1
|
Somville F, Van Bogaert P, Wellens B, De Cauwer H, Franck E. Work stress and burnout among emergency physicians: a systematic review of last 10 years of research. Acta Clin Belg 2024; 79:52-61. [PMID: 37889050 DOI: 10.1080/17843286.2023.2273611] [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: 04/09/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Abstract
AIM OF THE STUDY First, to provide a synthesis and analysis of available scientific literature regarding the level of work stress and burnout among emergency physicians. Second, to identify the effect of the specific work situation-related factors. METHODS A systematic search was performed in NCBI PubMed and Embase. Comparative primary studies, both systematic review and cross-sectional, quantifying burnout in emergency physicians were included. Only studies published between 2011 and 2022 were retained. Synonym sets were compiled for the search key for 'burnout & stress', 'emergency', 'physician' and 'burnout & posttraumatic stress disorder'. RESULTS Thirty-five papers were retained for further research. Emergency physicians scored significantly higher for all dimensions of burnout compared to other healthcare professions. Significant correlations for burnout were found with work characteristic and organizational factors. Critical incidents and aggression were identified as the most important acute work characteristics and organizational factors impacting emergency physician's mental wellbeing including the development of posttraumatic stress disorder. Moreover, personal factors such as age, personality, and coping strategies also play an important role in the development of burnout as well as work-related trauma. CONCLUSION Available studies show that emergency physicians report higher scores of emotional exhaustion and depersonalization when compared to other healthcare professionals. Work characteristics contribute to this, but work-related traumatic incidents and aggression are important determinants. Personal characteristics such as age, personality type D, previous experiences and coping strategies seem to be determining factors likewise. Emergency physicians showed a high risk for developing burnout and work stress-related problems.
Collapse
Affiliation(s)
- F Somville
- Department of Emergency Medicine, University of Antwerp, Edegem, Belgium
- Department of Emergency and Traumatology, AZ St Dimpna, Geel, Belgium
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Wilrijk, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - P Van Bogaert
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Wilrijk, Belgium
| | - B Wellens
- Department of Emergency and Traumatology, AZ St Dimpna, Geel, Belgium
| | - H De Cauwer
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Neurology, AZ St Dimpna, Geel, Belgium
| | - E Franck
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Wilrijk, Belgium
| |
Collapse
|
2
|
Mondal S, Oakes D, Humphrey T, Kolarczyk L, Trzcinka A. Women in Anesthesiology and the Mid-Career Stall: Why They Are Not Advancing Into Senior Leadership. Anesth Analg 2024:00000539-990000000-00716. [PMID: 38289857 DOI: 10.1213/ane.0000000000006826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Women anesthesiologists face many challenges when trying to advance their careers and find balance in personal and professional endeavors. In this article, we introduce the reader to several concepts central to understanding the challenges faced by mid-career women anesthesiologists and highlight why these challenges become particularly pronounced when women enter the mid-career stage. We describe how lack of constructive actionable feedback combined with lack of mentorship and sponsorship negatively affects women in the workplace. We also outline barriers and bias that mid-career women anesthesiologists face in high-level leadership roles along with the disproportionally high burden of nonpromotable work. We present a discussion of mistreatment and burnout, which are compounded by concurrent demands of parenthood and a professional career. We conclude with the impact that these barriers have on mid-career women anesthesiologists and recommendations for mitigating these challenges. They include a systematic increase in mentorship and sponsorship, an individualized professional development strategy, and an improved and comprehensive approach to promotion.
