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Linking physician burnout and patient outcomes: Exploring the dyadic relationship between physicians and patients

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Abstract

Although patient outcomes of hospital stays have been widely explored, particularly patient satisfaction, there is a dearth of research linking health care provider burnout and patient outcomes at a dyadic level. In this article, we develop and test a model to explain the relationship between dimensions of burnout and patient outcomes, including patient satisfaction and recovery time. The purpose of this article is to explore the relationship between physician burnout and patient satisfaction and the time required to regain normal functioning after hospital discharge. This study was based upon a survey of 178 matched pairs of patients and physicians. The patients were people who had been hospitalized within the previous year. We found support for the notion that the depersonalization dimension of physician burnout was associated with patient outcomes of lower satisfaction and longer post discharge recovery time (after controlling for severity of illness and other demographic factors). The findings suggest that physician burnout has an impact on patient outcomes. Although this is a preliminary study, it suggests that organizations that take proactive steps to reduce burnout through system wide intervention programs will see greater benefits in terms of patient satisfaction and recovery.

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... For example, providers suffering from burnout are less likely to ask open-ended questions and might miss details that are important to the patient and their care, leading to longer perceived recovery times and decreased patient satisfaction. 9 Organizations suffer from lost revenue through decreased productivity and high turnover costs. 9,10 Clinicians suffer from higher rates of depression with suicide rates 100% to 200% higher than the general population. ...
... 9 Organizations suffer from lost revenue through decreased productivity and high turnover costs. 9,10 Clinicians suffer from higher rates of depression with suicide rates 100% to 200% higher than the general population. 11 It has been shown that PAs experience the highest rates of burnout between 5 and 9 years of experience. ...
Article
Introduction: Nearly half of all medical students suffer from burnout, which not only has detrimental effects on the students themselves but can transfer into the clinical realm. Yet, studies exploring burnout and interpersonal toxicity in physician assistant (PA) students are rare. This study examined the role that interpersonal toxicity and abuse play in PA student burnout. Methods: Nearly 2500 PA students in the United States responded to a survey about well-being, stress, and experiences with interpersonal toxicity in PA school as part of a larger cross-sectional study on PA student experiences in their didactic and clinical years. The present research focuses on overall measures among all PA students, as well as differences between didactic and clinical students, including the extent to which experiences of interpersonal toxicity predict symptoms associated with burnout. Results: Overall, PA students reported high levels of satisfaction and happiness in school and life, but enthusiasm for school decreased for clinical students. More than two-thirds of students reported moderate to high levels of life stress, and more than 9 in 10 reported moderate to high levels of school stress. Symptoms of burnout were reported by many students, with clinical students reporting interpersonal toxicity exposure more often than didactic students. Experiencing interpersonal toxicity or abuse predicted symptoms of burnout. Discussion: While PA students report high levels of life and school satisfaction, given the high levels of stress also reported, burnout metrics and well-being programs are needed. PA programs should work to create a supportive and engaging educational environment to ensure students' long-term career success.
... 1,2 Burnout is a WHO recognized occupational syndrome 3 associated with adverse health consequences [4][5][6][7] including depression, [8][9][10] sleep-related impairment, 11,12 diabetes, 13 and heart disease. 14,15 Physician burnout is also associated with adverse patient care outcomes [16][17][18][19] and higher health care costs. [20][21][22][23][24][25][26] Studies of occupational distress in physicians commonly assess components of burnout including exhaustion and depersonalization at work. ...
... For example, in other studies, patients' postehospital discharge recovery times were demonstrably longer if the doctor responsible for their care during hospitalization had higher levels of depersonalization. 19 Without adjusting for burnout or sleeprelated impairment, the results of the present study could be reasonably postulated as being due to a potentially confounding relationship between IWPR with burnout or sleep-related impairment and unsolicited patient complaints. However, the association between the adverse IWPR and unsolicited patient complaints persisted and was of similar magnitude after adjusting for interpersonal disengagement, overall burnout, and sleep-related impairment, arguing against this notion. ...
Article
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Objective To evaluate the relationship between an adverse impact of work on physicians’ personal relationships and unsolicited patient complaints about physician behavior — a well-established indicator of patient care quality. Participants and Methods We paired data from a physician wellness survey collected in April and May 2013 with longitudinal unsolicited patient complaint data collected independently from January 1, 2013, to December 31, 2016. Unsolicited patient complaints were used to calculate the Patient Advocacy Reporting System (PARS) score, an established predictor of clinical outcomes and malpractice suits. The primary outcome was PARS score tercile. Ordinal logistic regression mixed effects models were used to assess the association between the impact of work on a physician’s personal relationships and PARS scores. Results Of 2384 physicians eligible to participate, 831 (34.9%) returned surveys including 429 (51.6%) who consented for their survey responses to be linked to independent data and had associated PARS scores. In a multivariate model adjusting for gender and specialty category, each 1-point higher impact of work on personal relationships score (0-10 scale; higher score unfavorable) was associated with a 19% greater odds of being in the next higher PARS score tercile of unsolicited patient complaints (odds ratio, 1.19; 95% CI, 1.07-1.33) during the subsequent 4-year study period. Conclusion An adverse impact of work on physicians’ personal relationships is associated with independently assessed, unsolicited patient complaints. Organizational efforts to mitigate an adverse impact of work on physicians’ personal relationships are warranted as part of efforts to improve the quality of patient experience and malpractice risk.
... HCP burnout is dangerous. It associates with stress [26], suicidal ideation [18,27], motor vehicle accidents [28], decreased productivity [29,30], decreased empathy [15], increased medical errors [15,17,28], suboptimal care [19,[31][32][33] and increased costs [34,35]. This finding is a critical issue that needs addressing. ...
Article
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Background The COVID-19 pandemic is placing a significant strain on healthcare. We conducted a national survey of the UK nephrology workforce to understand its impacts on their working lives. Methods An online questionnaire incorporating the Maslach Burnout Inventory Score was distributed between 31st March and 1st May 2021, with a focus on COVID-19 and long COVID incidence, vaccine uptake, burnout, and working patterns. Data were analysed qualitatively and quantitatively; multivariable logistic regression was used to identify associations. Results 423 responses were received. 29% had contracted COVID-19, more common among doctors and nurses (OR 2.18, 95%CI 1.13–4.22), and those under the age of 55 (OR 2.60, 95%CI 1.38–4.90). 36% of those who contracted COVID-19 had symptoms of long COVID, more common among ethnicities other than White British (OR 2.57, 95% CI 1.09–6.05). 57% had evidence of burnout, more common amongst younger respondents (OR 1.92, 95% CI 1.10–3.35) and those with long COVID (OR 10.31, 95% CI 1.32–80.70). 59% with reconfigured job plans continue to work more hours. More of those working full-time wished to retire early. 59% experienced remote working, with a majority preference to continue this in the future. 95% had received one dose of a COVID-19 vaccine; 86% had received two doses by May 2021. Conclusions Burnout and long COVID is prevalent with impacts on working lives. Some groups more at risk. Vaccination uptake is high, and remote and flexible working were well received. Institutional interventions are needed to prevent workforce attrition.
... 37 For instance, the presence of BO has been linked to significantly greater odds of reporting suboptimal patient care attitudes and behaviors including not discussing treatment options and making treatment or medication errors among pediatric 38 and emergency physicians. 39 Also, high levels of EE and DP among physicians [40][41][42] and nurses 43 have been associated with lower patient satisfaction scores in primary care. 40 Beyond these, BO and compassion fatigue can even lead to increased medical disputes, 44 increased costs to healthcare organizations, 45 decreased productivity, and high staff turnover. ...
