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Ward S. Do physicians need tragic optimism? Intern Med J 2024; 54:348-351. [PMID: 38350660 DOI: 10.1111/imj.16315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/19/2023] [Indexed: 02/15/2024]
Abstract
In 2016, as a trainee doctor, I wrote a paper on changing the culture of medicine. I felt the medical system was broken back then, and it seems even less functional now, with higher rates of burnout, dropout and staff shortages nationally. As a result of a lack of resources, it feels impossible to provide the care to our communities expected of us, making our work challenging and disheartening. Until all stakeholders acknowledge the systemic issues faced by our workforce, service outcomes and physician well-being may not improve. We need to collaborate and innovate to reform the healthcare system taking a multifaceted, evidence-based approach, implementing an appropriate balance of systemic change and interventions to support individual well-being. As we collectively work towards these changes, tragic optimism may spur physicians to develop meaning and purpose despite the inevitable challenges. This may serve as the motivation and fuel required to survive and sustain our practice but also thrive working in careers of value.
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Maksutova M, Kemp MT, Sharma SB, Shen M, Leininger L, Singer AA, Krueger M, Kim GJ, Kwakye G, Alam HB, Sandhu G. "You've Got Gratitude!"- A Multispecialty and Multi-institution Program Encouraging Expressions of Gratitude. J Surg Educ 2023; 80:1741-1744. [PMID: 37723013 DOI: 10.1016/j.jsurg.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE Efforts to improve physician well-being have focused on gratitude, which predicts health and happiness. Despite reported benefits, expressions of gratitude in healthcare can seem infrequent. Here, we describe Gratitude-Grams, an intervention to cultivate expressions of gratitude throughout a department. METHODS/APPROACH Piloted in our Department of Surgery and adopted by others, Gratitude-Grams employs a web-based platform (Qualtrics). Program feedback was solicited during teaching conferences using an anonymous department survey. RESULTS Gratitude-Grams streamlines and encourages expressions of gratitude while minimizing maintenance, cost, and time. The platform has been highly utilized and well-received in our Department of Surgery. CONCLUSION Expressing and receiving gratitude has been shown to be critical for well-being. Gratitude-Grams is a highly utilized, simple, and attainable system to support expressions of gratitude and is ready for rapid implementation.
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Affiliation(s)
- Mariam Maksutova
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Michael T Kemp
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Mary Shen
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lisa Leininger
- Department of Surgery, Graduate Medical Education Program Administrator, University of Michigan, Ann Arbor, Michigan
| | - Andrew A Singer
- Department of Surgery, Surgical Education Administrative Manager, Northwestern University, Chicago, Illinois
| | - Mackenzie Krueger
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Grace J Kim
- Department of Surgery, Section of Minimally Invasive Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gifty Kwakye
- Department of Surgery, Section of Colorectal Surgery, University of Michigan, Ann Arbor, Michigan
| | - Hasan B Alam
- Department of Surgery, Northwestern University, Chicago, Illinois
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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3
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Yadav S, Rawal G, Jeyaraman M. Decision Fatigue in Emergency Medicine: An Exploration of Its Validity. Cureus 2023; 15:e51267. [PMID: 38288179 PMCID: PMC10823191 DOI: 10.7759/cureus.51267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
Emergency physicians face a relentless stream of complex, high-stakes decisions in a fast-paced and dynamic environment. The concept of decision fatigue, a phenomenon characterized by a decline in the quality of decision-making after a long sequence of choices, has garnered increasing attention within healthcare. Several investigations show that the number and complexity of decisions made during prolonged shifts correlate with increased self-reported fatigue; however, the effect on clinical decision quality is uncertain. Conversely, a subset of studies found no clear relationship between decision fatigue and errors in clinical judgment. Importantly, some researchers argue that decision fatigue may be mitigated by factors such as experience, training, and support systems. This narrative review highlights the existing literature on decision fatigue among emergency physicians and explores whether this concept holds as a valid concern or remains a myth in the context of their practice.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
| | - Gautam Rawal
- Respiratory Medical Critical Care, Max Super Speciality Hospital, New Delhi, IND
| | - Madhan Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
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Uong AM, Cabana MD, Serwint JR, Bernstein CA, Schulte EE. Pediatric Faculty Engagement and Associated Areas of Worklife After a COVID19 Surge. J Healthc Leadersh 2023; 15:375-383. [PMID: 38046535 PMCID: PMC10693203 DOI: 10.2147/jhl.s410797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/23/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose Healthcare organizations strive to increase physician engagement and decrease attrition. However, little is known about which specific worklife areas may be targeted to improve physician engagement or retention, especially after stressful events such as a COVID19 surge. Our objective was to identify demographic characteristics and worklife areas most associated with increased physician engagement and decreased intent to leave in pediatric faculty. Patients and Methods In September 2020, we conducted a cross-sectional survey of faculty at an academic, tertiary-care children's hospital. A convenience and voluntary sampling approach was used. The survey included demographics, Maslach Burnout Index-Human Services Survey (MBI-HSS) and the Areas of Worklife Survey (AWS). The MBI-HSS was used to measure faculty engagement. The AWS measures satisfaction with six worklife areas (workload, control, reward, fairness, community, values). We used bivariate analyses to examine relationships between worklife areas and engagement and between worklife areas and intent to leave. We included multivariate logistic regression models to examine worklife areas most associated with increased work engagement and decreased intent to leave. Results Our response rate was 41% (113/274 participants). In bivariate analysis, engaged faculty reported higher satisfaction in all worklife areas. In multivariate analyses, positive perceptions of workload (odds ratio (OR) 2.83; 95% confidence interval (CI), 1.2-6.9), control (OR, 3.24; 95% CI 1.4-7.3), and community (OR, 6.07; 95% CI 1.9-18.7) were associated with engagement. Positive perceptions of values (OR, 0.07; 95% CI 0.02-0.32) and community (OR, 0.19; 95% CI 0.05-0.78) were negatively associated with intent to leave. Conclusion We found that positive perceptions of workload, control, and community were most associated with engagement. Alignment of values and increased sense of community were associated with decreased intent to leave. Our findings suggest specific worklife areas may be targeted to increase faculty engagement and retention.
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Affiliation(s)
- Audrey M Uong
- Department of Pediatrics, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael D Cabana
- Department of Pediatrics, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Janet R Serwint
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carol A Bernstein
- Department of Psychiatry, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elaine E Schulte
- Department of Pediatrics, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA
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Pollard KJ, Gittelsohn J, Patel P, Lianov L, Freeman K, Staffier KL, Pauly KR, Karlsen MC. Lifestyle Medicine Practitioners Implementing a Greater Proportion of Lifestyle Medicine Experience Less Burnout. Am J Health Promot 2023; 37:1121-1132. [PMID: 37368959 PMCID: PMC10631282 DOI: 10.1177/08901171231182875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE To identify reasons for burnout, characterize the effect of lifestyle medicine (LM) practice on burnout, and assess the risk of burnout in relation to the proportion of LM practice. DESIGN Analysis of mixed methods data from a large, cross-sectional survey on LM practice. SETTING Web-based survey platform. PARTICIPANTS Members of an LM medical professional society at the time of survey administration. METHODS Practitioner members of a medical professional society were recruited to a cross-sectional, online survey. Data were collected on LM practice and experiences with burnout. Free-text data were thematically grouped and counted, and the association of burnout with the proportion of lifestyle-based medical practice was analyzed using logistic regression. RESULTS Of 482 respondents, 58% reported currently feeling burned out, 28% used to feel burned out but no longer do, and 90% reported LM had positively impacted their professional satisfaction. Among LM practitioners surveyed, practicing more LM was associated with a 43% decrease (0.569; 95% CI: 0.384, 0.845; P = 0.0051) in the odds of experiencing burnout. Top reasons for positive impact included professional satisfaction, sense of accomplishment, and meaningfulness (44%); improved patient outcomes and patient satisfaction (26%); enjoyment of teaching/coaching and engaging in relationships (22%); and helps me personally: quality of life and stress (22%). CONCLUSION Implementing LM as a greater proportion of medical practice was associated with lower likelihood of burnout among LM practitioners. Results suggest that increased feelings of accomplishment due to improved patient outcomes and reduced depersonalization contribute to reduced burnout.