Collapse
Affiliation(s)
- Samhati Mondal
- From the Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Daryl Oakes
- Department of Anesthesiology, Stanford School of Medicine, Stanford, California
| | - Tara Humphrey
- Department of Anesthesiology, Keck Hospital of University of Southern California, Los Angeles, California
| | - Lavinia Kolarczyk
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Agnieszka Trzcinka
- Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
3
|
Love JS, Loo GT, Murphy L, Temple C, Spyres MB, Manini AF, O'Connor AD. A Decade in Review: Trends in Female Authorship in Peer-Reviewed Toxicology Journals. J Med Toxicol 2024; 20:22-30. [PMID: 38078994 PMCID: PMC10774494 DOI: 10.1007/s13181-023-00975-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Gender diversity in both emergency medicine and medical toxicology has grown over the last decade. However, disparities in promotion, awards, and speakership still exist. No studies have examined gender disparities in authorship in medical toxicology journals. RESEARCH QUESTIONS Does the proportion of female first authors and female senior authors in medical toxicology publications increase over time? What factors predict female authorship in the first author or last author positions in two major medical toxicology journals? METHODS We performed a retrospective review of all non-abstract publications in two medical toxicology journals, Clinical Toxicology and Journal of Medical Toxicology, between 2011 and 2020. We collected author names, number of authors, publication type, and publication year. Author names were used to identify author gender using Gender-API integrative tool. Data on the percentages of female medical toxicology fellows and medical toxicologists was provided by the American Board of Emergency Medicine (ABEM). RESULTS A total of 2212 publications were reviewed and 2171 (97.9%) were included in the dataset. Overall, 31.7% of first authors were identified as female and 67.0% were identified as male by the Gender-API tool. There were 46.8% male-male author dyads, 24.2% female-male author dyads, 12.1% male-female author dyads, and 5.7% female-female author dyads. Predictors of female first authorship included research and case report articles, and percentage of ABEM female toxicologists. Predictors of female senior authorship included number of authors and percentage of ABEM female toxicologists. The proportion of female authorship in both categories increased over the study period. CONCLUSIONS The frequency of female authorship in the first author position has grown over the last decade and is associated with increasing female representation in medical toxicology and specific manuscript subtypes, specifically research manuscripts.
Collapse
Affiliation(s)
- Jennifer S Love
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - George T Loo
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren Murphy
- Department of Emergency Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Courtney Temple
- Oregon Health & Science University, Portland, OR, USA
- Oregon & Alaska Poison Center, Portland, OR, USA
| | - Meghan B Spyres
- Department of Medical Toxicology, Banner University Medical Center Phoenix, Phoenix, AZ, USA
- Department of Emergency Medicine and Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | - Alex F Manini
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Research on Emerging Substances, Poisoning, Overdose, and New Discoveries (RESPOND), NYC Health + Hospitals/Elmhurst, New York, NY, USA
| | - Ayrn D O'Connor
- Department of Emergency Medicine and Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| |
Collapse
|
4
|
Schaechter JD, Goldstein R, Zafonte RD, Silver JK. Workplace Belonging of Women Healthcare Professionals Relates to Likelihood of Leaving. J Healthc Leadersh 2023; 15:273-284. [PMID: 37908972 PMCID: PMC10615104 DOI: 10.2147/jhl.s431157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Purpose There is a high rate of attrition of professionals from healthcare institutions, which threatens the economic viability of these institutions and the quality of care they provide to patients. Women professionals face particular challenges that may lower their sense of belonging in the healthcare workplace. We sought to test the hypothesis that workplace belonging of women healthcare professionals relates to the likelihood that they expect to leave their institution. Methods Participants of a continuing education course on women's leadership skills in health care completed a survey about their experiences of belonging in workplace and their likelihood of leaving that institution within the next 2 years. An association between workplace belonging (measured by the cumulative number of belonging factors experienced, scale 0-10) and likelihood of leaving (measured on a 5-point Likert scale) was evaluated using ordinal logistic regression. The relative importance of workplace belonging factors in predicting the likelihood of leaving was assessed using dominance analysis. Results Ninety-nine percent of survey participants were women, and 63% were clinicians. Sixty-one percent of participants reported at least a slight likelihood of leaving their healthcare institution within the next 2 years. Greater workplace belonging was found to be associated with a significant reduction in the reported likelihood of leaving their institution after accounting for the number of years having worked in their current institution, underrepresented minority status, and the interaction between the latter two covariates. The workplace belonging factor found to be most important in predicting the likelihood of leaving was the belief that there was an opportunity to thrive professionally in the institution. Belonging factors involving feeling able to freely share thoughts and opinions were also found to be of relatively high importance in predicting the likelihood of leaving. Conclusion Greater workplace belonging was found to relate significantly to a reduced likelihood of leaving their institution within the next 2 years. Our findings suggest that leaders of healthcare organizations might reduce attrition of women by fostering workplace belonging with particular attention to empowering professional thriving and creating a culture that values open communication.
