform 2021; 12:1082-1090. [PMID: 34937102 PMCID: PMC8695058 DOI: 10.1055/s-0041-1739519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This study set out to obtain a general profile of physician time expenditure and electronic health record (EHR) limitations in a large university medical center in Germany. We also aim to illustrate the merit of a tool allowing for easier capture and prioritization of specific clinical needs at the point of care for which the current study will inform development in subsequent work. METHODS Nineteen physicians across six different departments participated in this study. Direct clinical observations were conducted with 13 out of 19 physicians for a total of 2,205 minutes, and semistructured interviews were conducted with all participants. During observations, time was measured for larger activity categories (searching information, reading information, documenting information, patient interaction, calling, and others). Semistructured interviews focused on perceived limitations, frustrations, and desired improvements regarding the EHR environment. RESULTS Of the observed time, 37.1% was spent interacting with the health records (9.0% searching, 7.7% reading, and 20.5% writing), 28.0% was spent interacting with patients corrected for EHR use (26.9% of time in a patient's presence), 6.8% was spent calling, and 28.1% was spent on other activities. Major themes of discontent were a spread of patient information, high and often repeated documentation burden, poor integration of (new) information into workflow, limits in information exchange, and the impact of such problems on patient interaction. Physicians stated limited means to address such issues at the point of care. CONCLUSION In the study hospital, over one-third of physicians' time was spent interacting with the EHR, environment, with many aspects of used systems far from optimal and no convenient way for physicians to address issues as they occur at the point of care. A tool facilitating easier identification and registration of issues, as they occur, may aid in generating a more complete overview of limitations in the EHR environment.
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Affiliation(s)
- Tom de Hoop
- Innovation Center Computer Assisted Surgery, Institute at the Faculty of Medicine, Leipzig University, Leipzig, Germany,Address for correspondence Tom de Hoop, MD University of Leipzig, Innovation Center Computer Assisted Surgery (ICCAS)Semmelweisstraße 14, 04103 LeipzigGermany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery, Institute at the Faculty of Medicine, Leipzig University, Leipzig, Germany
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Nguyen OT, Turner K, Apathy NC, Magoc T, Hanna K, Merlo LJ, Harle CA, Thompson LA, Berner ES, Feldman SS. Primary care physicians' electronic health record proficiency and efficiency behaviors and time interacting with electronic health records: a quantile regression analysis. J Am Med Inform Assoc 2021; 29:461-471. [PMID: 34897493 PMCID: PMC8800512 DOI: 10.1093/jamia/ocab272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/05/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aimed to understand the association between primary care physician (PCP) proficiency with the electronic health record (EHR) system and time spent interacting with the EHR. MATERIALS AND METHODS We examined the use of EHR proficiency tools among PCPs at one large academic health system using EHR-derived measures of clinician EHR proficiency and efficiency. Our main predictors were the use of EHR proficiency tools and our outcomes focused on 4 measures assessing time spent in the EHR: (1) total time spent interacting with the EHR, (2) time spent outside scheduled clinical hours, (3) time spent documenting, and (4) time spent on inbox management. We conducted multivariable quantile regression models with fixed effects for physician-level factors and time in order to identify factors that were independently associated with time spent in the EHR. RESULTS Across 441 primary care physicians, we found mixed associations between certain EHR proficiency behaviors and time spent in the EHR. Across EHR activities studied, QuickActions, SmartPhrases, and documentation length were positively associated with increased time spent in the EHR. Models also showed a greater amount of help from team members in note writing was associated with less time spent in the EHR and documenting. DISCUSSION Examining the prevalence of EHR proficiency behaviors may suggest targeted areas for initial and ongoing EHR training. Although documentation behaviors are key areas for training, team-based models for documentation and inbox management require further study. CONCLUSIONS A nuanced association exists between physician EHR proficiency and time spent in the EHR.
