Burnout in Obstetricians-Gynecologists: Its Prevalence, Identification, Prevention, and Reversal

Comparison of Medicare Reimbursement for Common Urologic and Gynecologic Procedures: An Economic Analysis of Inflation-Adjusted Physician Fees Across a Ten-Year Period

OBJECTIVE

To assess physician fees for general urologic procedures compared to gynecologic over the past decade, analyzing trends in reimbursement and the impact of inflation on Medicare compensation due to the need to balance fair wages with decreased financial burden for patients.

METHODS

Utilizing CPT codes, we assessed procedures via the governmental Physician Fee Schedule Look-Up Tool for Medicare from 2015-2024. Annual physician fee reimbursements were collected as the "non-adjusted values"; each year was then adjusted to reflect yearly inflation rates and documented as "inflation adjusted values". Mann-Kendall tests were used to assess both non-adjusted and inflation adjusted trends for each procedure over time; t-tests were used to compare urologic compensation trends to gynecologic.

RESULTS

Over the decade, both urology and OBGYN reimbursements decreased significantly at an inflation-adjusted rate of-47.44% and -33.15%, respectively. Non-adjusted rates for both specialties exhibit a 2.00% increase for OBGYN and an -11.03% decrease for urology. Such trends highlight an increasing disparity across both fields, with urology facing significantly steeper declines.

DISCUSSION

These reductions leave urologists with reduced payments for the same services, diminishing physician compensation across this subspecialty. This trend impacts the financial stability of providers while affecting access to care if physicians are disincentivized to perform these procedures or accept certain insurances due to declining reimbursements. These trends are unsustainable for practice in an overburdened medical system.

Ob/Gyn physician perspectives on maintenance of certification

OBJECTIVE

To evaluate physician perspectives on the current maintenance of certification (MOC) activities utilized by the American Board of Obstetrics and Gynecology (ABOG).

STUDY DESIGN

We performed a convergent mixed methods study, using parallel quantitative and qualitative data collected via the internet plus paper surveys of a nationwide sample of Obstetrics and Gynecology physicians from November 12 to December 13, 2024. The questionnaire included 23 items about various aspects of maintenance of certification, physician burnout and demographics. Three open-ended questions regarding the pros and cons of MOC and recommendations for improvement were also included.

RESULTS

Of the 5,083 requests sent, we received 503 responses (response rate 9.9 %), 54 were excluded because they do not participate in MOC through ABOG. Of the 449 remaining respondents, a significant majority of physicians reported that MOC was valuable relative to their time spent (62.8 %) and relevant to caring for their patients (77.8 %). Most respondents felt that MOC aided their professional development (70.3 %), lifelong learning (64.3 %) and patient safety (53.3 %). Conversely, forty-six percent of respondents perceived MOC activities as a burden. Over half of physicians presently experience burnout (54.1 %) and one-third of these felt MOC was a major contributor. Extending the recertification cycle to 2-years was supported by 61.8 % of respondents and to a 3-year cycle by 46 %. The most common suggestions for improving MOC were extending the time for recertification and stopping or overhauling the Practice Improvement/Chart Review activities.

CONCLUSION

Most Ob/Gyn physicians view the current MOC process as valuable and relevant to their practice of Medicine. However, most respondents also felt the process could be improved.

Physician Personal Well-Being and Resilience: An Action Plan and Sustainable Approach

This comprehensive review addresses the critical issue of burnout among obstetricians and gynecologists (OB/GYNs), exploring strategies to enhance personal well-being and resilience. The study examines the personal and professional consequences of burnout, including its impact on patient care and health care systems. It outlines institutional responsibilities and provides practical strategies for creating supportive work environments. Additionally, the review offers guidance on developing personal wellness plans and building individual resilience. By advocating for a holistic approach that combines personal wellness practices with institutional support, the authors present a sustainable model for combating burnout and promoting career satisfaction among OB/GYNs.

Defining competence profiles in obstetrics and gynecology using the modified requirement tracking questionnaire

BACKGROUND

Data about the competencies needed for physicians in obstetrics and gynecology (O&G) is currently insufficient. The aim of this study is to define the competence profile needed in this sector for daily professional activity, in order to account for these criteria in future recruitment.

METHODS

The modified requirement-tracking questionnaire (R-track) was sent to 307 physicians working in the field of O&G with different training levels and practice locations. The R-track is designed to assess professional competence profiles and contains 66 items covering the following eight competence areas: "Mental abilities", "Social sensibility", "Psychomotor and multitasking abilities", "Solutions orientation", "Social interactive competences", "Personality traits", "Verbal competences" and "Resistance capacity". The mean scores of single items and competence areas were calculated. Results were compared between gender, training level, and place of practice.

RESULTS

The participation rate was 65.5%, with 201 physicians returning the questionnaire. In this sample, 50.2% of them were in training and 49.8% were practicing O&G specialists. The proportion of physicians working in a hospital setting was 64.7% while 30.3% worked in private practice. The competence areas "Social sensibility" and "Psychomotor & multitasking abilities" appear to be the most important for daily professional activity. At the item level, "Stress resistance", followed by "Workload management" and "Tactfulness" were considered as the most valuable characteristics. Differences between gender, level of training, and place of practice were not significant.