Collapse
Affiliation(s)
- Judith D Schaechter
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, MA, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|
5
|
Reisdorff EJ, Masselink LE, Gallahue FE, Suter RE, Chappell BP, Evans DD, Salsberg E, Marco CA. Factors associated with emergency physician income. J Am Coll Emerg Physicians Open 2023; 4:e12949. [PMID: 37064163 PMCID: PMC10090942 DOI: 10.1002/emp2.12949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/18/2023] Open
Abstract
Objective Income fairness is important, but there are limited data that describe income equity among emergency physicians. Understanding the magnitude of and factors associated with income differences may be helpful in eliminating disparities. This study analyzed the associations of demographic factors, training, practice setting, and board certification with emergency physician income. Methods We distributed a survey to professional members of the American College of Emergency Physicians. The survey included questions on annual income, educational background, practice characteristics, gender, age, race, ethnicity, international medical graduate status, type of medical degree (MD vs DO), completion of a subspecialty fellowship, job characteristics, and board certification. Respondents also reported annual income. We used linear regression to determine the respondent characteristics associated with reported annual income. Results From 45,961 members we received 3407 responses (7.4%); 2350 contained complete data for regression analysis. The mean reported annual income was $315,306 (95% confidence interval [CI], $310,649 to $319,964). The mean age of the respondents was 47.4 years, 37.4% were women, 3.2% were races underrepresented in medicine (Black, American Indian, or Alaskan Native), and 4.8% were Hispanic or Latino. On linear regression, female gender was associated with lower reported annual income; difference -$43,565, 95% CI, -$52,217 to -$34,913. Physician age, degree (MD vs DO), underrepresented racial minority status, and underrepresented ethnic minority status were not associated with annual income. Fellowship training was associated with lower income; Accreditation Council for Graduate Medical Education (ACGME) program difference -$30,048; 95% CI, -$48,183 to -$11,912, non-ACGME-program difference -$27,640, 95% CI, -$40,970 to -$14,257. Working at a for-profit institution was associated with higher income; difference $12,290, 95% CI, $3693 to $20,888. Board certification was associated with higher income; difference, $43,267, 95% CI, $30,767 to $55,767. Conclusions This study identified income disparities associated with gender, practice setting, fellowship completion, and American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine certification.
Collapse
Affiliation(s)
| | - Leah E. Masselink
- George Washington University Fitzhugh Mullan Institute for Health Workforce EquityWashingtonDCUSA
| | - Fiona E. Gallahue
- Department of Emergency MedicineThe University of WashingtonSeattleWashingtonUSA
| | - Robert E. Suter
- Department of Emergency MedicineUniversity of Texas SouthwesternDallasTexasUSA
- Department of Military MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Brad P. Chappell
- Department of Emergency MedicineUniversity of California, Harbor‐UCLA Medical CenterLos AngelesCaliforniaUSA
| | - Dian D. Evans
- Emory University Nell Hodgson Woodruff School of NursingAtlantaGeorgiaUSA
| | - Ed Salsberg
- George Washington University Fitzhugh Mullan Institute for Health Workforce EquityWashingtonDCUSA
| | - Catherine A. Marco
- Department of Emergency MedicinePenn State Health, Hershey Medical CenterHersheyPennsylvaniaUSA
| |
Collapse
|
6
|