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Affiliation(s)
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Liana Lianov
- Global Positive Health Institute, Sacramento, CA, USA
| | - Kelly Freeman
- American College of Lifestyle Medicine, Chesterfield, MO, USA
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Pham A, Dalkic AE, Achan K, Gibson L, Limaye S. Supporting home-based meal preparation improves lunchtime habits and self-assessed work performance of interns at a tertiary hospital. Intern Med J 2023; 53:1701-1705. [PMID: 37665728 DOI: 10.1111/imj.16219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/25/2023] [Indexed: 09/06/2023]
Abstract
There is ample evidence that doctors frequently miss meals at work, which negatively impacts concentration, decision-making and overall patient care. Junior doctors are particularly vulnerable given their heavy workload. We report on the impact of a pilot programme supporting home-based meal preparation on the dietary habits and energy levels of interns at a tertiary hospital and demonstrate this is one strategy healthcare organisations can adopt to promote a healthier workforce.
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Affiliation(s)
- Alec Pham
- Concord Hospital, Sydney, New South Wales, Australia
| | | | - Kripa Achan
- MDOK, Concord Hospital, Sydney, New South Wales, Australia
| | - Lauren Gibson
- MDOK, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sandhya Limaye
- MDOK, Concord Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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Wasfie T, Kirkpatrick H, Barber K, Hella JR, Anderson T, Vogel M. Longitudinal Study of Emotional Intelligence, Well-being, and Burnout of Surgical and Medical Residents. Am Surg 2023:31348231157813. [PMID: 36800898 DOI: 10.1177/00031348231157813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Emotional intelligence (EI) as a concept is becoming increasingly relevant in the healthcare industry. In order to examine the relationship between EI, burnout, and wellness, we administered these measures quarterly in resident physicians and analyzed the variables in each subset to gain insights and understanding of their relationship. METHODS In 2017 and 2018, all residents entering the training programs in year one (PGY-1) were administered The Emotional Intelligence Questionnaire - Short Form (TEIQue-SF), The Maslach Burnout Inventory (MBI), and The Physician Wellness Inventory (PWI). The questionnaires were completed quarterly. Statistical analysis included ANOVA and ANCOVA. RESULTS The overall combined PGY-1 resident year (n = 80) had an EI global trait mean score of 5.47 (SD: 0.59) at the beginning of their first year. The domains of burnout and physician wellness were examined across four different time points during the resident's first year. Domain scores changed significantly over the four time points during the first year. There was a relative 46% increase in exhaustion (P < .001), 48% increase in depersonalization (P < .001), and an 11% decrease in personal achievement (P < .001). Physician wellness domains also changed significantly between time 1 and the end of the year (time 4). There was a relative 12% decrease in career purpose (P < .001), a 30% increase in distress (P < .001), and 6% decrease in cognitive flexibility (P < .001). Each burnout domain and physician wellness domain were highly correlated with emotional quotient (EQ). Emotional quotient was independently assessed with each domain at baseline and with changes overtime. The lowest EQ group reported their distress increased significantly over time (P = .003) and a decline in career purpose (P < .001) and cognitive flexibility (P = .04). The response rate was 100%. CONCLUSION Emotional intelligence is associated with well-being and burnout in individual residents; therefore, it is important to identify those who require increased support during residency in order to succeed.
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Affiliation(s)
- Tarik Wasfie
- Department of Surgery, 3577Ascension Genesys Hospital, Michigan State University College of Human Medicine, Grand Blanc, MI, USA
| | - Heather Kirkpatrick
- Department of Medical Education, 3577Ascension Genesys Hospital, Michigan State University College of Human Medicine, Grand Blanc, MI, USA
| | - Kimberly Barber
- Department of Research, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Jennifer R Hella
- Department of Research, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Tara Anderson
- Department of Family Medicine, University of Minnesota Hospitals, Minneapolis, St. Paul, MN, USA
| | - Mark Vogel
- Department of Medical Education, 3577Ascension Genesys Hospital, Michigan State University College of Human Medicine, Grand Blanc, MI, USA
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Society for Maternal-Fetal Medicine Special Statement: Curriculum outline on patient safety and quality for maternal-fetal medicine fellows. Am J Obstet Gynecol 2023; 228:B2-B17. [PMID: 36738911 DOI: 10.1016/j.ajog.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To help fellows in maternal-fetal medicine gain a well-rounded education in patient safety and quality, we present a curriculum outline that addresses the requirements of the Accreditation Council for Graduate Medical Education and the American Board of Obstetrics and Gynecology. For each month of fellowship, the outline suggests brief video clips, readings, and activities. Emphasis is placed on helping fellows develop and complete a quality improvement project. If desired, the curriculum can be modified to fit program-specific needs and can be adapted for use with residents in obstetrics and gynecology.
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Webber SA, Byrne BJ, Starmer AJ, Somberg CA, Frintner MP. Examining Early Career Pediatrician Characteristics, Sacrifices, and Satisfaction. Acad Pediatr 2023; 23:587-596. [PMID: 36682450 DOI: 10.1016/j.acap.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Explore relationships between pediatrician characteristics, sacrifices made for career, and career and life satisfaction. METHODS Surveys of early career pediatricians (ECPs) who recently graduated residency (2016-18), as part of the AAP Pediatrician Life and Career Experience Study (PLACES) were administered in 2019. Logistic regression analyzed association of pediatrician characteristics with personal sacrifices (a lot vs some or no sacrifices) made for one's career and whether career was worth the sacrifices made to become a physician, and association of characteristics and sacrifices with overall career and life satisfaction. RESULTS Of 918 ECPs in the cohort, 90% responded to the 2019 survey. Seventy-seven percent agreed their career was worth the sacrifices and 40% reported they made a lot of personal sacrifices for their career. In multivariable analysis, female sex was associated with lower odds of viewing career as worth the sacrifices made [adjusted odds ratio [aOR] 0.45; 95% confidence interval [CI], 0.28-0.71], a higher odds of delaying starting a family [aOR 2.25; CI, 1.32-3.86] and making sacrifices in having children for career [aOR 2.60; CI, 1.48-4.58]. Those in fellowship training also reported making more sacrifices related to having children for their career [aOR 1.73; CI, 1.08-2.78]. ECPs who reported making a lot of sacrifices for their career were less likely to be satisfied with their overall career and life. CONCLUSIONS Most ECPs believe their sacrifices to become a pediatrician were worth it. Female pediatricians were less likely to feel personal sacrifices were worth it and reported more sacrifices related to having children.