Article
Healthcare staff across varied clinical settings are faced with varied stressors that can lead to compassion fatigue. However, there is currently no review examining the phenomenon in-depth in the burn unit. Thus, the current study sought to scope existing studies to ascertain the prevalence, contributing factors, and effects of compassion fatigue in the burn unit. Compassion fatigue was conceptualized as comprising of burnout and secondary traumatic stress. Arksey and O’Malley scoping review approach was used and reported according to the PRISMA extension guidelines. Searches were undertaken across peer-reviewed databases and grey literature sources for quantitative studies. Following the search and screening process, nine studies were retained. Codes were formulated across studies following which narrative synthesis was undertaken. Majority of the studies (n=5) focused on burn care nurses. High levels of emotional exhaustion and depersonalization and comparatively low level of personal achievement were reported among burn care staff which is indicative of burnout. Compassion fatigue was also observed to be high among burn care staff. Contributing factors are varied albeit some variables such as age, staffing levels, remuneration, nature of the work environment, and number of years worked were consistent across some studies. In conclusion, working in the burn unit is challenging with significant stressors that can lead to burnout, traumatic stress, and subsequently, compassion fatigue. Interventions to promote resilience, hardiness, optimal working environment, peer, and psychosocial support are greatly needed.
... General practitioner burnout (including physicians and other medical specialties) is a recognised health care problem that has become widespread over time and for which the adverse effects on clinicians [1][2][3][4][5][6][7][8][9][10][11][12][13] and patients 14,2 have been documented. Given these deleterious effects, estimating the prevalence of General Practitioners' burnout is important. ...
Article
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Background Burnout is a work-related syndrome documented to have negative consequences for general practitioners (GPs) and their patients. Our objective was to conduct a systematic review and meta-analysis of the literature to provide an estimate of how widespread this phenomenon is. Aim: To review the existing literature concerning studies published up to December, 2020, on the prevalence of burnout amongst GPs in general practice, to determine GP burnout estimates worldwide. Design and setting: Systematic literature search and meta-analysis. Method: Searches of CINAHL Plus, Embase, MEDLINE, PsycINFO, and Scopus were conducted to identify published peer-reviewed quantitative empirical studies in English up to December, 2020, that have used the Maslach Burnout Inventory-Human Services Survey to establish the prevalence of burnout in practising GPs (i.e., excluding GPs in training). A random-effects model was employed. Results: Wide-ranging prevalence estimates (6% to 32%) for 22,177 GPs across 29 countries were reported for 60 studies included in this review. Mean burnout estimates were as follows: 16.43 (EE); 6.74 (DEP); and 29.28 (PA). Subgroup and meta-analyses documented that country-specific factors may be important determinants of the variation in GP burnout estimates. Moderate overall burnout cut-offs were found to be determinants of the variation in moderate overall burnout estimates. Conclusion: Moderate to high GP burnout exist worldwide. However, substantial variations in how burnout is characterised and operationalised resulted in considerable heterogeneity in GP burnout prevalence estimates. This highlights the challenge of developing a uniform approach, and the importance of considering the GP's work context, to better characterise burnout.
... Career-wise, burnout has been related to serious thoughts of resignation or dropping out, a decline in professional work effort, unprofessional conduct, lower patient satisfaction, and reduced quality of care [8][9][10]. Regarding the provision of care for different types of disorders, studies have examined which subsets could be at the highest risk of burnout. ...
Article
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Burnout in healthcare workers (HCWs) is defined as a state of emotional, physical, and mental exhaustion that results from unmanaged, excessive, and long-term workplace stressors. This study aims to assess the prevalence of burnout and the levels of anxiety and depression among HCWs who primarily work with children who have autism spectrum disorder (ASD). A quantitative cross-sectional survey was conducted utilizing the Arabic version of the Maslach Burnout Inventory (MBI), Areas of Worklife Survey (AWS), Patient Health Questionnaire for Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire for Depression (PHQ-9). Among the 381 participants working in autism centers, the majority were young Saudi females (326) working full-time as specialists in the private sector with less than five years of experience. The HCWs’ overall mean scores on the three Maslach Burnout Inventory (MBI) subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were 62%, 23.7%, and 76.5%, respectively. A total of 51.4% of HCWs reported moderate to high anxiety levels on GAD-7, and 47.8% showed moderate to very high levels of depression on PHQ-9. The mean perceived EE converged significantly but negatively on their overall mean perceived satisfaction with AWS (p-value < 0.001), demonstrating that greater emotional fatigue predicts less satisfaction with their work. The PA scores correlated significantly and positively with their overall mean satisfaction with their AWS score (p-value < 0.001). Considering sociodemographic variables, HCWs aged between 20–29 years have significantly lower mean PA scores than HCWs aged thirty and older (p = 0.007). Also, male HCWs perceived significantly higher work-related DP than females. More research is required to determine the nature of variables that contribute to burnout, depression, and anxiety in HCWs helping children with ASD.
... It is linked to a lack of compassion, increased tendency towards medication errors, and consequently, poor patient satisfaction and poor outcomes. A cross-sectional study on the relationship between physician burnout and patient outcomes concluded that physician's emotional exhaustion and physician depersonalization are significantly correlated with longer recovery time and patient dissatisfaction [6]. Indirectly, the physician burnout also compromises patient care as it relates to higher attrition rates and consequently to a diminished healthcare workforce pool. ...
Article
Background Neurology residents are particularly vulnerable to burnout because of the novel logistical and clinical challenges brought about by the coronavirus disease 2019 (COVID-19) pandemic. Despite its implications, knowledge on burnout and its predictors among neurology residents is lacking. This study aimed to determine the prevalence of burnout among neurology residents during the pandemic, to compare burnout subscale scores and sociodemographic and work characteristics, and to explore residents’ perceptions on how to address burnout.Methods We conducted a cross-sectional survey among all 120 residents from the nine institutions in the Philippines offering neurology residency programs from March to August 2020. We obtained sociodemographic and work characteristics using questionnaire. We measured burnout using the Maslach Burnout Inventory. We performed an inductive thematic analysis to analyze perceptions on how to reduce burnout.ResultsThe response rate was 71.67% (86/120). The mean age was 30.1 ± 3.1 years. Using predefined subscale critical boundaries, the prevalence of burnout was 94% (95% CI 89, 99). The lack of compensation and number of on-duty days influenced emotional exhaustion scores. The number of on-duty days influenced depersonalization scores. Thematic analysis revealed five themes: increasing manpower; self-care; reducing clerical tasks; improving work environment; and adequate compensation.Conclusions The prevalence of burnout among neurology residents during the COVID-19 pandemic was alarmingly high. Reforms in hiring policies, work-hour management, manpower organization, work environment, and logistics may be considered.
... 15 Burnout is associated with major depression, poor patient outcomes and more negative feelings towards patients. [16][17][18] Physician burnout also results in significant economic loss. 19 By contrast, psychiatry is well placed to drive positive change. ...
Article
Background: Burnout is a widely reported syndrome consisting of emotional exhaustion, depersonalization, and a lowered sense of accomplishment. Mindfulness practices have been shown to be useful in lowering distress and burnout in clinical and non-clinical cohorts. Our aim was to explore the potential personal and occupational benefits of a structured mindfulness intervention on a cohort of mental health professionals. A mixed-methods approach was utilised in order to enhance the exploratory power of the study. Methods : We conducted a pilot study involving healthcare practitioners employed at a community outpatient mental health clinic. As a pilot, we relied on a single group and implemented a quasi-experimental, simultaneous mixed methods design by incorporating both quantitative pre- and post- testing alongside written qualitative post-test responses. Results : Analysis of the data demonstrated a significant difference between overall mindfulness when comparing post-test (mean=140.8, standard deviation=18.9) with pre-test data (mean=128.3, standard deviation=28.6). Participants also showed a statistically significant difference in three of the subscales: observation, describing, and non-reactivity. A moderate effect size was seen for each of the above differences. Analysis of the qualitative data revealed a range of potential themes which may be used to explain the differences exhibited across participants’ personal and professional lives, which can be grouped into two thematic overarching groups: emotional reactivity and listening/communicating. Conclusions : The results of this pilot study indicate that a structured, six-week mindfulness program has the potential to benefit clinicians, personally by reducing emotional reactivity and professionally by promoting deep listening and communication.