Robiner WN, Buum HT, Eckerstorfer M, Kim MH, Kirsch JD. Sabbaticals in US Medical Schools. Am J Med 2023; 136:322-328. [PMID: 36481235 DOI: 10.1016/j.amjmed.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sabbaticals are an important feature of academia for faculty and their institutions. Whereas sabbaticals are common in institutions of higher learning, little is known about their role and utilization in US medical schools. This perspective piece examining sabbaticals in medical school faculty was undertaken at a time that well-being of health professionals was increasingly being recognized as a workforce health priority. METHODS We surveyed associate deans at US medical schools in 2021 about faculty who had taken sabbaticals within the past 3 years, the parameters of the sabbaticals, and institutional policies and respondents' predictions of future sabbatical use. RESULTS A total of 53% of respondents reported any faculty had taken sabbaticals in the past 3 years (M = 6.27; Median = 3; range = 1-60). Institutions rated enhancing research as the most important objective, while recognizing other benefits. Sabbaticals were more commonly taken by male, white, senior faculty PhDs. Details about sabbaticals, including eligibility, expectations, length, financial support, and benefits were reviewed. Most (54.8%) respondents expected no change in the number of faculty seeking sabbaticals. Nearly all anticipated the COVID-19 pandemic would not affect sabbatical policies. CONCLUSION In contrast to other institutions of higher learning, sabbatical-taking by medical school faculty is rare. We explore factors that may contribute to this phenomenon (eg, the tripartite mission, faculty clinical responsibilities, culture of medicine, and student debt). Despite financial and other barriers, a closer look at the benefits of sabbaticals is warranted as a mechanism that may support faculty well-being, retention, and mental health.
Collapse
Affiliation(s)
- William N Robiner
- Department of Medicine, University of Minnesota, Minneapolis; Department of Pediatrics, University of Minnesota, Minneapolis
| | | | | | - Michael H Kim
- Department of Medicine, University of Minnesota, Minneapolis; Department of Pediatrics, University of Minnesota, Minneapolis
| | | |
Collapse
|
7
|
Are We There Yet? No. Gender Disparities Still Exist and Affect Surgeon Burnout. CURRENT TRAUMA REPORTS 2023. [DOI: 10.1007/s40719-022-00250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
8
|
Norvell J, Unruh G, Norvell T, Templeton KJ. Addressing Burnout Among Women Residents: Results from Focus Group Discussions. Kans J Med 2023; 16:83-87. [PMID: 37124099 PMCID: PMC10136605 DOI: 10.17161/kjm.vol16.18364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/03/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Physician burnout has been described as more common among women than men. Even if there are no gender-based differences in prevalence, risk factors, such as work/home integration/conflict and gendered biases, likely differ. Prior administrations of an annual resident wellness survey at a single urban academic institution confirmed that rates of burnout were higher among women, especially during the PGY-2 year. Methods A series of focus groups of PGY-3 women residents across specialties were organized in 2019 at a single urban academic medical center. Given the number of participants, demographics were not collected to maintain participant anonymity. The moderator for all groups used a discussion guide consisting of eight open-ended questions based on a review of the literature. Results Ten residents agreed to participate in one of four hour-long focus group discussions. While the residents identified some factors that were not gender-specific, they also discussed issues that they faced as women in medicine, including needing to work harder to prove themselves and unconscious gendered biases from faculty and patients. The residents thought that their well-being would be improved if their training programs better understood the experiences and needs of women residents and recommended a series of interventions, including improved mentoring and networking opportunities. Conclusions Interventions to improve well-being need to consider gender-based differences. While mentoring and networking can help all residents, these may be especially useful for women and should be considered as a component of an overarching plan to improve diversity, equity, inclusion, and belonging.