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Affiliation(s)
- Oliver T Nguyen
- Corresponding Author: Oliver T. Nguyen, MSHI, Department of Community Health and Family Medicine, University of Florida, College of Medicine, PO Box 100211, Gainesville, FL 32610, USA;
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA,Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
| | - Nate C Apathy
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tanja Magoc
- Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA
| | - Karim Hanna
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Lisa J Merlo
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA
| | - Christopher A Harle
- Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA,Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Eta S Berner
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sue S Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
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The impact of data-driven learning on graduate medical education. J Clin Anesth 2021; 78:110621. [PMID: 34872825 DOI: 10.1016/j.jclinane.2021.110621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/23/2022]
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Sinsky CA, Brown RL, Stillman MJ, Linzer M. COVID-Related Stress and Work Intentions in a Sample of US Health Care Workers. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1165-1173. [PMID: 34901752 PMCID: PMC8651505 DOI: 10.1016/j.mayocpiqo.2021.08.007] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE To evaluate relationships between coronavirus disease 2019 (COVID-19)-related stress and work intentions in a sample of US health care workers. PATIENTS AND METHODS Between July 1 and December 31, 2020, health care workers were surveyed for fear of viral exposure or transmission, COVID-19-related anxiety or depression, work overload, burnout, and intentions to reduce hours or leave their jobs. RESULTS Among 20,665 respondents at 124 institutions (median organizational response rate, 34%), intention to reduce hours was highest among nurses (33.7%; n=776), physicians (31.4%; n=2914), and advanced practice providers (APPs; 28.9%; n=608) while lowest among clerical staff (13.6%; n=242) and administrators (6.8%; n=50; all P<.001). Burnout (odds ratio [OR], 2.15; 95% CI, 1.93 to 2.38), fear of exposure, COVID-19-related anxiety/depression, and workload were independently related to intent to reduce work hours within 12 months (all P<.01). Intention to leave one's practice within 2 years was highest among nurses (40.0%; n=921), APPs (33.0%; n=694), other clinical staff (29.4%; n=718), and physicians (23.8%; n=2204) while lowest among administrators (12.6%; n=93; all P<.001). Burnout (OR, 2.57; 95% CI, 2.29 to 2.88), fear of exposure, COVID-19-related anxiety/depression, and workload were predictors of intent to leave. Feeling valued by one's organization was protective of reducing hours (OR, 0.65; 95% CI, 0.59 to 0.72) and intending to leave (OR, 0.40; 95% CI, 0.36 to 0.45; all P<.01). CONCLUSION Approximately 1 in 3 physicians, APPs, and nurses surveyed intend to reduce work hours. One in 5 physicians and 2 in 5 nurses intend to leave their practice altogether. Reducing burnout and improving a sense of feeling valued may allow health care organizations to better maintain their workforces postpandemic.
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Affiliation(s)
| | | | - Martin J. Stillman
- Department of Medicine, Hennepin Health System and University of Minnesota, Minneapolis
| | - Mark Linzer
- Department of Medicine, Hennepin Health System and University of Minnesota, Minneapolis
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Kaplan CA, Chan CC, Feingold JH, Kaye-Kauderer H, Pietrzak RH, Peccoralo L, Feder A, Southwick S, Charney D, Burka L, Basist M, Ripp J, Akhtar S. Psychological Consequences Among Residents and Fellows During the COVID-19 Pandemic in New York City: Implications for Targeted Interventions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1722-1731. [PMID: 34380941 PMCID: PMC8603436 DOI: 10.1097/acm.0000000000004362] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To examine the psychological impact of the COVID-19 pandemic on medical trainees (residents and fellows) working at Mount Sinai Hospital (MSH) in New York City (NYC), the initial epicenter of the United States pandemic. METHOD The authors administered a survey to 991 trainees in frontline specialties working at MSH in NYC between April and May 2020. The instrument assessed symptoms of major depressive disorder, generalized anxiety disorder, COVID-19-related posttraumatic stress disorder, and burnout. Psychiatric screens were aggregated into 1 composite measure, and meeting criteria on any of the 3 scales was considered a positive screen for psychiatric symptoms. The survey also assessed COVID-19-related exposures, worries, coping strategies, and desired interventions. Multivariable logistic regressions were conducted to identify factors associated with psychiatric symptoms and burnout. RESULTS Of the 560 respondents (56.6% response rate), 29.7% screened positive for psychiatric symptoms and 35.8% screened positive for burnout. History of a mental illness, COVID-19-related duties and personal/career worries, and coping by substance use were associated with increased likelihood of screening positive for psychiatric symptoms. Positive emotion-focused coping and feeling valued by supervisors were associated with decreased likelihood. Internal medicine and surgical specialties, a history of mental illness, increased duty hours, duty-related worries, personal/career worries, coping via self-blame and venting, and coping via substance use were associated with higher odds of burnout. Feeling valued by supervisors was associated with decreased burnout odds. The most common crisis-related needs included access to personal protective equipment, food provisions, and financial support. CONCLUSIONS Psychological distress and burnout affected approximately one-third of trainees sampled during the height of the pandemic in NYC. As the pandemic surged beyond NYC, these findings suggest that interventions should include addressing basic needs, promoting leadership affirmation, moderating duty hours, supporting trainees financially, and enhancing mental health support.