... Physician and healthcare worker burnout is an important topic in academic medicine and increasing issue of concern during the COVID-19 pandemic. Physician burnout is associated with increased turnover [1], increased medical errors, reduced patient satisfaction, and longer patient recovery [2][3][4]. Burnout is multifactorial, including emotional exhaustion, depersonalization (callous reactions toward patients), and reduced efficacy [5]. While burnout among physicians is well-documented, limited research among psychologists working in academic medicine has occurred. ...
Article
Objective Burnout in academic medicine has been widely studied, but most work has been conducted among physicians. Psychologists in academic medicine have unique burnout factors. Therefore, investigating the prevalence and predictors of burnout among psychologists in academic medicine during the COVID-19 pandemic represents an important addition to the literature.Methods Sixty-two psychologists responded to burnout-related items in a larger, 40-item Psychiatry Department climate survey conducted from October to November 2020. Five items from the MINI-Z survey were administered to examine control over workload and sufficiency of documentation time as predictors of both continuous and dichotomously defined burnout. Linear and logistic regression was employed with years as a faculty member entered as a covariate.ResultsSlightly less than half (48.4%) of respondents met dichotomous criteria for burnout. Faculty with fewer years of experience scored higher on their level of continuous burnout. Both control over workload and sufficiency of time for documentation were independent predictors of continuous burnout, but only control over workload remained a statistically significant predictor in a simultaneous model. Control over workload was a significant predictor in dichotomous models but did not remain so once sufficiency of documentation time was also added.Conclusion Burnout prevalence among psychologists was comparable to rates among physicians at other institutions, even when examined during the COVID-19 pandemic. Academic medicine administrators and organizational leaders should consider policies and programming to increase control over workload, especially among junior psychologist faculty.
... Burnout among physicians can have devastating effects on patient care, including a significantly increased risk of medical errors (Shanafelt et al. 2010;Hall et al. 2016), a decreased job productivity (Dewa et al. 2014;Shanafelt et al. 2016) and a lower patient satisfaction rate (Haas et al. 2000;Halbesleben and Rathert 2008). Furthermore, physicians with burnout may suffer from somatic and mental health problems, including depression and substance abuse (Oreskovich et al. 2012;Medisauskaite and Kamau 2017), an increased risk of vehicular accidents (West et al. 2012) and an increased suicide risk (van der Heijden et al. 2008). ...
Article
Full-text available
Purpose Oncologists are at an increased risk of developing burnout, leading to negative consequences in patient care and in professional satisfaction and quality of life. This study was designed to investigate exhaustion and disengagement among German oncologists and assess the prevalence of burnout among oncologists within different professional settings. Furthermore, we wanted to examine possible relations between sociodemographic factors, the oncological setting, professional experience and different aspects of burnout. Methods In a cross-sectional study design, an Internet-based survey was conducted with 121 oncologists between April and July 2020 using the Oldenburg Burnout Inventory, which contains items on exhaustion, disengagement, and burnout. Furthermore, sociodemographic data of the participants were assessed. The participants were members of the Working Group Medical Oncology ( Arbeitsgemeinschaft Internistische Onkologie ) within the German Cancer Society. Results The survey showed a burnout prevalence of 43.8%, which correlated with age and professional experience; that is, the prevalence is particularly high among younger oncologists. Exhaustion is closely related to employment status; that is, it was significantly higher among employed oncologists. There were remarkably low levels of disengagement among oncologists, highlighting the own demand to fulfil job requirements despite imminent or actual overburdening in daily work. Conclusion More support is necessary to mitigate the professional stressors in the healthcare system. To ensure quality medical care, employees should be offered preventive mental health services early in their careers.
... In a recent study, almost 80% of PA students met criteria for at least one of the burnout dimensions [23]. The extraordinary levels of suffering among frontline medical providers have profoundly harmful effects on quality of care, patient satisfaction, safety, and treatment adherence [21,[24][25][26][27][28][29][30][31][32][33]. In addition, provider burnout and depression increase attrition and contribute to the current and estimated shortages of physicians and PAs [13,[34][35][36][37][38][39][40]. ...
Article
Full-text available
While much attention has been paid to healthcare provider and trainee burnout, less is known about provider well-being (i.e., flourishing) or about the effects of well-being on immune function. This study examined the demographic and psycho-social correlates of well-being among healthcare trainees (resident physicians and physician assistant (PA) trainees) and evaluated the association of well-being with the “conserved transcriptional response to adversity” (CTRA) characterized by up-regulated expression of pro-inflammatory genes and down-regulated expression of innate antiviral genes. Participants (n = 58) completed self-reported assessments of sleep disturbance, loneliness, depressive symptoms, anxiety, stress, and well-being (flourishing). Blood sample RNA profiles were analyzed by RNA sequencing to assess the CTRA. Slightly over half (n = 32; 55.2%) of healthcare trainees were categorized as flourishing. Flourishing was less prevalent among primary caregivers, and more prevalent among trainees who exercised more frequently and those with fewest days sick. Loneliness (AOR = 0.75; 95% CI = 0.61, 0.91; p = 0.003) and stress (AOR = 0.65; 95% CI = 0.45, 0.94; p = 0.02) were associated with decreased odds of flourishing when controlling for other variables. Flourishing was associated with down-regulated CTRA gene expression, whereas loneliness was associated with up-regulated CTRA gene expression (both p < 0.05). Assessing these relationships in a larger, multi-site study is of critical importance to inform policy, curricula, and interventions to bolster sustainable trainee well-being.
... Diversos estudios publicados desde el inicio de la pandemia COVID-19 evidencian una alta prevalencia de burnout en profesionales de la salud que asisten a pacientes contagiados, con valores que oscilan entre el 31% y el 90% dependiendo, entre otras cosas, del país, el área o servicio y rol que desempeñan los profesionales en la institución, y el período en el que se realizó el estudio 11,12,13 . La presencia de burnout en profesionales de la salud se ha asociado con mayor ansiedad y depresión, mayor ausentismo e intención de abandonar la profesión, mayor tasa de errores médicos y un tiempo de recuperación más lento en pacientes 14,15,16,17 . En consecuencia, resulta de gran interés identificar los factores que pueden evitar o disminuir el riesgo de desarrollar burnout. ...