Collapse
Affiliation(s)
- Jeff Norvell
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Greg Unruh
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS
| | | | - Kimberly J Templeton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS
| |
Collapse
|
9
|
Gettel CJ, Courtney DM, Janke AT, Rothenberg C, Mills AM, Sun W, Venkatesh AK. The 2013 to 2019 Emergency Medicine Workforce: Clinician Entry and Attrition Across the US Geography. Ann Emerg Med 2022; 80:260-271. [PMID: 35717274 PMCID: PMC9398978 DOI: 10.1016/j.annemergmed.2022.04.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE We sought to identify longitudinal trends in workforce entry and attrition among rural and urban emergency physicians, nonemergency physicians, and advanced practice providers. METHODS We performed a repeated cross-sectional analysis, from 2013 to 2019, of emergency clinicians who received reimbursement for at least 50 Evaluation and Management services [99281-99285] from Medicare part B within any study year. We calculated the emergency workforce's entry and attrition rates annually. Entry was defined as clinicians newly entering or re-entering the workforce, and attrition was defined as clinicians leaving permanently or temporarily. We stratified the analyses by rural designation and assessed the proportions and state-level changes in clinician density. RESULTS In total, 82,499 unique clinicians performed at least 50 Evaluation and Management services within any of the 7 study years examined, including 47,000 emergency physicians, 9,029 nonemergency physicians, and 26,470 advanced practice providers. Emergency physicians made up a decreasing proportion of the workforce (68.1% in 2013; 65.5% in 2019), and advanced practice providers made up an increasing proportion of the workforce (20.9% in 2013; 26.1% in 2019). Annually, 5.9% to 6.8% (2,186 to 2,407) of emergency physicians newly entered and 0.8% to 1.4% (264 to 515) re-entered the workforce, whereas 3.8% to 4.9% (1,241 to 1,793) permanently left and 0.8% to 1.6% (276 to 521) temporarily left. Additionally, the total proportion of clinicians practicing in rural designations decreased, and advanced practice providers separately made up a substantially increasing proportion of the rural workforce (23.0% in 2013; 32.7% in 2019). Substantial state-level variation existed in the supply and demand of emergency clinician densities per 100,000 population. CONCLUSION The annual rate of emergency physician attrition was collectively more than 5%, well above the 3% assumed in a recently publicized projection, suggesting a potential overestimation of the anticipated future clinician surplus. Notably, the attrition of emergency physicians has disproportionately affected vulnerable rural areas. This work can inform emergency medicine workforce decisions regarding residency training, advanced practice provider utilization, and clinician employment.
Collapse
Affiliation(s)
- Cameron J Gettel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT.
| | - D Mark Courtney
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alexander T Janke
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Craig Rothenberg
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Angela M Mills
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Wendy Sun
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT
| |
Collapse
|
10
|
Madsen TE, Heron S, Lall MD, Blomkalns A, Arbelaez C, Lopez B, Lin M, Rounds K, Sethuraman KN, Safdar B. Institutional solutions addressing disparities in compensation and advancement of emergency medicine physicians: A critical appraisal of gaps and associated recommendations. Acad Emerg Med 2022; 29:710-718. [PMID: 35064998 DOI: 10.1111/acem.14452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Disparities in salary and advancement of emergency medicine (EM) faculty by race and gender have been consistently demonstrated for over three decades. Prior studies have largely focused on individual-level solutions. To identify systems-based interventions, the Society for Academic Emergency Medicine (SAEM) formed the Research Equity Task Force in 2018 with members from multiple academies (the Academy of Academic Chairs in Emergency Medicine [AACEM], the Academy of Academic Administrators in Emergency Medicine [AAAEM], the Academy for Women in Academic Emergency Medicine [AWAEM], and the Academy for Diversity and Inclusion in Emergency Medicine [ADIEM]) and sought recommendations from EM departmental leaders. METHODS The task force conducted interviews containing both open-ended narrative and closed-ended questions in multiple phases. Phase 1 included a convenience sample of chairs of EM departments across the United States, and phase 2 included vice-chairs and other faculty who lead promotion and advancement. The task force identified common themes from the interviews and then developed three-tiered sets of recommendations (minimal, target, and aspirational) based on participant responses. In phase 3, iterative feedback was collected and implemented on these recommendations from study participants and chairs participating in a national AACEM webinar. RESULTS In findings from 53 interviews of chairs, vice-chairs, and faculty leaders from across the United States, we noted heterogeneity in the faculty development and promotion processes across institutions. Four main themes were identified from the interviews: the need for a directed, structured promotion process; provision of structured mentorship; clarity on requirements for promotion within tracks; and transparency in salary structure. Recommendations were developed to address gaps in structured mentorship and equitable promotion and compensation. CONCLUSIONS These recommendations for AEM departments have the potential to increase structured mentorship programs, improve equity in promotion and advancement, and reduce disparities in the AEM workforce. These recommendations have been endorsed by SAEM, AACEM, AWAEM, ADIEM, and AAAEM.