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Affiliation(s)
- Sarah A Webber
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (SA Webber), Madison, Wis.
| | - Bobbi J Byrne
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine (BJ Byrne), Indianapolis, Ind
| | - Amy Jost Starmer
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School (AJ Starmer), Boston, Mass
| | - Chloe A Somberg
- Department of Research, American Academy of Pediatrics (CA Somberg and MP Frintner), Itasca, Ill
| | - Mary Pat Frintner
- Department of Research, American Academy of Pediatrics (CA Somberg and MP Frintner), Itasca, Ill
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10
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Penick E, Beltran T, Foglia L. Survey Highlighting Impostor Phenomenon (SHIP): Evaluating the Prevalence of Impostor Phenomenon Among Physicians in a Military Treatment Facility. J Med Educ Curric Dev 2023; 10:23821205231203827. [PMID: 37822781 PMCID: PMC10563454 DOI: 10.1177/23821205231203827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Impostor Phenomenon (IP) describes feelings of distrust in one's own capabilities or accomplishments. This experience exists across many professional settings, affecting men and women across diverse backgrounds. IP has not been studied within a military health system. The purpose of this study was to evaluate the prevalence of IP among physicians at a military hospital. METHODS An online survey was constructed incorporating the Clance Impostor Phenomenon Scale (CIPS) and demographic data. All physicians at the institution received the survey link via email and the survey remained open for 1 month for completion. Multivariable analysis was performed to identify significant differences among groups as well as characteristics associated with IP. Exploratory factor analysis was used to examine the factor structure of the CIPS. RESULTS The response rate was 25% (94/376). Forty-one respondents (44.1%) had CIPS scores ranging between 41 and 60, classifying the respondent as having moderate IP experiences. Differences in scores were noted for age and years of experience (both P < .01). No differences were noted based on gender, self-reported race/ethnicity, or surgical versus nonsurgical specialty. Active-duty respondents had a mean IP score of 62 (SD = 16) and civilian respondents had a mean IP score of 49 (SD = 12, P < .01). CONCLUSION With nearly half (46.3%) of respondents reporting frequent or intense IP experiences, this study underscores the pervasiveness of the issue and indicates concordance with previously published data. IP is not limited to certain subgroups or gender identity but rather is a common issue which may negatively affect a physician's well-being.
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Affiliation(s)
- Emily Penick
- Department of Gynecologic Surgery & Obstetrics, Womack Army Medical Center, Fort Bragg, NC, USA
| | - Thomas Beltran
- Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, NC, USA
| | - Lisa Foglia
- Department of Gynecologic Surgery & Obstetrics, Womack Army Medical Center, Fort Bragg, NC, USA
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Muacevic A, Adler JR, Katta R. Healthcare Workers' Well-Being: A Systematic Review of Positive Psychology Interventions. Cureus 2023; 15:e34102. [PMID: 36843822 PMCID: PMC9946896 DOI: 10.7759/cureus.34102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 01/25/2023] Open
Abstract
Given persistent occupational stressors and multiple challenges in the delivery of healthcare, there is an increased focus on the well-being of healthcare workers. Responding to these challenges will require a multipronged approach, focusing on system level, organization, and individual actions. Positive psychology interventions (PPIs) represent a promising area for individual action. This systematic review indicates that PPI, delivered via many methods, holds promise for improving the well-being of healthcare workers, although there is a clear need for additional randomized controlled trials utilizing defined and standardized outcome measures. In this review, the most commonly evaluated PPIs were mindfulness-based or gratitude-based interventions. These were delivered via different methods, with many administered in the workplace and commonly in the form of courses ranging from two days to eight weeks. Researchers documented measurable improvements in multiple studied outcomes, noting reductions in symptoms of depression, anxiety, burnout, and stress. Some interventions increased well-being, job and life satisfaction, self-compassion, relaxation, and resilience. Most studies emphasized that these are simple, accessible, low-cost interventions. Limitations included some nonrandomized or quasi-experimental designs, alongside generally small sample sizes and varying methods of intervention delivery. Another concern is the lack of standardized outcome assessments and long-term follow-up data. As almost all studies included were performed before the pandemic, further research will be required post-pandemic. Overall, however, PPI shows promise as one arm of a multipronged approach to improving the well-being of healthcare workers.
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Beck J, Falco CN, O'Hara KL, Bassett HK, Randall CL, Cruz S, Hanson JL, Dean W, Senturia K. The Norms and Corporatization of Medicine Influence Physician Moral Distress in the United States. Teach Learn Med 2022:1-11. [PMID: 35466844 DOI: 10.1080/10401334.2022.2056740] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
PhenomenonMoral distress, which occurs when someone's moral integrity is seriously compromised because they feel unable to act in accordance with their core values and obligations, is an increasingly important concern for physicians. Due in part to limited understanding of the root causes of moral distress, little is known about which approaches are most beneficial for mitigating physicians' distress. Our objective was to describe system-level factors in United States (U.S.) healthcare that contribute to moral distress among pediatric hospitalist attendings and pediatric residents.ApproachIn this qualitative study, we conducted one-on-one semi-structured interviews with pediatric hospitalist attendings and pediatric residents from 4 university-affiliated, freestanding children's hospitals in the U.S. between August 2019 and February 2020. Data were coded with an iteratively developed codebook, categorized into themes, and then synthesized.FindingsWe interviewed 22 hospitalists and 18 residents. Participants described in detail how the culture of medicine created a context that cultivated moral distress. Norms of medical education and the practice of medicine created conflicts between residents' strong sense of professional responsibility to serve the best interests of their patients and the expectations of a hierarchical system of decision-making. The corporatization of the U.S. healthcare system created administrative and financial pressures that conflicted with the moral responsibility felt by both residents and hospitalists to provide the care that their patients and families needed.InsightsThese findings highlight the critical role of systemic sources of moral distress. These findings suggest that system-level interventions must supplement existing interventions that target individual health care providers. Preventing and managing moral distress will require a broad approach that addresses systemic drivers, such as the corporatization of medicine, which are entrenched in the culture of medicine.
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Affiliation(s)
- Jimmy Beck
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Carla N Falco
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Kimberly L O'Hara
- Department of Pediatrics, University of Colorado School of Medicine, CO, USA
| | - Hannah K Bassett
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Cameron L Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Stephanie Cruz
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Janice L Hanson
- Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Wendy Dean
- Moral Injury of Healthcare LLC, Carlisle, PA, USA
| | - Kirsten Senturia
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
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13
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Brady KJS, Ni P, Carlasare L, Shanafelt TD, Sinsky CA, Linzer M, Stillman M, Trockel MT. Establishing Crosswalks Between Common Measures of Burnout in US Physicians. J Gen Intern Med 2022; 37:777-784. [PMID: 33791938 PMCID: PMC8904666 DOI: 10.1007/s11606-021-06661-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Physician burnout is often assessed by healthcare organizations. Yet, scores from different burnout measures cannot currently be directly compared, limiting the interpretation of results across organizations or studies. OBJECTIVE To link common measures of burnout to a single metric in psychometric analyses such that group-level scores from different assessments can be compared. DESIGN Cross-sectional survey. SETTING US practices. PARTICIPANTS A total of 1355 physicians sampled from the American Medical Association Physician Masterfile. MAIN MEASURES We linked the Stanford Professional Fulfillment Index (PFI) and Mini-Z Single-Item Burnout (MZSIB) scale to the Maslach Burnout Inventory (MBI) in item response theory (IRT) fixed-calibration and equipercentile analyses and created crosswalks mapping PFI and MZSIB scores to corresponding MBI scores. We evaluated the accuracy of the results by comparing physicians' actual MBI scores to those predicted by linking and described the closest cut-point equivalencies across scales linked to the same MBI subscale using the resulting crosswalks. KEY RESULTS IRT linking produced the most accurate results and was used to create crosswalks mapping (1) PFI Work Exhaustion (PFI-WE) and MZSIB scores to MBI Emotional Exhaustion (MBI-EE) scores and (2) PFI Interpersonal Disengagement (PFI-ID) scores to MBI Depersonalization (MBI-DP) scores. The commonly used MBI-EE raw score cut-point of ≥27 corresponded most closely with respective PFI-WE and MZSIB raw score cut-points of ≥7 and ≥3. The commonly used MBI-DP raw score cut-point of ≥10 corresponded most closely with a PFI-ID raw score cut-point of ≥9. CONCLUSIONS Our findings allow healthcare organizations using the PFI or MZSIB to compare group-level scores to historical, regional, or national MBI scores (and vice-versa).