Article
Full-text available
Objetivos: la pandemia COVID-19 representa un gran desafío para la salud mental, especialmente para los profesionales de la salud que trabajan en primera línea de atención. Uno de los principales indicadores de daño psicológico que se observa en el personal de salud es el incremento de agotamiento o burnout. El presente estudio evalúa el impacto de la satisfacción con diferentes recursos laborales (líder, tarea, equipo, organización) sobre el burnout y work engagement en trabajadores de la salud. Material y métodos: se aplicó una encuesta anónima online a 125 trabajadores (médicos, enfermeros) de una institución privada de salud de la ciudad de Córdoba, Argentina. El 76% de los participantes fueron mujeres. Resultados: los resultados obtenidos mediante análisis de correlación bivariada y regresión múltiple evidenciaron la influencia positiva de la satisfacción con los recursos en el work engagement, y negativa sobre el burnout. De manera específica, el análisis de regresión mostró que la satisfacción con los recursos organizacionales fue el factor que mejor predijo, negativamente, el burnout (βagotamiento = -.22; βcinismo = -.53) mientras que la satisfacción con los recursos de tarea fue el principal predictor del work engagement (βdedicación = .45; βabsorción = .34). Conclusiones: los resultados destacan la importancia de la satisfacción con los recursos laborales para cuidar la salud de los profesionales en contextos de crisis sanitaria y alta demanda. Se proponen algunas recomendaciones prácticas que pueden ser útiles para disminuir el burnout, promover el work engagement y cuidar la salud del personal de salud en futuras crisis sanitarias.
... Burnout is conceptualized as a consequence of chronic stress, with chronic feelings of exhaustion, negative attitudes towards work, and decreased professional efficacy [12]. Among physicians, burnout is associated with decreased well-being and worse quality of patient care [13][14][15]. One theory of burnout, the Job Demands-Resources (JDR) theory, describes two major elements contributing to burnout: 1) high job demands including workload, role ambiguity, role conflict, role stress, stressful events, and work pressure, combined with 2) limited job resources including social support, autonomy, and skill variety. ...
Article
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Background Physician burnout and wellbeing are an ongoing concern. Limited research has reported on the impact of the COVID 19 pandemic on burnout over time among U.S. physicians. Methods We surveyed U.S. frontline physicians at two time points (wave one in May–June 2020 and wave two in Dec 2020-Jan 2021) using a validated burnout measure. The survey was emailed to a national stratified random sample of family physicians, internists, hospitalists, intensivists, emergency medicine physicians, and infectious disease physicians. Burnout was assessed with the Professional Fulfillment Index Burnout Composite scale (PFI-BC). Responses were weighted to account for sample design and non-response bias. Random effects and quantile regression analyses were used to estimate change in conditional mean and median PFI-BC scores, adjusting for physician, geographic, and pandemic covariates. Results In the random effects regression, conditional mean burnout scores increased in the second wave among all respondents (difference 0.15 (CI: 0.24, 0.57)) and among respondents to both waves (balanced panel) (difference 0.21 (CI: − 0.42, 0.84)). Conditional burnout scores increased in wave 2 among all specialties except for Emergency medicine, with the largest increases among Hospitalists, 0.28 points (CI: − 0.19,0.76) among all respondents and 0.36 (CI: − 0.39,1.11) in the balanced panel, and primary care physicians, 0.21 (CI: − 0.23,0.66) among all respondents and 0.31 (CI: − 0.38,1.00) in the balanced panel. The conditional mean PFI-BC score among hospitalists increased from 1.10 (CI: 0.73,1.46) to 1.38 (CI: 1.02,1.74) in wave 2 in all respondents and from 1.49 (CI: 0.69,2.29) to 1.85 (CI: 1.24,2.46) in the balanced panel, near or above the 1.4 threshold indicating burnout. Findings from quantile regression were consistent with those from random effects. Conclusions Rates of physician burnout during the first year of the pandemic increased over time among four of five frontline specialties, with greatest increases among hospitalist and primary care respondents. Our findings, while not statistically significant, were consistent with worsening burnout; both the random effects and quantile regressions produced similar point estimates. Impacts of the ongoing pandemic on physician burnout warrant further research.
... This is an important tool as it helps to review the estimated burnout prevalence [7]. It is important to recognize burnout as it has been associated with an array of complications such as increased medical errors, [8] and negligence, reduced patient satisfaction, longer convalescence times and decreased professional work ethic [8][9][10]. Other consequences, including substance abuse, disruptive behavior, absenteeism, attrition, strained personal relationships, divorce, depression, suicidal ideation, and suicide have also been identified [11,12]. ...
Article
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Introduction : The more effort put into work, the greater the chances of burnout. This is common among surgical personnel. We carried out this review study to determine the overall prevalence of burnout in surgery and per-subspecialty prevalence as well as to identify the factors that affect burnout positively and/or negatively. Methods : All full-text articles reporting data related to burnout in surgery and surgical subspecialties using the Maslach Burnout Inventory (MBI) were included. The following bibliographic databases were searched PubMed, Embase and Google Scholar (First 500 pages). We extracted data on the characteristics of the articles including the burnout prevalence and factors. Results : 27 articles met the criteria. The studies involved 8617 surgeons of various surgical specialties. The overall prevalence was 47%. The rate per specialty ranged between 15% and 77% with Ear, Nose and Throat (ENT) surgeons having the highest rates. Associated factors were work-related issues and poor work/life balance while career advancement, increase in postgraduate years, and having good relationships with co-residents were protective. Our findings are similar to findings from other studies. ENT is seen to have the highest burnout rate while paediatric surgery the lowest. Conclusion : The high prevalence of burnout among surgeons is concerning and the identified factors responsible should be explored by surgeons, hospital management boards, training colleges, and all bodies concerned to see how burnout among surgeons can be reduced.
... Given that burnout was a significant component to the "compassion capacity" latent construct, these findings also contribute to our understanding of the relationship between burnout and clinical care. Over the last decade, extensive research has highlighted the concerning prevalence of burnout among healthcare providers, as well as its harmful effects on clinical care and safety (Dyrbye & Shanafelt, 2011;Halbesleben & Rathert, 2008;Salyers et al., 2017;Shanafelt et al., 2005Shanafelt et al., , 2010Windover et al., 2018). More recent research has uncovered some of the psychosocial and cognitive mechanisms that mediate the relationship between burnout and suboptimal clinical care. ...
Article
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Objectives Although hospital chaplains play a critical role in delivering emotional and spiritual care to a broad range of both religious and non-religious patients, there is remarkably little research on the best practices or “active ingredients” of chaplain spiritual consults. Here, we examined how chaplains’ compassion capacity was associated with their linguistic behavior with hospitalized inpatients, and how their language in turn related to patient outcomes. Methods Hospital chaplains ( n = 16) completed self-report measures that together were operationalized as self-reported “compassion capacity.” Next, chaplains conducted consultations with inpatients ( n = 101) in five hospitals. Consultations were audio-recorded, transcribed, and analyzed using Linguistic Inquiry Word Count (LIWC). We used exploratory structural equation modeling to identify associations between chaplain-reported compassion capacity, chaplain linguistic behavior, and patient depression after the consultation. Results We found that compassion capacity was significantly associated with chaplains’ LIWC clout scores, a variable that reflects a confident leadership, inclusive, and other-oriented linguistic style. Clout scores, in turn, were negatively associated with patient depression levels controlling for pre-consult distress, indicating that patients seen by chaplains displaying high levels of clout had lower levels of depression after the consultation. Compassion capacity exerted a statistically significant indirect effect on patient depression via increased clout language. Conclusions These findings inform our understanding of the linguistic patterns underlying compassionate and effective chaplain-patient consultations and contribute to a deeper understanding of the skillful means by which compassion may be manifest to reduce suffering and enhance well-being in individuals at their most vulnerable.
... The physicians' role in dealing with patients that require difficult decision-making, complex interactions, challenges such as rapidly evolving technology, changing legislation, and increased productivity expectations may be contributory towards higher burnout amongst physicians [9,10]. Physicians dealing with patients with lifelong conditions such as diabetes may require constant engagement and motivation to support patients to take over control of their condition and those with burnout can find it more difficult to motivate patients with chronic conditions, which may lead to decreased patient satisfaction and engagement [11][12][13]. ...