Collapse
Affiliation(s)
- Tracy E. Madsen
- Department of Emergency Medicine Department of Epidemiology Alpert Medical School of Brown University, Brown University School of Public Health Providence Rhode Island USA
| | - Sheryl Heron
- Department of Emergency Medicine Emory University Atlanta Georgia USA
| | - Michelle D. Lall
- Department of Emergency Medicine Emory University Atlanta Georgia USA
| | - Andra Blomkalns
- Department of Emergency Medicine Stanford University Stanford California USA
| | - Christian Arbelaez
- Department of Emergency Medicine Boston Medical Center Providence Rhode Island USA
| | - Bernard Lopez
- Department of Emergency Medicine, Sidney Kimmel Medical College Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Michelle Lin
- Departments of Emergency Medicine and Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York New York USA
| | - Kirsten Rounds
- Formerly of Brown Emergency Medicine Providence Rhode Island USA
| | | | - Basmah Safdar
- Department of Emergency Medicine Yale University New Haven Connecticut USA
| |
Collapse
|
11
|
Stankovic M, Papp L, Ivánkovits L, Lázár G, Pető Z, Töreki A. Psychological immune competency predicts burnout syndrome among the high-risk healthcare staff: A cross-sectional study. Int Emerg Nurs 2021; 60:101114. [PMID: 34953439 DOI: 10.1016/j.ienj.2021.101114] [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: 10/18/2020] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Burnout and psychological immune competency have not been investigated together among employees of high-risk specializations such as emergency medicine, intensive care or surgery. AIM In this study we aim to examine the prevalence of burnout among high-risk clinical staff and explore whether the strength of psychological immune competency predict burnout. DESIGN A cross-sectional design utilizing a self-administrated questionnaire was used to collect data from the participants (n = 216). Nurses (n = 145) and physicians (n = 71) from emergency medicine, intensive care and surgery departments participated in the study. METHOD Burnout syndrome was measured using the Maslach Burnout Inventory, while psychological immune competency was measured using the Psychological Immune Competency Questionnaire. The data collection started in June of 2018 and was finished in March of 2019. RESULTS Participants with higher psychological immune competency reported lower levels of burnout: emotional exhaustion (r = -0.478; p < 0.001), depersonalization (r = -0.459; p < 0.001) and personal accomplishment (r = 0.543; p < 0.001). Multiple linear stepwise regression analysis revealed the psychological immune competency to be a stable predictor of burnout on all three scales. CONCLUSION Psychological immune competency shows a strong relationship with scales of burnout syndrome and as such should be further examined due to development of successful intervention and prevention programs.
Collapse
Affiliation(s)
- Mona Stankovic
- University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Department of Emergency Medicine, Semmelweis utca 6, 6720 Szeged, Hungary.
| | - László Papp
- University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Department of Emergency Medicine, Semmelweis utca 6, 6720 Szeged, Hungary.
| | - László Ivánkovits
- University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Department of Emergency Medicine, Semmelweis utca 6, 6720 Szeged, Hungary.
| | - György Lázár
- University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Department of Surgery, Semmelweis utca 8, 6720 Szeged, Hungary.
| | - Zoltán Pető
- University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Department of Emergency Medicine, Semmelweis utca 6, 6720 Szeged, Hungary.
| | - Annamária Töreki
- University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Department of Emergency Medicine, Semmelweis utca 6, 6720 Szeged, Hungary.