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Affiliation(s)
- Keri J S Brady
- Health Law, Policy & Management Department, Boston University School of Public Health, Boston, MA, USA.
| | - Pengsheng Ni
- Health Law, Policy & Management Department, Boston University School of Public Health, Boston, MA, USA.,Biostatistics & Epidemiology Data Analytic Center, Boston University School of Public Health, Boston, MA, USA
| | | | - Tait D Shanafelt
- Stanford Medicine WellMD Center, Stanford University, Stanford, CA, USA
| | | | - Mark Linzer
- Hennepin Healthcare Research Institute and Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA
| | - Martin Stillman
- Hennepin Healthcare Research Institute and Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA
| | - Mickey T Trockel
- Stanford Medicine WellMD Center, Stanford University, Stanford, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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14
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Nagasaki K, Shikino K, Nishimura Y, Kuriyama A, Nonaka S, Izumiya M, Makiishi T. Translation, Cultural Adaptation, and Validation of the Mini-Z 2.0 Survey among Japanese Physicians and Residents. Intern Med 2021; 60:2405-2411. [PMID: 33612686 PMCID: PMC8381173 DOI: 10.2169/internalmedicine.6749-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The Mini-Z 2.0 is a new, simple, and nonproprietary tool for assessing physician well-being and burnout. To date, a non-English version of the Mini-Z 2.0 survey has not been validated. Therefore, we aimed to develop a Japanese version of the Mini-Z 2.0 and to evaluate its validity and reliability using survey data from physicians affiliated with an internal medicine academic society. Methods The Mini-Z 2.0 survey was translated into Japanese using a forward-backward translation method. The participants belonged to the American College of Physicians' Japan Chapter. The translated version of the Mini-Z 2.0 survey was distributed to participants using an electronic mailing list. Convergent validity was assessed between burnout and other items using Pearson's product-moment statistic. Structural validity was evaluated using an exploratory factor analysis and confirmatory factor analysis, and reliability was assessed using internal consistency. Results Of the 1,255 physicians and medical residents contacted, 283 responded (22.5%). Burnout was present in 34.6% of the participants, with 48.8% reporting high stress levels. Convergent validity was demonstrated, with satisfactory correlations between burnout and satisfaction, value alignment, work control, and stress. An exploratory factor analysis identified two factors (i.e., Well-Being and Relationships and Work-Related Stressors); however, the three models evaluated using the confirmatory factor analysis revealed a poor fit. Cronbach's alpha for the sample was 0.80. Conclusion The Japanese version of the Mini-Z 2.0 demonstrated good internal consistency and convergent validity. Despite its inadequate structural validity, it can be used to measure physician well-being and related workplace conditions in Japan.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Japan
| | - Yoshito Nishimura
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Japan
| | | | - Masashi Izumiya
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Japan
| | - Tetsuya Makiishi
- Department of General Medicine, Faculty of Medicine, Shimane University, Japan
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15
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Akbar F, Mark G, Prausnitz S, Warton EM, East JA, Moeller MF, Reed ME, Lieu TA. Physician Stress During Electronic Health Record Inbox Work: In Situ Measurement With Wearable Sensors. JMIR Med Inform 2021; 9:e24014. [PMID: 33908888 PMCID: PMC8116996 DOI: 10.2196/24014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/02/2021] [Accepted: 03/21/2021] [Indexed: 01/08/2023] Open
Abstract
Background Increased work through electronic health record (EHR) messaging is frequently cited as a factor of physician burnout. However, studies to date have relied on anecdotal or self-reported measures, which limit the ability to match EHR use patterns with continuous stress patterns throughout the day. Objective The aim of this study is to collect EHR use and physiologic stress data through unobtrusive means that provide objective and continuous measures, cluster distinct patterns of EHR inbox work, identify physicians’ daily physiologic stress patterns, and evaluate the association between EHR inbox work patterns and physician physiologic stress. Methods Physicians were recruited from 5 medical centers. Participants (N=47) were given wrist-worn devices (Garmin Vivosmart 3) with heart rate sensors to wear for 7 days. The devices measured physiological stress throughout the day based on heart rate variability (HRV). Perceived stress was also measured with self-reports through experience sampling and a one-time survey. From the EHR system logs, the time attributed to different activities was quantified. By using a clustering algorithm, distinct inbox work patterns were identified and their associated stress measures were compared. The effects of EHR use on physician stress were examined using a generalized linear mixed effects model. Results Physicians spent an average of 1.08 hours doing EHR inbox work out of an average total EHR time of 3.5 hours. Patient messages accounted for most of the inbox work time (mean 37%, SD 11%). A total of 3 patterns of inbox work emerged: inbox work mostly outside work hours, inbox work mostly during work hours, and inbox work extending after hours that were mostly contiguous to work hours. Across these 3 groups, physiologic stress patterns showed 3 periods in which stress increased: in the first hour of work, early in the afternoon, and in the evening. Physicians in group 1 had the longest average stress duration during work hours (80 out of 243 min of valid HRV data; P=.02), as measured by physiological sensors. Inbox work duration, the rate of EHR window switching (moving from one screen to another), the proportion of inbox work done outside of work hours, inbox work batching, and the day of the week were each independently associated with daily stress duration (marginal R2=15%). Individual-level random effects were significant and explained most of the variation in stress (conditional R2=98%). Conclusions This study is among the first to demonstrate associations between electronic inbox work and physiological stress. We identified 3 potentially modifiable factors associated with stress: EHR window switching, inbox work duration, and inbox work outside work hours. Organizations seeking to reduce physician stress may consider system-based changes to reduce EHR window switching or inbox work duration or the incorporation of inbox management time into work hours.
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Affiliation(s)
- Fatema Akbar
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, CA, United States
| | - Gloria Mark
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, CA, United States
| | - Stephanie Prausnitz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - E Margaret Warton
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Jeffrey A East
- The Permanente Medical Group, Oakland, CA, United States.,Department of Adult and Family Medicine, Kaiser Permanente, Richmond, CA, United States.,Department of Adult and Family Medicine, Kaiser Permanente, San Rafael, CA, United States
| | - Mark F Moeller
- The Permanente Medical Group, Oakland, CA, United States.,Department of Adult and Family Medicine, Kaiser Permanente, Napa, CA, United States
| | - Mary E Reed
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Tracy A Lieu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.,The Permanente Medical Group, Oakland, CA, United States
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16
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Abstract
While physicians advise patients on healthy lifestyle habits, physicians may struggle to abide by their own recommendations. We sought to characterize resident physician participation in exercise, their barriers to exercise, and the effect of exercise on their overall wellness. We hypothesized that residents who exercised would have less depression and greater wellbeing. Trainees at a university-based institution were surveyed. Data regarding exercise habits, hours worked, barriers to exercise, and mental health were acquired. Mental health was assessed via the Patient Health Questionnaire-2. Inter-group differences were analyzed using chi-squared testing; statistical significance was set at PÃ0.05. 129 trainees responded to the survey. 84 trainees reported exercising while 45 denied. 63 exercisers reported “living a healthy lifestyle” compared to 18 nonexercisers (PÃ0.001). Exercisers were more likely to report “Time” as their greatest barrier to exercise (PÃ0.001). Fifty-five exercisers answered “Not at all” when asked about how often they experience anhedonia compared to 23 non-exercisers. Trainees who exercise are more likely to report living a healthy lifestyle and less likely to experience anhedonia than non-exercisers, demonstrating the importance of exercise during residency.
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Affiliation(s)
- John D Milner
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Aristides I Cruz
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
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17
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Webber S, Babal JC, Shadman KA, Coller RJ, Moreno MA. Exploring Academic Pediatrician Perspectives of Factors Impacting Physician Well-Being. Acad Pediatr 2020; 20:833-839. [PMID: 32097783 DOI: 10.1016/j.acap.2020.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/10/2020] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Promotion of physician well-being has emerged as a national priority, yet meaningful interventions depend on further understanding the factors that promote and detract from physician well-being. The aim of this study was to better understand the perspectives of academic pediatricians regarding the factors influencing their well-being. METHODS We conducted a qualitative study using grounded theory methodology. In June 2018, we performed facilitated focus groups with academic pediatric faculty at our institution. Focus groups were audio recorded, transcribed, and analyzed using the constant comparative method to identify key themes. RESULTS Fifty-four pediatricians participated in the focus groups. Key themes included 1) pediatricians feel inundated by collective professional and personal pressures, 2) pediatricians feel they have lost control over how time at work is spent, and 3) obscured professional-personal boundaries can cause erosion of personal life. CONCLUSIONS Pediatricians identified 3 key barriers to well-being: collective pressures, including increasing and competing academic and clinical responsibilities; low value tasks that consume their time; and erosion of personal life. This study adds to the growing literature describing physician well-being as strongly influenced by workplace factors, and offers examples of modifiable factors for further investigation.