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Affiliation(s)
- Carly A. Kaplan
- C.A. Kaplan is a medical student, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chi C. Chan
- C.C. Chan is assistant professor of psychiatry, Icahn School of Medicine at Mount Sinai, New York, and research health scientist, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Jordyn H. Feingold
- J.H. Feingold is a psychiatry resident, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Halley Kaye-Kauderer
- H. Kaye-Kauderer is a psychiatry resident, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert H. Pietrzak
- R.H. Pietrzak is associate professor of psychiatry and public health, Yale School of Medicine, New Haven, Connecticut, director, translational psychiatric epidemiology laboratory, Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for PTSD, West Haven, Connecticut, and adjunct professor of psychiatry and environmental medicine and public health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lauren Peccoralo
- L. Peccoralo is associate dean for faculty well-being and resilience and associate professor of medicine, general internal medicine, and medical education, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Adriana Feder
- A. Feder is director for research, Center for Stress, Resilience, and Personal Growth, co-director, Ehrenkranz Laboratory for the Study of Human Resilience, and associate professor of psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Steven Southwick
- S. Southwick is professor emeritus of psychiatry, Yale School of Medicine, New Haven, Connecticut, and adjunct professor of psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dennis Charney
- D. Charney is Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and president for academic affairs, Mount Sinai Health System, New York, New York
| | - Larissa Burka
- L. Burka is a registered nurse, Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Madeleine Basist
- M. Basist is a third-year internal medicine resident, Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Jonathan Ripp
- J. Ripp is senior associate dean for well-being and resilience, chief wellness officer, and professor of medicine, medical education and geriatrics and palliative medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Saadia Akhtar
- S. Akhtar is associate dean for trainee well-being and resilience and associate professor of emergency medicine and medical education, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
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Gluschkoff K, Hakanen JJ, Elovainio M, Vänskä J, Heponiemi T. The relative importance of work-related psychosocial factors in physician burnout. Occup Med (Lond) 2021; 72:28-33. [PMID: 34729593 PMCID: PMC8758190 DOI: 10.1093/occmed/kqab147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Identifying the most significant risk factors for physician burnout can help to define the priority areas for burnout prevention. However, not much is known about the relative importance of these risk factors. Aims This study was aimed to examine the relative importance of multiple work-related psychosocial factors in predicting burnout dimensions among physicians. Methods In a cross-sectional sample of 2423 Finnish physicians, dominance analysis was used to estimate the proportionate contribution of psychosocial factors to emotional exhaustion, depersonalization and reduced personal accomplishment. The psychosocial factors included job demands (time pressure, patient-related stress, lack of support, stress related to information systems, work–family conflict) and job resources (job control, team climate, organizational justice). Results Together, psychosocial factors explained 50% of the variance in emotional exhaustion, 24% in depersonalization and 11% in reduced professional efficacy. Time pressure was the most important predictor of emotional exhaustion (change in total variance explained ΔR2 = 45%), and patient-related stress was the most important predictor of both depersonalization (ΔR2 = 52%) and reduced professional accomplishment (ΔR2 = 23%). Stress related to information systems was the least important predictor of the burnout dimensions (ΔR2 = 1–2%). Conclusions Psychosocial factors in physicians’ work are differently associated with the dimensions of burnout. Among the factors, the most significant correlates of burnout are job demands in the form of time pressure and patient-related stress.
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Affiliation(s)
- K Gluschkoff
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Finnish Institute of Occupational Health, Helsinki, Finland
- Correspondence to: K. Gluschkoff, Finnish Institute of Occupational Health, P.O. Box 40, FI-00032 Työterveyslaitos, Helsinki, Finland. Tel: +358 30 474 3255; e-mail:
| | - J J Hakanen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - M Elovainio
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - J Vänskä
- Finnish Medical Association, Helsinki, Finland
| | - T Heponiemi
- Finnish Institute for Health and Welfare, Helsinki, Finland
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