| |
Collapse
|
12
|
Staats K, Counts CR, Dyer KS, Stemerman R, Braithwaite S, Luke A, Mercer MP. Characteristics and Experiences of Women Physicians and Professionals in NAEMSP. PREHOSP EMERG CARE 2021; 26:689-699. [PMID: 34644240 DOI: 10.1080/10903127.2021.1992051] [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: 10/20/2022]
Abstract
Introduction:One of the six guiding principles of the EMS Agenda 2050 is to foster a socially equitable care delivery system. A specific recommendation within this principle is that "local EMS leadership, educators and clinicians [should] reflect the diversity of their communities." Research has shown that women comprise a minority of emergency medicine services (EMS) field clinicians. In academic settings, women are represented at lower rates among experienced EMS faculty than within Emergency Medicine clinicians or faculty at large. The reasons for these differences are also unknown. Little data exist describing the number or experience of female physicians and professionals in EMS.Purpose:Our objective was to describe the composition and experiences of EMS physicians, researchers and professionals who participate in the Women in EMS group of the National Association of EMS Physicians (NAEMSP).Methods:We performed a cross-sectional, mixed-methods descriptive study of women belonging to the Women in EMS Committee of NAEMSP. A survey was sent to the 143 members of this group using a list-serve, and the data was collected in Redcap.Results:Seventy-four people completed the survey. Respondents were 96% female, 82% Caucasian, 11% underrepresented minorities (URM), and 7% LGBTQI. Of the 88% that are physicians, 78% are board certified in Emergency Medicine, compared to 55% in EMS.Forty-eight percent reported they received some form of mentorship. Among these respondents, a minority reported female mentorship, which was usually from a remote rather than local mentor (41% vs. 15%).Eighty-three percent of respondents had experienced some form of discrimination or harassment in their career, but only 68% reported their workplace culture discourages such behavior. Thirty-three percent of respondents report receiving unequal recognition because of gender.Thematic evaluation of the qualitative responses showed that respondents felt there were fewer barriers to mentorship and professional advancement opportunities in local work versus national engagement.Conclusions:In a survey evaluating representation of female professionals in EMS, participants reported on their career representations, and experiences of gender-based inequity within their EMS career settings. Several opportunities exist to improve diversity, equity, and inclusion for women in EMS based on our findings.
Collapse
Affiliation(s)
- Katherine Staats
- Stanford Health Care, Emergency Medicine, Stanford, United States
| | | | - K Sophia Dyer
- Boston Medical Center, Department of Emergency Medicine, Boston, United States
| | - Rachel Stemerman
- The University of North Carolina at Chapel Hill, Graduate School, Chapel Hill, United States
| | - Sabina Braithwaite
- Washington University in St Louis School of Medicine, Emergency Medicine, St Louis, United States
| | - Anuradha Luke
- Mayo Clinic Minnesota, Emergency Medicine, Rochester, United States
| | - Mary P Mercer
- UCSF Medical Center, Emergency Medicine, San Francisco, United States
| |
Collapse
|
13
|
Affiliation(s)
- Eileen P Ryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 1670 Upham Drive, Suite 130, Columbus, OH 43210-1250, USA
| |
Collapse
|
14
|
Impacts and challenges of the COVID-19 pandemic on emergency medicine physicians in the United States. Am J Emerg Med 2021; 48:38-47. [PMID: 33836387 PMCID: PMC8016733 DOI: 10.1016/j.ajem.2021.03.088] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Emergency medicine (EM) physicians have been on the front line of the COVID-19 pandemic. This study aims to determine the impact of COVID-19 pandemic and other related factors such as resource availability and institutional support on well-being, burnout and job-satisfaction of EM physicians in the United States. METHODS A cross-sectional survey study of EM physicians was conducted through the Emergency Medicine Practice Research Network of the ACEP. The survey focused on resource adequacy, institutional support, well-being, and burnout. A total of 890 EM physicians were invited to participate. Both descriptive and risk adjusted, and multivariate regressions were performed with a statistical significance defined as p < 0.05. RESULTS EM physicians' response rate was 18.7% (166) from 39 states. Burnout was reported by 74.7% (124) since the start of the pandemic. Factors contributing included work-related emotional strain and anxiety, isolation from family and friends, and increased workload. Those reporting inadequate resources felt ignored by their institutions (p < 0.0001). Physicians who felt there was inadequate institutional support, were also dissatisfied with patient care resources (p = 0.001). Physicians expressing job dissatisfaction were more likely to report feelings of burnout (p = 0.001). CONCLUSION EM physicians face greater burnout in the COVID-19 pandemic. This may be compounded by resource scarcity, psychological stress, isolation, and job dissatisfaction. Many of the survey respondents reported inadequate mental health services and resources. The findings of this study may help identify solutions to mitigate these issues.