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Affiliation(s)
- Sarah Webber
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Jessica C Babal
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Kristin A Shadman
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Megan A Moreno
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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18
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Abstract
Pediatricians caring for patients with child abuse or neglect (CABN) may experience secondary traumatic stress (STS) from traumatized patients, or burnout (BO) from workplace stress. This may be buffered by compassion satisfaction (CS), positive meaning from one's work. For this study, STS, BO, and CS specific to a pediatrician's care of CABN were assessed for residents, hospitalists, intensivists, and outpatient physicians. Using the Professional Quality of Life Scale modified for CABN experiences, participants (n = 62) had a mean STS score at the 84th percentile, a mean BO score at the 66th percentile, and a mean CS score at the 17th percentile. Reporting one CABN patient as most emotionally impactful predicted STS, caring for all types of CABN predicted BO, and perceived knowledge no longer predicted CS when adjusting for the experience of mandated reporting or CABN fatality. These results highlight the need to support pediatricians involved with CABN.
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Affiliation(s)
- Mandy A O'Hara
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA.,New York-Presbyterian Hospital, New York, USA
| | - Teresa A McCann
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA.,New York-Presbyterian Hospital, New York, USA
| | - Weijia Fan
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, USA
| | - Mariellen M Lane
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA.,New York-Presbyterian Hospital, New York, USA
| | - Steven G Kernie
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA.,New York-Presbyterian Hospital, New York, USA
| | - Susan L Rosenthal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA.,New York-Presbyterian Hospital, New York, USA
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19
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Khera R, Dhingra LS, Jain S, Krumholz HM. An Evaluation of the Vulnerable Physician Workforce in the United States During the Coronavirus Disease-19 Pandemic. medRxiv 2020:2020.03.26.20044263. [PMID: 32511623 PMCID: PMC7276050 DOI: 10.1101/2020.03.26.20044263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BackgroundThe coronavirus disease-19 (COVID-19) pandemic threatens to overwhelm the healthcare resources of the country, but also poses a personal hazard to healthcare workers, including physicians. To address the potential impact of excluding physicians with a high risk of adverse outcomes based on age, we evaluated the current patterns of age of licensed physicians across the United States.MethodsWe compiled information from the 2018 database of actively licensed physicians in the Federation of State Medical Boards (FSMB) across the US. Both at a national- and the state-level, we assessed the number and proportion of physicians who would be at an elevated risk due to age over 60 years.ResultsOf the 985,026 licensed physicians in the US, 235857 or 23.9% were aged 25-40 years, 447052 or 45.4% are 40-60 years, 191794 or 19.5% were 60-70 years, and 106121 or 10.8% were 70 years or older. Age was not reported in 4202 or 0.4% of physicians. Overall, 297915 or 30.2% of physicians were 60 years of age or older, 246167 (25.0%) 65 years and older, and 106121 (10.8%) 70 years or older. States in the US reported that a median 5470 licensed physicians (interquartile range [IQR], 2394 to 10108) were 60 years of age or older. Notably, states of North Dakota (n=1180) and Vermont (n = 1215) had the lowest and California (n=50786) and New York (n=31582) the highest number of physicians over the age of 60 years (Figure 1). Across states, the median proportion of physicians aged 60 years and older was 28.9% (IQR, 27.2%, 31.4%), and ranged between 25.9% for Nebraska to 32.6% for New Mexico (Figure 2).DiscussionOlder physicians represent a large proportion of the US physician workforce, particularly in states with the worst COVID-19 outbreak. Therefore, their exclusion from patient care will be impractical. Optimizing care practices by limiting direct patient contact of physicians vulnerable to adverse outcomes from COVID-19, potentially by expanding their participation in telehealth may be a strategy to protect them.
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Affiliation(s)
- Rohan Khera
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Snigdha Jain
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, TX
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
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20
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Abstract
INTRODUCTION The prevalence of childhood trauma, as measured by the Adverse Childhood Experiences (ACE) Study questionnaire, has been studied in a wide variety of community settings. However, little is known about physicians' familiarity with and use of the ACE questionnaire or the prevalence of childhood trauma in the physician community. OBJECTIVE To survey a convenience sample of community-based physicians and resident physicians to assess for familiarity with and use of the ACE questionnaire in clinical practice and to measure the prevalence of their own ACEs. METHODS An electronic survey was created and disseminated that included demographic questions, questions about physician awareness and use of the ACE questionnaire in clinical practice, and the 10-point ACE questionnaire. RESULTS Most physicians surveyed (81%) reported they had never heard of the ACE questionnaire. Even fewer (3%) reported using the questionnaire in clinical practice. Most physicians (55.5%) reported no personal history of ACEs. Physicians reporting a history of childhood trauma reported a wide range of ACE scores (1-9). Compared with men, women reported a statistically higher number of ACEs (p < 0.001). CONCLUSION In this sample of community physicians, familiarity with and clinical use of the ACE questionnaire was low. Most physicians surveyed reported no personal history of childhood trauma. Of physicians reporting a history of childhood trauma, women were disproportionately affected. Physicians in this study reported a lower prevalence of ACEs than the population they serve. Physicians must become better educated and actively address the effects of ACEs on their patients and on themselves.
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Affiliation(s)
- Brian R Stork
- Department of Urology, University of Michigan, Ann Arbor
| | | | - Yongmei Qin
- Department of Urology, University of Michigan, Ann Arbor
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor
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21
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Abstract
Elisabeth Kübler-Ross' seminal 1969 work, On Death and Dying, opened the door to understanding individuals' emotional experiences with serious illness and dying. Patient's emotions, however, are only half the story in the patient-physician relationship. In recent years physicians' emotional reactions have gotten more attention. These sometimes-unacknowledged emotions influence how we approach our work, including life and death decisions. This article reviews some of the main emotions physicians experience when caring for seriously ill and dying patients and the challenges physicians face in regulating their emotions in a professional setting. We also discuss some of the ways that physician emotion may influence medical decision-making and contribute to conflict. Attention to the emotional level of physician experience may promote better care.
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22
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Wagner L, Pather MK. Exploring resilience in family physicians working in primary health care in the Cape Metropole. Afr J Prim Health Care Fam Med 2019; 11:e1-e10. [PMID: 31714119 PMCID: PMC6852591 DOI: 10.4102/phcfm.v11i1.1982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 06/07/2019] [Accepted: 09/05/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Despite the high prevalence of burnout among doctors, studies have shown that some doctors who choose to remain in primary healthcare (PHC) survive, even thrive, despite stressful working conditions. The ability to be resilient may assist family physicians (FPs) to adapt successfully to the relatively new challenges they are faced with. This research seeks to explore resilience through reflection on the lived experiences of FPs who have been working in PHC. AIM To explore the resilience of FPs working in PHC in the Cape Metropole. SETTING The study was conducted among FPs in PHC in the Cape Town metropole, Western Cape province, South Africa. METHODS A phenomenological qualitative study involved interviewing 13 purposefully selected FPs working in the public sector PHC in the Cape Metropole. Data were analysed using the framework method. RESULTS The mean resilience scale was moderate. Six key aspects of resilience were identified: having a sense of purpose, 'silver lining' thinking, having several roles with autonomy, skilful leadership, having a support network and self-care. CONCLUSION The aspects that contribute to FP resilience are multi-faceted. It entails having a sense of purpose, 'silver lining' thinking, having several roles with autonomy, skilful leadership, having a support network and valuing self-care. Our exploration of resilience in FPs in the Cape Metropole corroborates the findings of previous studies. To ensure physician wellness and improved patient outcomes, we recommend that individual and organisational strategies should be implemented in the absence of long-term policy changes.