Article
Background Presence of either emotional exhaustion, depersonalization or lack of personal accomplishment define Burnout Syndrome which may lead to decreased workforce productivity, increased absenteeism, depression and medical errors as well as decreased patient satisfaction. Objective The aim of this study was to assess the frequency of burnout syndrome among Diabetes Specialist Registrars across England, Scotland and Wales and to identify any self-reported factors which may be contributory to burnout. Methods Over 430 Diabetes Specialist Registrars were invited to anonymously participate in an electronic survey which used Maslach Burnout Inventory and selfreporting questionnaire to identify burnout and contributory factors. Results In this pre-pandemic times study, Burnout was identified in 61 (57.5%; n = 106) respondents using Maslach burnout cut-off scores. 45.2% (48/106) participants had scored high in Emotional Exhaustion, while lack of personal accomplishment and depersonalization was seen in 24.5% (26/106) and 21.6% (23/106) of the respondents respectively. The commonest self-reported stressors by participants were “General Internal Medicine workload” 60.4% (64/106) followed by “Lack of specialty training” 36.8% (39/106) and “Lack of audit/research/Continuing Professional Development time” 10.8% (11/106) Conclusion Burnout syndrome is frequent among the participating Diabetes Specialist Registrars and urgent steps may be required address this problem nationally to ensure that these physicians remain physically and mentally healthy, especially after the pandemic.
... Professional burnout is a psychological syndrome characterized by emotional exhaustion, depersonalization, and a feeling of reduced personal accomplishment in one's work. 1 Many of the studies examining physician burnout have sought to highlight the scale of the problem, the association between demographic characteristics and rates of burnout among physicians, the disparate causes of burnout in medicine, and the consequences of burnout on both clinicians and patients, as well as the effectiveness of various system-level interventions that have been implemented to address this phenomenon. [2][3][4][5][6][7][8][9][10] Moreover, a great number of studies have demonstrated that burnout is an especially notable problem among resident physicians, with a prevalence rate ranging from 27 to 75% depending on specialty. [11][12][13][14][15][16][17][18] Although the literature exploring burnout among physicians is relatively robust, our understanding of physician well-being is more limited. ...
Article
Background: While a great deal of research has brought attention to the issue of physician burnout in recent years, and resident physician burnout in particular, the topics of physician well-being, and by extension physician thriving, have been relatively understudied. Consequently, we propose a model of resident physician thriving. Objective To understand what factors contribute to a subjective sense of thriving among resident physicians. Design: In this study, we conducted in-depth interviews from May 2020 through February 2021 with resident physicians to determine what factors have contributed to their sense of thriving in their careers as well as in their lives more generally. We used a snowball sampling technique to recruit participants. Validated instruments were used to quantify the participant's subjective level of job and life satisfaction as well as their level of career burnout. To derive our conclusions, we employed thematic content analysis using a grounded theory-based approach. Participants: Resident physicians in the internal medicine, pediatrics, and combined internal medicine-pediatrics residency programs at a single university-affiliated institution. Approach: We interviewed those residents with high life, career, and residency satisfaction who did not meet criteria for burnout to explore those factors that contribute to their sense of thriving. Key results: Thirty-seven screening interviews were conducted. Twenty-four participants met criteria for life, career, and residency satisfaction while also not meeting criteria for burnout. The six key themes contributing to resident thriving that we identified during the course of our analysis included program leadership, learning climate, connectedness, joy in medicine, life balance, and intrinsic factors. Conclusions: This project proposes a model of resident thriving that can potentially inform program structure, culture, and values.
... This is a critically important dynamic to explore, as burnout among service providers has the potential to adversely impact not only the well-being of those providers, but also the patients and clients who they serve. In addition to concerns for job turnover, several studies have suggested suboptimal job performance due to burnout can lead to adverse outcomes for patients/clients [12,18]. ...
Article
Full-text available
Background HIV-focused organizations, care providers and research programs often hire Black gay, bisexual and other men who have sex with men (GBMSM) in their efforts to reach highly affected communities. Due to their unique social position within and outside of organizations, Black GBMSM are ideally situated to contribute to HIV care and prevention programming targeting their own communities, but may also be at risk for stress and burnout in these settings. Despite this critical role for Black GBMSM in efforts to end the epidemic, little is known about subjective experiences of Black GBMSM who work in the HIV field. Methods We conducted qualitative interviews with 19 Black GBMSM who were identified as key informants. All were working in community-based organizations, clinical or academic settings in the area of HIV prevention and treatment in Atlanta, Georgia. We used a thematic analysis approach to identify salient themes with respect to the workplace experiences of Black GBMSM as well as the role of their identities in their work in the field. Results Participants discussed: (1) Shared experiences and growth; (2) Work-related stressors; (3) Worker burnout; and (4) Commitment to continue working in the HIV field. On the whole, Black GBMSM derived meaning from their work, and found their intersectional identities to be a strength in fulfilling job duties. At the same time, Black GBMSM described multiple stresses faced as they balanced their personal and professional connections to this work, while also dealing with their own challenges related to discrimination, socioeconomic status, and health. Participants repeatedly described sacrificing their own well-being for the greater good of their communities, highlighting contributors to burnout within and outside of the workplace. Conclusions Our participants derived meaning from their work in the HIV field and were affirmed by professional interactions with other Black GBMSM. At the same time, they also faced work-related and other psychosocial stressors that predisposed them to frustration and burnout. To promote workplace equity and wellness for Black GBMSM, we share recommendations for HIV-focused organizations that employ and serve men in this demographic.
... For example, physicians experiencing burnout might have less time or commitment to optimise the care of their patients, can take more unnecessary risks, or might lack accountability. 74 Conversely, exposure to adverse patient events or recognition of poor quality of care can result in burnout, which in turn could force physicians to quit. This process can often be referred to as secondary trauma, particularly in relation to sentinel events or important safety incidents. ...
Article
Full-text available
Objective To examine the association of physician burnout with the career engagement and the quality of patient care globally. Design Systematic review and meta-analysis. Data sources Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021. Eligibility criteria for selecting studies Observational studies assessing the association of physician burnout (including a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalisation, and a sense of ineffectiveness and little personal accomplishment) with career engagement (job satisfaction, career choice regret, turnover intention, career development, and productivity loss) and the quality of patient care (patient safety incidents, low professionalism, and patient satisfaction). Data were double extracted by independent reviewers and checked through contacting all authors, 84 (49%) of 170 of whom confirmed their data. Random-effect models were used to calculate the pooled odds ratio, prediction intervals expressed the amount of heterogeneity, and meta-regressions assessed for potential moderators with significance set using a conservative level of P<0.10. Results 4732 articles were identified, of which 170 observational studies of 239 246 physicians were included in the meta-analysis. Overall burnout in physicians was associated with an almost four times decrease in job satisfaction compared with increased job satisfaction (odds ratio 3.79, 95% confidence interval 3.24 to 4.43, I2=97%, k=73 studies, n=146 980 physicians). Career choice regret increased by more than threefold compared with being satisfied with their career choice (3.49, 2.43 to 5.00, I2=97%, k=16, n=33 871). Turnover intention also increased by more than threefold compared with retention (3.10, 2.30 to 4.17, I2=97%, k=25, n=32 271). Productivity had a small but significant effect (1.82, 1.08 to 3.07, I2=83%, k=7, n=9581) and burnout also affected career development from a pooled association of two studies (3.77, 2.77 to 5.14, I2=0%, n=3411). Overall physician burnout doubled patient safety incidents compared with no patient safety incidents (2.04, 1.69 to 2.45, I2=87%, k=35, n=41 059). Low professionalism was twice as likely compared with maintained professionalism (2.33, 1.96 to 2.70, I2=96%, k=40, n=32 321), as was patient dissatisfaction compared with patient satisfaction (2.22, 1.38 to 3.57, I2=75%, k=8, n=1002). Burnout and poorer job satisfaction was greatest in hospital settings (1.88, 0.91 to 3.86, P=0.09), physicians aged 31-50 years (2.41, 1.02 to 5.64, P=0.04), and working in emergency medicine and intensive care (2.16, 0.98 to 4.76, P=0.06); burnout was lowest in general practitioners (0.16, 0.03 to 0.88, P=0.04). However, these associations did not remain significant in the multivariable regressions. Burnout and patient safety incidents were greatest in physicians aged 20-30 years (1.88, 1.07 to 3.29, P=0.03), and people working in emergency medicine (2.10, 1.09 to 3.56, P=0.02). The association of burnout with low professionalism was smallest in physicians older than 50 years (0.36, 0.19 to 0.69, P=0.003) and greatest in physicians still in training or residency (2.27, 1.45 to 3.60, P=0.001), in those who worked in a hospital (2.16, 1.46 to 3.19, P<0.001), specifically in emergency medicine specialty (1.48, 1.01 to 2.34, P=0.042), or situated in a low to middle income country (1.68, 0.94 to 2.97, P=0.08). Conclusions This meta-analysis provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care. Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency. Systematic review registration PROSPERO number CRD42021249492.