CONCLUSION

The identified competence profile could serve as a basis for developing a new method of O&G residency selection. In addition, such a profile could help medical students to decide on a professional specialization at a very early stage by comparing their personal competence profile with the one in the field or with their mentors.

[Development of a measuring tool for performance anxiety in obstetrics]

OBJECTIVE

Developing a measuring tool for physician's performance anxiety during obstetrical procedures, as a self-administered questionnaire.

METHODS

We used the Delphi method. First, we did a literature review to identify the items to submit for the first round. A panel of experts was asked to rate the relevance of items from one to six. For the first round of Delphi, items were retained if more than 70% of respondents assigned a five or six rating. Items were excluded if more than 70% of respondents assigned a one or two rating. All the other items, plus those suggested by the panel, were submitted to a second round of Delphi. The same item selection conditions were applied to the second round.

RESULTS

The overall response rate to the Delphi was 79% (19 respondents). At the end of the first round, 14 items were consensually relevant, no item was consensually irrelevant. For the second round, the 18 items that did not find consensus and seven new items suggested by the experts in the first round were submitted. At the end of the second round, nine items were retained by consensus as relevant.

CONCLUSION

This study defined by consensus 23 items for a self-questionnaire to measure specific performance anxiety in obstetrics divided into five dimensions: perceived stress, assessment of the risk of complications, medico-legal risk, impact of the healthcare team and peers, self-confidence and decision-making confidence. We intend to validate this tool in real population.

Associations among the workplace violence, burnout, depressive symptoms, suicidality, and turnover intention in training physicians: a network analysis of nationwide survey

Depression and anxiety are the most common mental disorders among physicians, who have a greater risk of suicide than those in other professional occupations. Relationships among a demanding workload, workplace violence, burnout, and intention to turnover have also been reported. The current study examined the principal components and propagating patterns of mental health and working environment interactions in training physicians. A total of 1981 training physicians completed online self-report questionnaires during September-October (midpoint of the training year) 2020. Regularized partial correlations in a mixed graphical model (MGM) and joint probability distributions (directed acyclic graph; DAG) were estimated for four subtypes of workplace violence (verbal abuse/physical violence perpetrated by clients/hospital staff), three burnout subdomains (Maslach Burnout Inventory), thoughts about quitting, and nine depressive symptoms, including suicidality, comprising the DSM-5 diagnostic criteria for major depressive disorder (assessed using the Patient Health Questionnaire-9). Thoughts of death/self-harm showed directional dependencies on the joint probability distributions of psychomotor agitation/retardation, concentration difficulty, self-reproach, and sadness in the DAG. In the MGM, a partial correlation with psychomotor agitation/retardation (r = 0.196) accounted for 56.5% of the variance in thoughts of death/self-harm. Partial correlations with concentration difficulties (r = 0.294), self-reproach (r = 0.257), changes in appetite (r = 0.184), and worker-on-worker physical violence (r = 0.240) in the MGM accounted for 54.4% of the variance in psychomotor agitation/retardation. Thoughts about quitting were partially correlated with and dependent upon the joint probability distributions of emotional exhaustion (r = 0.222), fatigue (r = 0.142), anhedonia (r = 0.178), and sadness (r = 0.237). In contrast, worker-on-worker (r = 0.417) and client-on-physician (r = 0.167) verbal abuse had regularized partial correlations with directional dependencies on thoughts about quitting. Organization-level interventions aiming to reduce the worker-on-worker violence and individual-level approaches of clinical screening program and psychiatric counseling clinic are required. Follow-up studies to verify the effectiveness of these interventions for training physicians are needed.

Anger: an underappreciated destructive force in healthcare

Anger is an emotional state that occurs when unexpected things happen to or around oneself and is "an emotional state that varies in intensity from mild irritation to intense fury and rage." It is defined as "a strong feeling of displeasure and usually of antagonism," an emotion characterized by tension and hostility arising from frustration, real or imagined injury by another, or perceived injustice. It can manifest itself in behaviors designed to remove the object of the anger (e.g., determined action) or behaviors designed merely to express the emotion. For the Roman philosopher Seneca anger is not an uncontrollable, impulsive, or instinctive reaction. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It seems that the year 2022 was a year when many Americans were plainly angry. "Why is everyone so angry?" the New York Times asked in the article "The Year We Lost It." We believe that Seneca is correct in that anger is unacceptable. Anger is a negative emotion that must be controlled, and Seneca provides us with the tools to avoid and destroy anger. Health care professionals will be more effective, content, and happier if they learn more about Seneca's writings about anger and implement his wisdom on anger from over 2000 years ago.

Subspecialization in Obstetrics and Gynecology: Is It Affecting the Future Availability of Women's Health Specialists?

The growth in the number of obstetrics and gynecology resident graduates pursuing fellowships has exceeded growth in the number of resident graduates, because more fellowship programs are being developed in more subspecialties rather than additional residency programs. Approximately 1 in 4 residents pursues subspecialty training, compared with 1 in 12 in 2001. The number of fellowships remains competitive, because nearly all programs fill their match and the number of applicants exceeds the number of positions. Graduating residents who serve as frontline women's health specialists need to serve as leaders of interprofessional teams to better serve their patients, especially in underserved areas.