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Affiliation(s)
- Leigh Wagner
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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23
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Makowski MS, Shanafelt TD, Hausel A, Bohman BD, Roberts R, Trockel MT. Associations Between Dietary Patterns and Sleep-Related Impairment in a Cohort of Community Physicians: A Cross-sectional Study. Am J Lifestyle Med 2019; 15:644-652. [PMID: 34916885 DOI: 10.1177/1559827619871923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/18/2019] [Accepted: 08/05/2019] [Indexed: 11/15/2022] Open
Abstract
There is increasing evidence that diet can mitigate fatigue. The objective of this study was to assess the associations between dietary habits and sleep-related impairment (SRI) in a cohort of community physicians. In this cross-sectional study, we analyzed data from 245 physicians who had completed a wellness survey in March 2016 (98% response rate). Three dietary patterns were derived using principal component analysis: plant based, high protein, and high saturated fat and sugar. In the adjusted analysis, every SD increase in the plant-based dietary pattern score was associated with a 0.71-point decrease (β = -0.72; SE = 0.32; P = .027; 95% CI = -1.35 to -0.08) in the SRI score, and every SD increase in the high saturated fat and sugar dietary pattern score was associated with a 0.77-point increase (β = 0.77; SE = 0.32; P = .015; 95% CI = 0.15 to 1.39) in the SRI score. There were no associations between high protein diets and SRI scores. Physicians adhering to diets that are high in plant-based foods and low in saturated fat and added sugars had less SRI. Physicians currently face significant barriers to maintaining a healthy diet. This study highlights the potential role of workplace nutrition on SRI and work performance of physicians.
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Affiliation(s)
- Maryam S Makowski
- Department of Psychiatry and Behavioral Sciences and Stanford Medicine WellMD
- WellPhD Center (MSH, MTT), Stanford University School of Medicine, California.,Department of Medicine and Stanford Medicine WellMD
- WellPhD Center (TDS), Stanford University School of Medicine, California.,Department of Anesthesiology, Perioperative and Pain Medicine (BDB), Stanford University School of Medicine, California.,University HealthCare Alliance, California (AH, BDB).,University Medical Partners, California (RR)
| | - Tait D Shanafelt
- Department of Psychiatry and Behavioral Sciences and Stanford Medicine WellMD
- WellPhD Center (MSH, MTT), Stanford University School of Medicine, California.,Department of Medicine and Stanford Medicine WellMD
- WellPhD Center (TDS), Stanford University School of Medicine, California.,Department of Anesthesiology, Perioperative and Pain Medicine (BDB), Stanford University School of Medicine, California.,University HealthCare Alliance, California (AH, BDB).,University Medical Partners, California (RR)
| | - Andrea Hausel
- Department of Psychiatry and Behavioral Sciences and Stanford Medicine WellMD
- WellPhD Center (MSH, MTT), Stanford University School of Medicine, California.,Department of Medicine and Stanford Medicine WellMD
- WellPhD Center (TDS), Stanford University School of Medicine, California.,Department of Anesthesiology, Perioperative and Pain Medicine (BDB), Stanford University School of Medicine, California.,University HealthCare Alliance, California (AH, BDB).,University Medical Partners, California (RR)
| | - Bryan D Bohman
- Department of Psychiatry and Behavioral Sciences and Stanford Medicine WellMD
- WellPhD Center (MSH, MTT), Stanford University School of Medicine, California.,Department of Medicine and Stanford Medicine WellMD
- WellPhD Center (TDS), Stanford University School of Medicine, California.,Department of Anesthesiology, Perioperative and Pain Medicine (BDB), Stanford University School of Medicine, California.,University HealthCare Alliance, California (AH, BDB).,University Medical Partners, California (RR)
| | - Rachel Roberts
- Department of Psychiatry and Behavioral Sciences and Stanford Medicine WellMD
- WellPhD Center (MSH, MTT), Stanford University School of Medicine, California.,Department of Medicine and Stanford Medicine WellMD
- WellPhD Center (TDS), Stanford University School of Medicine, California.,Department of Anesthesiology, Perioperative and Pain Medicine (BDB), Stanford University School of Medicine, California.,University HealthCare Alliance, California (AH, BDB).,University Medical Partners, California (RR)
| | - Mickey T Trockel
- Department of Psychiatry and Behavioral Sciences and Stanford Medicine WellMD
- WellPhD Center (MSH, MTT), Stanford University School of Medicine, California.,Department of Medicine and Stanford Medicine WellMD
- WellPhD Center (TDS), Stanford University School of Medicine, California.,Department of Anesthesiology, Perioperative and Pain Medicine (BDB), Stanford University School of Medicine, California.,University HealthCare Alliance, California (AH, BDB).,University Medical Partners, California (RR)
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24
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Lefebvre D, Dong KA, Dance E, Rosychuk RJ, Yarema M, Blouin D, Williams J, Rowe BH. Resident Physician Wellness Curriculum: A Study of Efficacy and Satisfaction. Cureus 2019; 11:e5314. [PMID: 31592369 PMCID: PMC6773458 DOI: 10.7759/cureus.5314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Recent literature highlights the alarming prevalence of burnout, depression, and illness during residency training; a trend that is also linked to suboptimal patient care. Dedicated wellness curricula may be one solution to this concerning issue. Purpose To determine the effect of a multi-faceted wellness curriculum during emergency medicine residency training on wellness scores and to assess resident satisfaction with the program. Methods This study was conducted via a longitudinal survey. In 2009, a faculty-derived resident wellness curriculum (F-RWC) was initiated. This program was then bolstered with a parallel resident-derived curriculum (R-RWC) one year later, in 2010. Emergency medicine residents were surveyed in 2009, 2010, and 2011 to assess wellness at baseline, after one year of the F-RWC, and after one year of combined RWCs, respectively. Surveys included two validated assessment instruments (the Brief Resident Wellness Profile (BRWP) and the SF-8TM Health Survey), a satisfaction Likert scale, and a demographics information sheet. Results The survey response rates were 89% (n=17), 100% (n=17), and 83% (n=24) from 2009, 2010, and 2011, respectively, for a total of 58 participants. From baseline in 2009, there was a significant improvement in resident wellness, with the addition of parallel RWC by 2011, as measured by the BRWP (p=0.024). The faces scale, a subset of the BRWP, showed a trend toward benefit but did not reach statistical significance (p=0.085). There was no evidence of a statistically significant change in SF-8TM scores over time. Participants consistently reported positive satisfaction scores with RWC initiatives. Conclusions Dedicated RWC, with input from both faculty and resident physicians, improved wellness during residency training with a high degree of participant satisfaction. Such programs are needed to support resident physicians during their training.