... 14 Burnout is associated with major depression, poor patient outcomes and more negative feelings towards patients. [15][16][17] Physician burnout also results in significant economic loss. 18 By contrast, psychiatry is well placed to drive positive change. ...
Article
Background: Burnout is a widely reported syndrome consisting of emotional exhaustion, depersonalization, and a lowered sense of accomplishment. Mindfulness practices have been shown to be useful in lowering distress and burnout in clinical and non-clinical cohorts. Our aim was to explore the potential personal and occupational benefits of a structured mindfulness intervention on a cohort of mental health professionals. A mixed-methods approach was utilised in order to enhance the exploratory power of the study. Methods: We conducted a pilot study involving healthcare practitioners employed at a community outpatient mental health clinic. As a pilot, we relied on a single group and implemented a quasi-experimental, simultaneous mixed methods design by incorporating both quantitative pre-and post-testing alongside written qualitative post-test responses. Results: Analysis of the data demonstrated a significant difference between overall mindfulness when comparing post-test (mean=140.8, standard deviation=18.9) with pre-test data (mean=128.3, standard deviation=28.6). Participants also showed a statistically significant difference in three of the subscales: observation, describing, and non-reactivity. A moderate effect size was seen for each of the above differences. Analysis of the qualitative data revealed a range of potential themes which may be used to explain the differences exhibited across participants' personal and professional lives, which can be grouped into two thematic overarching groups: emotional reactivity and listening/communicating. Conclusions: The results of this pilot study indicate that a structured, six-week mindfulness program has the potential to benefit clinicians, personally by reducing emotional reactivity and professionally by promoting deep listening and communication.
... 10 Similarly, a growing body of research has documented an association between burnout and poorer work performance 11,12 ; decreased cognitive function 13,14 ; and, poorer patient outcomes. 15 Overall, stress and burnout in HCPs have been estimated to be costly on the health care system, warranting attention to intervention and prevention strategies. 16 Responding to calls to address the so-called ''burnout epidemic,'' research investigating mindfulness-based interventions has grown in the recent decade. ...
... HCPs, in particular, are at higher risk for burnout, 3 and this can have significant impacts on patient care and outcomes. 4 Physician burnout through the Medscape National Physician Burnout and Suicide report was estimated to be 43%. 5 Among nurses in the USA, 31.5% of registered nurses (RNs) who were leaving their job cited burnout as a reason. ...
Article
Full-text available
Objective Healthcare provider (HCP) burnout is on the rise with electronic medical record (EMR) use being cited as a factor, particularly with the rise of the COVID-19 pandemic. Burnout in HCPs is associated with negative patient outcomes, and, therefore, it is crucial to understand and address each factor that affects HCP burnout. This study aims to (a) assess the relationship between EMR use and burnout and (b) explore interventions to reduce EMR-related burnout. Methods We searched MEDLINE (Ovid), CINAHL and SCOPUS on 29 July 2021. We selected all studies in English from any publication year and country that discussed burnout in HCPs (physicians, nurse practitioners and registered nurses) related to EMR use. Studies must have reported a quantitative relationship to be included. Studies that implemented an intervention to address this burnout were also included. All titles and abstracts were screened by two reviewers, and all full-text articles were reviewed by two reviewers. Any conflicts were addressed with a third reviewer and resolved through discussion. Quality of evidence of all included articles was assessed using the Quality Rating Scheme for Studies and Other Evidence. Findings The search identified 563 citations with 416 citations remaining after duplicate removal. A review of abstracts led to 59 studies available for full-text assessment, resulting in 25 studies included in the scoping review. Commonly identified associations between EMR-related burnout in HCPs included: message and alert load, time spent on EMRs, organisational support, EMR functionality and usability and general use of EMRs. Two articles employed team-based interventions to improve burnout symptoms without significant improvement in burnout scores. Conclusions and relevance Current literature supports an association between EMR use and provider burnout. Very limited evidence exists for burnout-reducing interventions that address factors such as time spent on EMRs, organisational support or EMR design.
... [21,22]). Burnout can impact the care quality in various ways, for example, the draining of emotional energy may lead to less commitment providing a good care, decreased ability to concentrate on performing important details of the work, or becoming more directive rather than collaborative and patient centred [23]. Thereby, we expect that a low level of burnout among staff will increase the likelihood of caries patients to receive preventive care. ...
Article
Full-text available
Objectives: Dental caries is a health problem that can be prevented. The aim of this study is to analyse if the quality of leadership, in Swedish Public Dental Health clinics, influences the extent to which patients with caries receive preventive care, and if any such effect is mediated through a collaborative work climate, clear role expectations and a low average level of burnout among staff. Methods: The multilevel cross-sectional design includes work environment data from surveys of 75 general public dental clinics, register-based data on preventive measures provided to 5398 patients who received a dental filling due to a caries diagnosis, and patient demographics. Using a multilevel path analysis with logistic regression, we tested a model with one direct and three indirect pathways, controlling for the potential confounding effect of patient demographic factors. Results: Leadership quality, as assessed by the staff at the clinic, was associated with increased odds of patients with caries receiving prevention, controlling for patient demographic factors. Leadership quality was also positively related to a collaborative work climate, clear role expectations and a low average level of burnout among staff. Against expectations, however, no indirect effect from leadership quality on prevention through the other work environment factors was found. Conclusions: In conclusion, the quality of leadership in Swedish Public Dental Health clinics was positively related to a good work environment for staff and to delivery of preventive care to patients experiencing caries.
... Demographics and characteristics of participants at baseline will be summarised and assessed for comparability between the intervention and control arms [20]. The primary analysis will be conducted using ANCOVA adjusted for randomisation stratification factors on an intention to treat population. ...