Collapse
|
15
|
Norvell JG, Baker AM, Carlberg DJ, Diller D, Dziedzic JM, Finnell JT, Greenberger S, Kessler C, Lo BM, Moungey BM, Schiller E, Walter LA. Does academic practice protect emergency physicians against burnout? J Am Coll Emerg Physicians Open 2021; 2:e12329. [PMID: 33521781 PMCID: PMC7819260 DOI: 10.1002/emp2.12329] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022] Open
Abstract
Burnout is a complex syndrome thought to result from long-term exposure to career-related stressors. Physicians are at higher risk for burnout than the general United States (US) working population, and emergency medicine has some of the highest burnout rates of any medical specialty. Burnout impacts physicians' quality of life, but it can also increase medical errors and negatively affect patient safety. Several studies have reported lower burnout rates and higher job satisfaction in academic medicine as compared with private practice. However, researchers have only begun to explore the factors that underlie this protective effect. This paper aims to review existing literature to identify specific aspects of academic practice in emergency medicine that may be associated with lower physician burnout rates and greater career satisfaction. Broadly, it appears that spending time in the area of emergency medicine one finds most meaningful has been associated with reduced physician burnout. Certain non-clinical academic work, including involvement in research, leadership, teaching, and mentorship, have been identified as specific activities that may protect against burnout and contribute to higher job satisfaction. Given the epidemic of physician burnout, hospitals and practice groups have a responsibility to address burnout, both by prevention and by early recognition and support. We discuss methods by which organizations can actively foster physician well-being and provide examples of 2 leading academic institutions that have developed comprehensive programs to promote physician wellness and prevent burnout.
Collapse
Affiliation(s)
- Jeffrey G. Norvell
- Department of Emergency MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Annalee M. Baker
- Department of Emergency MedicineAventura Hospital and Medical CenterFIU Herbert Wertheim College of MedicineAventuraFloridaUSA
| | - David J. Carlberg
- Department of Emergency MedicineGeorgetown University Hospital/Georgetown University School of MedicineWashington, DCUSA
| | - David Diller
- Department of Emergency MedicineLAC+USC Medical CenterKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jacqueline M. Dziedzic
- Department of Emergency MedicineLoyola University Chicago‐Stritch School of MedicineChicagoIllinoisUSA
| | - John T. Finnell
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Sarah Greenberger
- Department of Emergency MedicineDepartment of Emergency MedicineUniversity of Arkansas for Medical Sciences College of MedicineLittle RockArkansasUSA
| | - Chad Kessler
- Durham VA Medical CenterDepartment of Emergency MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Bruce M. Lo
- Department of Emergency MedicineSentara Norfolk General Hospital/Eastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Brooke M. Moungey
- The Ohio State University Department of Emergency MedicineColumbusOhioUSA
| | - Elizabeth Schiller
- Department of Emergency MedicineSaint Francis Hospital and Medical Center/University of Connecticut SOMHartfordConnecticutUSA
| | - Lauren A. Walter
- Department of Emergency MedicineThe University of Alabama at Birmingham School of MedicineBirminghamAlabamaUSA
| |
Collapse
|