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Affiliation(s)
| | - Kathryn A Dong
- Emergency Medicine, Addiction Medicine, University of Alberta, Edmonton, CAN
| | - Erica Dance
- Emergency Medicine, University of Alberta, Edmonton, CAN
| | | | - Mark Yarema
- Emergency Medicine, University of Calgary, Calgary, CAN
| | - Danielle Blouin
- Emergency Medicine, Kingston Health Sciences Centre / Queen's University, Kingston, CAN
| | | | - Brian H Rowe
- Emergency Medicine, School of Community Based Medicine, University of Alberta, Edmonton, CAN
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25
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Abstract
Purpose of review Symptoms of burnout affect approximately half of pediatricians and pediatric subspecialists at any given time, with similarly concerning prevalence of other aspects of physician distress, including fatigue, depressive symptoms, and suicidal ideation. Physician well-being affects quality of care, patient satisfaction, and physician turnover. Organizational factors influence well-being, stressing the need for organizations to address this epidemic. Recent findings Organizational characteristics, policies, and culture influence physician well-being, and specific strategies may support an environment where physicians thrive. We highlight four organizational opportunities to improve physician well-being: developing leaders, cultivating community and organizational culture, improving practice efficiency, and optimizing administrative policies. Leaders play a key role in aligning organizational and individual values, promoting professional fulfillment, and fostering a culture of collegiality and social support among physicians. Reducing documentation burden and improving practice efficiency may help balance job demands and resources. Finally, reforming administrative policies may reduce work-home conflict, support physician's efforts to attend to their own well-being, and normalize use of supportive resources. Summary Physician well-being is critical to organizational success, sustainment of an adequate workforce, and optimal patient outcomes. Because burnout is primarily influenced by organizational factors, organizational interventions are key to promoting well-being. Developing supportive leadership, fostering a culture of wellness, optimizing practice efficiency, and improving administrative policies are worthy of organizational action and further research.
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Affiliation(s)
- Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.,California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Sarah Webber
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
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26
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Mirza W, Mirza AM, Saleem MS, Chacko PP, Ali M, Tarar MN, Babar A, Freiwald J, Talitskiy K. Well-being Assessment of Medical Professionals in Progressive Levels of Training: Derived from the WHO-5 Well-being Index. Cureus 2018; 10:e3790. [PMID: 30868004 PMCID: PMC6402727 DOI: 10.7759/cureus.3790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The provision of quality health care is of utmost importance for a physician. Over the years, there has been much debate regarding work-life imbalance and physician burnout, which may, in turn, have adverse effects on the quality of care. Medical school students, residents, interview candidates for residency, and internal medicine faculty are all under a varying degree of stress, which may impact their personal and professional lives. We distributed questionnaires to investigate our hypothesis: Progression in training years leads to a decline in well-being. The main objective of our assessment was to help devise interventions to improve the quality of training and the productivity of internal medicine physicians. Understanding the emotional functioning of physicians will help us improve the learning environment and, in turn, have a positive impact in the future for medical professionals. Medical students are burdened with excessive loans for undergraduate and graduate studies, which contributes to higher rates of burnout, depression, and suicide among medical professionals, which can lead to a direct and negative impact on quality of care. Our study showed that well-being scores declined with increasing financial stress; they were also affected by the visa status and training background of our subjects as medical students.
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Affiliation(s)
- Wasique Mirza
- Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
| | | | | | - Pravin P Chacko
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Maryyam Ali
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | | | - Afia Babar
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Jeremy Freiwald
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Konstantin Talitskiy
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
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Brown-Johnson CG, Chan GK, Winget M, Shaw JG, Patton K, Hussain R, Olayiwola JN, Chang SI, Mahoney M. Primary Care 2.0: Design of a Transformational Team-Based Practice Model to Meet the Quadruple Aim. Am J Med Qual 2018; 34:339-347. [PMID: 30409021 DOI: 10.1177/1062860618802365] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A new transformational model of primary care is needed to address patient care complexity and provider burnout. An 18-month design effort (2015-2016) included the following: (1) Needs Finding, (2) Integrated Facility Design, (3) Design Process Assessment, and (4) Development of Evaluation. Initial outcome metrics were assessed. The design team successfully applied Integrated Facility Design to primary care transformation design; qualitative survey results suggest that design consensus was facilitated by team-building activities. Initial implementation of Quadruple Aim-related outcome metrics showed positive trends. Redesign processes may benefit from emphasis on team building to facilitate consensus and increased patient involvement to incorporate patient voices successfully.
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Affiliation(s)
| | - Garrett K Chan
- 1 Stanford University School of Medicine, Stanford, CA.,2 Stanford Health Care, Stanford, CA
| | - Marcy Winget
- 1 Stanford University School of Medicine, Stanford, CA
| | | | - Kendra Patton
- 1 Stanford University School of Medicine, Stanford, CA.,2 Stanford Health Care, Stanford, CA
| | | | - J Nwando Olayiwola
- 4 University of California San Francisco (UCSF), San Francisco, CA.,5 RubiconMD, New York, NY
| | | | - Megan Mahoney
- 1 Stanford University School of Medicine, Stanford, CA.,2 Stanford Health Care, Stanford, CA
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Pozdnyakova A, Laiteerapong N, Volerman A, Feld LD, Wan W, Burnet DL, Lee WW. Impact of Medical Scribes on Physician and Patient Satisfaction in Primary Care. J Gen Intern Med 2018; 33:1109-1115. [PMID: 29700790 PMCID: PMC6025675 DOI: 10.1007/s11606-018-4434-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/16/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Use of electronic health records (EHRs) is associated with physician stress and burnout. While emergency departments and subspecialists have used scribes to address this issue, little is known about the impact of scribes in academic primary care. OBJECTIVE Assess the impact of a scribe on physician and patient satisfaction at an academic general internal medicine (GIM) clinic. DESIGN Prospective, pre-post-pilot study. During the 3-month pilot, physicians had clinic sessions with and without a scribe. We assessed changes in (1) physician workplace satisfaction and burnout, (2) time spent on EHR documentation, and (3) patient satisfaction. PARTICIPANTS Six GIM faculty and a convenience sample of their patients (N = 325) at an academic GIM clinic. MAIN MEASURES A 21-item pre- and 44-item post-pilot survey assessed physician workplace satisfaction and burnout. Physicians used logs to record time spent on EHR documentation outside of clinic hours. A 27-item post-visit survey assessed patient satisfaction during visits with and without the scribe. KEY RESULTS Of six physicians, 100% were satisfied with clinic workflow post-pilot (vs. 33% pre-pilot), and 83% were satisfied with EHR use post-pilot (vs. 17% pre-pilot). Physician burnout was low at baseline and did not change post-pilot. Mean time spent on post-clinic EHR documentation decreased from 1.65 to 0.76 h per clinic session (p = 0.02). Patient satisfaction was not different between patients who had clinic visits with vs. without scribe overall or by age, gender, and race. Compared to patients 65 years or older, younger patients were more likely to report that the physician was more attentive and provided more education during visits with the scribe present (p = 0.03 and 0.02, respectively). Male patients were more likely to report that they disliked having a scribe (p = 0.03). CONCLUSION In an academic GIM setting, employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction.
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Affiliation(s)
| | - Neda Laiteerapong
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Anna Volerman
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lauren D Feld
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Wen Wan
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Deborah L Burnet
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Wei Wei Lee
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
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29
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Kao AC, Jager AJ, Koenig BA, Moller AC, Tutty MA, Williams GC, Wright SM. Physician Perception of Pay Fairness and its Association with Work Satisfaction, Intent to Leave Practice, and Personal Health. J Gen Intern Med 2018; 33:812-817. [PMID: 29380217 PMCID: PMC5975140 DOI: 10.1007/s11606-017-4303-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/01/2017] [Accepted: 12/13/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Primary care physicians generally earn less than specialists. Studies of other occupations have identified perception of pay fairness as a predictor of work- and life-related outcomes. We evaluated whether physicians' pay fairness perceptions were associated with their work satisfaction, turnover intention, and personal health. METHODS Three thousand five hundred eighty-nine physicians were surveyed. Agreement with "my total compensation is fair" was used to assess pay fairness perceptions. Total compensation was self-reported, and we used validated measures of work satisfaction, likelihood of leaving current practice, and health status. Hierarchical logistic regressions were used to assess the associations between pay fairness perceptions and work/life-related outcomes. RESULTS A total of 2263 physicians completed surveys. Fifty-seven percent believed their compensation was fair; there was no difference between physicians in internal medicine and non-primary care specialties (P = 0.58). Eighty-three percent were satisfied at work, 70% reported low likelihood of leaving their practice, and 77% rated their health as very good or excellent. Higher compensation levels were associated with greater work satisfaction and lower turnover intention, but most associations became statistically non-significant after adjusting for pay fairness perceptions. Perceived pay fairness was associated with greater work satisfaction (OR, 4.90; 95% CI, 3.94-6.08; P < 0.001), lower turnover intention (OR, 2.46; 95% CI, 2.01-3.01; P < 0.001), and better health (OR, 1.33; 95% CI, 1.08-1.65; P < 0.01). DISCUSSION Physicians who thought their pay was fair reported greater work satisfaction, lower likelihood of leaving their practice, and better overall health. Addressing pay fairness perceptions may be important for sustaining a satisfied and healthy physician workforce, which is necessary to deliver high-quality care.