Article
Full-text available
Background Existing therapeutic interventions to treat diabetes are well known, yet the majority of people with diabetes do not consistently achieve blood glucose targets (even individual therapy targets) for optimal health, despite the large range of treatment options available. Such outcomes have remained stubbornly poor for decades with <25% adults with diabetes achieving glycaemic targets. Patient behaviour, individually supported in routine clinical care, is an important missing component to improved outcomes, in a medical healthcare model not ideally suited to supporting successful diabetes management. Methods A multi-centre, parallel group, individually randomised trial comparing consultation duration in adults with type 1, type 2 or pre-diabetes using the Spotlight Consultations pre-clinic assessment compared to usual care in the Spotlight-AQ study. Two hundred adults with type 1, type 2 or pre-diabetes attending routine care outpatient appointments across up to ten participating sites will be invited to participate. Intervention An outpatient pre-clinic intervention delivered within 1 week prior to scheduled routine outpatient appointment. Primary outcome measure Duration of routine outpatient consultation. Secondary outcome measures Functional health status Diabetes distress Depression Treatment satisfaction Impact on self-care behaviours HCP burnout HCP treatment satisfaction and burden Hypoglycaemia (time less than 70mg/dL) Hyperglycaemia (time above 180 mg/dL) Change in weight Change in HbA 1c Cost effectiveness of intervention Discussion Results from the study will provide valuable insights into patient-professional communication practices within routine care and recommendations will be made, as necessary, for improvements to that. If the intervention is shown to be clinically and cost-effective, the feedback from participants and healthcare professionals will be used to make any improvements prior to its deployment to support improved communication and associated health outcomes. Ethics and dissemination The trial was approved by the Wales REC7 Research Ethics Committee (21/WA/0020). Results will be disseminated through national and international conferences, scientific journals, newsletters, magazines and social media. Target audiences include consultants and other clinicians in diabetes, and medical professionals or scientists overall. Trial registration ISRCTN15511689 . Registered on 10 November 2021
... For example, physicians experiencing burnout might have less time or commitment to optimise the care of their patients, can take more unnecessary risks, or might lack accountability. 74 Conversely, exposure to adverse patient events or recognition of poor quality of care can result in burnout, which in turn could force physicians to quit. This process can often be referred to as secondary trauma, particularly in relation to sentinel events or important safety incidents. ...
Article
Full-text available
Objective To examine the association of physician burnout with the career engagement and the quality of patient care globally. Design Systematic review and meta-analysis. Data sources Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021. Eligibility criteria for selecting studies Observational studies assessing the association of physician burnout (including a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalisation, and a sense of ineffectiveness and little personal accomplishment) with career engagement (job satisfaction, career choice regret, turnover intention, career development, and productivity loss) and the quality of patient care (patient safety incidents, low professionalism, and patient satisfaction). Data were double extracted by independent reviewers and checked through contacting all authors, 84 (49%) of 170 of whom confirmed their data. Random-effect models were used to calculate the pooled odds ratio, prediction intervals expressed the amount of heterogeneity, and meta-regressions assessed for potential moderators with significance set using a conservative level of P<0.10. Results 4732 articles were identified, of which 170 observational studies of 239 246 physicians were included in the meta-analysis. Overall burnout in physicians was associated with an almost four times decrease in job satisfaction compared with increased job satisfaction (odds ratio 3.79, 95% confidence interval 3.24 to 4.43, I ² =97%, k=73 studies, n=146 980 physicians). Career choice regret increased by more than threefold compared with being satisfied with their career choice (3.49, 2.43 to 5.00, I ² =97%, k=16, n=33 871). Turnover intention also increased by more than threefold compared with retention (3.10, 2.30 to 4.17, I ² =97%, k=25, n=32 271). Productivity had a small but significant effect (1.82, 1.08 to 3.07, I ² =83%, k=7, n=9581) and burnout also affected career development from a pooled association of two studies (3.77, 2.77 to 5.14, I ² =0%, n=3411). Overall physician burnout doubled patient safety incidents compared with no patient safety incidents (2.04, 1.69 to 2.45, I ² =87%, k=35, n=41 059). Low professionalism was twice as likely compared with maintained professionalism (2.33, 1.96 to 2.70, I ² =96%, k=40, n=32 321), as was patient dissatisfaction compared with patient satisfaction (2.22, 1.38 to 3.57, I ² =75%, k=8, n=1002). Burnout and poorer job satisfaction was greatest in hospital settings (1.88, 0.91 to 3.86, P=0.09), physicians aged 31-50 years (2.41, 1.02 to 5.64, P=0.04), and working in emergency medicine and intensive care (2.16, 0.98 to 4.76, P=0.06); burnout was lowest in general practitioners (0.16, 0.03 to 0.88, P=0.04). However, these associations did not remain significant in the multivariable regressions. Burnout and patient safety incidents were greatest in physicians aged 20-30 years (1.88, 1.07 to 3.29, P=0.03), and people working in emergency medicine (2.10, 1.09 to 3.56, P=0.02). The association of burnout with low professionalism was smallest in physicians older than 50 years (0.36, 0.19 to 0.69, P=0.003) and greatest in physicians still in training or residency (2.27, 1.45 to 3.60, P=0.001), in those who worked in a hospital (2.16, 1.46 to 3.19, P<0.001), specifically in emergency medicine specialty (1.48, 1.01 to 2.34, P=0.042), or situated in a low to middle income country (1.68, 0.94 to 2.97, P=0.08). Conclusions This meta-analysis provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care. Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency. Systematic review registration PROSPERO number CRD42021249492.
Article
Background Pet therapy, or animal-assisted interventions (AAI), have demonstrated positive effects for patients, families and health care providers (HCP) in inpatient settings. However, the evidence supporting AAI in emergency or ambulatory care settings is unclear. We conducted a systematic review to evaluate the effectiveness of AAI on patient, family, and HCP experience in these settings. Methods We searched (from inception to May 2020) Medline, Embase, Cochrane CENTRAL, PsycINFO, and CINAHL, plus grey literature, for studies assessing AAI in emergency and ambulatory care settings on: 1) patient and family anxiety/distress or pain; and 2) HCP stress. Screening, data extraction and quality assessment were done in duplicate with conflicts adjudicated by a third party. Random-effects meta-analyses are reported as mean differences (MD) or standardized mean differences (SMDs) and 95% confidence intervals (CIs), as appropriate. Results We included 9 randomized controlled trials (RCTs; 341 patients, 146 HCP, 122 child caregivers), 4 before-after (before-after; 83 patients), and 1 mixed-method study (124 patients). There was no effect across three RCTs measuring patient-reported anxiety/distress (n=380; SMD: -0.36, 95% CI: -0.95 to 0.23; I²=81%), while two before-after studies suggested a benefit (n=80; SMD: -1.95, 95% CI: -2.99 to -0.91; I²=72%). Four RCTs found no difference in measures of observed anxiety/distress (n=166; SMD: -0.44; 95% CI: -1.01 to 0.13; I²=73%) while one before-after study reported a significant benefit (n=60; SMD: -1.64, 95% CI: -2.23 to -1.05). Three RCTs found no difference in patient-reported pain (n=202; MD: -0.90; 95% CI: -2.01 to 0.22; I²=68%). Two RCTs reported positive but non-significant effects on HCP stress. Conclusions Limited evidence is available on the effectiveness of AAI in emergency and ambulatory care settings. Rigorous studies using global experience-oriented (or patient-identified) outcome measures are required.
Article
At the foundation of clinical medicine is the relationship among patients, families, and health care professionals. Implicit to that social contract, professionals pledge to bring clinical excellence to advance their patients' wellness and healing-and to prevent harm. Patients trust that those privileged to deliver care will do so unwaveringly in service of patients' best interests; however, the incentives and infrastructure surrounding health care delivery can promote or undermine individual performance, teamwork, and patient safety. Modeling professionalism and identifying slips and lapses supports pursuit of high reliability. Part 1, Promoting Professionalism, introduces the first of 3 pillars of advancing the clinical mission.