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Affiliation(s)
| | - Andrew J Jager
- American Medical Association, Chicago, IL, USA.,Health Research & Educational Trust, Chicago, IL, USA
| | | | - Arlen C Moller
- Illinois Institute of Technology and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Scott M Wright
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Conran RM, Powell SZE, Domen RE, McCloskey CB, Brissette MD, Cohen DA, Dixon LR, George MR, Gratzinger DA, Post MD, Roberts CA, Rojiani AM, Timmons CF, Johnson K, Hoffman RD. Development of Professionalism in Graduate Medical Education: A Case-Based Educational Approach From the College of American Pathologists' Graduate Medical Education Committee. Acad Pathol 2018; 5:2374289518773493. [PMID: 30014035 PMCID: PMC6039899 DOI: 10.1177/2374289518773493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/21/2018] [Indexed: 11/17/2022] Open
Abstract
Professionalism and physician well-being are important topics in academic medicine. Lapses in professional judgment may lead to disciplinary action and put patient's health at risk. Within medical education, students and trainees are exposed to professionalism in the institution's formal curriculum and hidden curriculum. Development of professionalism starts early in medical school. Trainees entering graduate medical education already have developed professional behavior. As a learned behavior, development of professional behavior is modifiable. In addition to role modeling by faculty, other modalities are needed. Use of case vignettes based on real-life issues encountered in trainee and faculty behavior can serve as a basis for continued development of professionalism in trainees. Based on the experience of program directors and pathology educators, case vignettes were developed in the domains of service, research, and education and subdivided into the areas of duty, integrity, and respect. General and specific questions pertaining to each case were generated to reinforce model behavior and overcome professionalism issues encountered in the hidden curriculum. To address physician burnout, cases were generated to provide trainees with the skills to deal with burnout and promote well-being.
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Affiliation(s)
- Richard M. Conran
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Ronald E. Domen
- Department of Pathology, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, USA
| | - Cindy B. McCloskey
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - David A. Cohen
- Emory University Hospital, Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - Lisa Ross Dixon
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Melissa Robin George
- Department of Pathology, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, USA
| | - Dita A. Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Miriam D. Post
- Department of Pathology, University of Colorado—Anschutz Medical Campus, Aurora, CO, USA
| | | | - Amyn M. Rojiani
- Department of Pathology, Augusta University-Medical College of Georgia, Augusta, GA, USA
| | | | | | - Robert D. Hoffman
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
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Abstract
There are many causes of physician burnout in today’s health care environment, including an ever increasing administrative workload, pressure to do more work in less time, and a drive to reduce costs and improve patient outcomes. Importantly, lack of meaning in work is a crucial documented driver of physician burnout. Clinical encounters perceived as meaningful by physicians could therefore potentially positively impact physician well-being. Here we reflect on the potential of interventions that aim to enhance the patient-physician interaction, such as shared decision making, to improve physician well-being by facilitating interactions with patients that are perceived as meaningful.
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Affiliation(s)
- Claudia C Dobler
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Colin P West
- Division of General Internal Medicine and Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
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Abstract
Providing care for simulated emergency patients may induce considerable acute stress in physicians. However, the acute stress provoked in a real-life emergency room (ER) is not well known. Our aim was to assess acute stress responses in residents during real emergency care and investigate the related personal and situational factors. A cross-sectional observational study was carried out at an emergency department of a tertiary teaching hospital. All second-year internal medicine residents were invited to voluntarily participate in this study. Acute stress markers were assessed at baseline (T1), before residents started their ER shift, and immediately after an emergency situation (T2), using heart rate, systolic, and diastolic blood pressure, salivary α-amylase activity, salivary interleukin-1 β, and the State-Trait Anxiety Inventory (STAI-s and STAI-t). Twenty-four residents were assessed during 40 emergency situations. All stress markers presented a statistically significant increase between T1 and T2. IL-1 β presented the highest percent increase (141.0%, p < .001), followed by AA (99.0%, p = .002), HR (81.0%, p < .001), DBP (8.0%, p < .001), and SBP (3.0%, p < .001). In the multivariable analysis, time of residency had a negative correlation with HR during the emergency (adjusted R-square = .168; F = 8.69; p = .006), SBP response (adjusted R-square = .210; F = 6.19; p = .005) and DBP response (adjusted R-square = .293; F = 9.09; p = .001). Trait anxiety (STAI-t) was positively correlated with STAI-s (adjusted R-square = .326; F = 19.9; p < .001), and number of procedures performed during emergency care had a positive association with HR response (adjusted R-square = .241; F = 5.02; p = .005). In the present study, emergency care provoked substantial acute stress in residents. Resident experience, trait anxiety, and number of emergency procedures were independently associated with acute stress response.
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Affiliation(s)
- Roger Daglius Dias
- a STRATUS Center for Medical Simulation , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
- b Emergency Department , Hospital das Clínicas, University of São Paulo Medical School , São Paulo , Brazil
| | - Augusto Scalabrini Neto
- b Emergency Department , Hospital das Clínicas, University of São Paulo Medical School , São Paulo , Brazil
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33
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Ratanawongsa N, Roter D, Beach MC, Laird SL, Larson SM, Carson KA, Cooper LA. Physician burnout and patient-physician communication during primary care encounters. J Gen Intern Med 2008; 23:1581-8. [PMID: 18618195 DOI: 10.1007/s11606-008-0702-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 05/27/2008] [Accepted: 06/04/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies relate physician burnout to observed patient-physician communication behaviors. OBJECTIVE To investigate the relationship between physician burnout and observed patient-physician communication outcomes in patient-physician encounters. DESIGN Longitudinal study of enrollment data from a trial of interventions to improve patient adherence to hypertension treatment. SETTING Fifteen urban community-based clinics in Baltimore, MD. PARTICIPANTS Forty physicians and 235 of their adult hypertensive patients, with oversampling of ethnic minorities and poor persons. Fifty-three percent of physicians were women, and the average practice experience was 11.2 years. Among the 235 patients, 66% were women, 60% were African-American, and 90% were insured. MEASUREMENTS Audiotape analysis of communication during outpatient encounters (one per patient) using the Roter Interaction Analysis System and patients' ratings of satisfaction with and trust and confidence in the physician. RESULTS The median time between the physician burnout assessment and the patient encounter was 15.1 months (range 5.6-30). Multivariate analyses revealed no significant differences in physician communication based on physician burnout. However, compared with patients of low-burnout physicians, patients of high-burnout physicians gave twice as many negative rapport-building statements (incident risk ratio 2.06, 95% CI 1.58-2.86, p < 0.001). Physician burnout was not significantly associated with physician or patient affect, patient-centeredness, verbal dominance, or length of the encounter. Physician burnout was also not significantly associated with patients' ratings of their satisfaction, confidence, or trust. CONCLUSIONS Physician burnout was not associated with physician communication behaviors nor with most measures of patient-centered communication. However, patients engaged in more rapport-building behaviors. These findings suggest a complex relationship between physician burnout and patient-physician communication, which should be investigated and linked to patient outcomes in future research.
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