Article
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Background: Professional burnout represents a significant threat to the American healthcare system. Organizational and individual factors may increase healthcare providers' susceptibility or resistance to burnout. We hypothesized that during the COVID-19 pandemic, 1) higher levels of perceived organizational support (POS) are associated with lower risk for burnout and anxiety, and 2) anxiety mediates the association between POS and burnout. Methods: In this longitudinal prospective study, we surveyed healthcare providers employed full-time at a large, multihospital healthcare system monthly over 6 months (April to November 2020). Participants were randomized using a 1:1 allocation stratified by provider type, gender, and academic hospital status to receive one of two versions of the survey instrument formulated with different ordering of the measures to minimize response bias due to context effects. The exposure of interest was POS measured using the validated 8-item Survey of POS (SPOS) scale. Primary outcomes of interest were anxiety and risk for burnout as measured by the validated 10-item Burnout scale from the Professional Quality (Pro-QOL) instrument and 4-item Emotional Distress-Anxiety short form of the Patient Reported Outcome Measurement Information System (PROMIS) scale, respectively. Linear mixed models evaluated the associations between POS and both burnout and anxiety. A mediation analysis evaluated whether anxiety mediated the POS-burnout association. Results: Of the 538 participants recruited, 402 (75%) were included in the primary analysis. 55% of participants were physicians, 73% 25-44 years of age, 73% female, 83% White, and 44% had ≥1 dependent. Higher POS was significantly associated with a lower risk for burnout (-0.23; 95% CI -0.26, -0.21; p<0.001) and lower degree of anxiety (-0.07; 95% CI -0.09, -0.06; p = 0.010). Anxiety mediated the associated between POS and burnout (direct effect -0.17; 95% CI -0.21, -0.13; p<0.001; total effect -0.23; 95% CI -0.28, -0.19; p<0.001). Conclusion: During a health crisis, increasing the organizational support perceived by healthcare employees may reduce the risk for burnout through a reduction in anxiety. Improving the relationship between healthcare organizations and the individuals they employ may reduce detrimental effects of psychological distress among healthcare providers and ultimately improve patient care.
Article
The hidden epidemic of burnout exacts a staggering toll on professionals and patients, reflected in increased risk of medical errors, complications, and staff turnover. For surgeons, nurses, and other team members working at the sharp end of care, adverse events can amplify work exhaustion, interpersonal disengagement, and risk of moral adversity. Visionary leaders are not content to mitigate burnout and moral injury; they elevate the human experience throughout health care by modeling wellness, fostering moral courage, promoting safety of professionals, and restoring joy in work. Part 3, Health Professional Wellness and Resilience, introduces the final pillar for advancing the clinical mission.
Article
Young adults with diabetes assume increasing responsibility for communicating with their health care providers, and engaging in high-quality health communication is an integral component of overall diabetes self-management. This article provides an overview of the main features of health communication, factors that may influence communication quality, interventions to promote communication skills, and practical strategies for clinicians working with young adults with diabetes. The review concludes with a comprehensive summary of future directions for health communication research.
Article
Introduction. Digital technologies are an essential condition for the development of modern health care. New forms of interaction between the supplier and the consumer of medical services determine the need to understand the attitude of the doctor and the patient to this employment operation. Purpose. Assess the change in the quality of communications between the doctor and the patient with the widespread introduction of electronic medical records. Material and methods. Within the framework of the project, a content analysis of media materials was held. Mass (questionnaire) survey of doctors and patients in November-December 2020 was executed. The comprehensive survey had 482 respondents, including 168 doctors and 314 patients. Results. Most (61.5%) of medical professionals indicate a decrease in time costs during the patient’s reception, an increase in time to work with patients is noted in 47.4% of respondents. 55% of doctors report that the service helps better focus on the provision of medical care, and 47.6% of respondents believe that the conduct of medical documentation in electronic form allows reducing the frequency of passing a significant pathology. Among patients, 52.2% believe that introducing electronic medical records will enable you to increase the time that the doctor pays to the patient during the reception. 68.9% of patients indicate an improvement in the interaction between doctors and patients. Conclusion. High-quality results can be achieved only if there is a medical staff with the skills of using modern digital technologies and new communication skills with a patient when using electronic medical records.
Preprint
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Purpose Oncologists are at an increased risk of developing burnout, leading to negative consequences in patient care and in professional satisfaction and quality of life. This study was designed to investigate exhaustion and disengagement among German oncologists and assess the prevalence of burnout among oncologists within different professional settings. Furthermore, we wanted to examine possible relations between sociodemographic factors, the oncological setting, professional experience and different aspects of burnout. Methods In a cross-sectional study design, an Internet-based survey was conducted with 121 oncologists between April and July 2020 using the Oldenburg Burnout Inventory, which contains items on exhaustion, disengagement, and burnout. Furthermore, sociodemographic data of the participants were assessed. The participants were members of the Working Group Medical Oncology (Arbeitsgemeinschaft Internistische Onkologie) within the German Cancer Society. Results The survey showed a burnout prevalence of 43.8%, which correlated with age and professional experience; that is, the prevalence is particularly high among younger oncologists. Exhaustion is closely related to employment status; that is, it was significantly higher among employed oncologists. There were remarkably low levels of disengagement among oncologists, highlighting the own demand to fulfill job requirements despite imminent or actual overburdening in daily work. Conclusion More support is necessary to mitigate the professional stressors in the healthcare system. To ensure quality medical care, employees should be offered preventive mental health services early in their careers.
Article
Introduction: To evaluate the effect on engagement, relational connection, and burnout of an intervention involving clinical faculty meeting in interprofessional self-facilitated groups and to determine whether a written discussion guide is necessary to achieve benefit. Methods: This is a randomized controlled trial, conducted at a large US academic medical center from May to August 2018. Subjects included 25 clinical physicians, nurse practitioners, and certified nurse midwives. The intervention involved three monthly self-facilitated groups for faculty. Groups were randomized to have no discussion guide, or to receive a one-page guide. Outcomes of burnout, engagement, and empowerment in work, and stress from uncertainty were assessed using validated metrics. Results: Rates of emotional exhaustion and depersonalization decreased significantly over the course of the 3-month study (56%-36%; P < .001; and 20%-15%; P = .006) and overall burnout decreased from 56% to 41% of faculty (P = .002). The percentage of faculty who felt engaged in their work increased from 80% to 96% (P = .03). No statistically significant differences in empowerment at work or in reaction to uncertainty were seen. The groups without a discussion guide had equivalent outcomes and benefits. Cost per participant was under $100. Discussion: A three-month, low-cost, self-facilitated series of dinner meetings for interprofessional clinical faculty decreased burnout and improved engagement, sense of connection to colleagues, and sense of departmental commitment to well-being. Structured discussion guides were not necessary to achieve benefit. This study broadens the possibilities for cost-effective opportunities to transform institutional culture and effectively enhance faculty well-being.
Chapter
A vast literature that includes the paradigm of dignity-in-care has repeatedly underlined the need for a patient-centered approach in medicine. The medical system is obligated to relate to patients in all the appropriate humanistic dimensions (i.e., biological, psychological, social, and spiritual) to provide quality healthcare. However, many healthcare systems across the globe are changing due to the despotism of bureaucracy, budgeting, and downsizing of resources. A transformation of the doctor-patient relationship has occurred to accommodate a sort of commercial trade between producers and consumers. The reduction of medicine to a technological evidence-based paradigm (e.g., rigid clinical methods with only objective perspectives and quantitative measurement searching for one absolute quantifiable objective “truth”) stands in opposition to a person-oriented value-based medicine (e.g., with flexible methods and subjective perspectives gained through qualitative approaches and awareness of the relativity of “truths”) and has undermined the long-standing and venerated humanistic approach in medicine. “Dignity” within the dyadic doctor-patient relationship means to recuperate the personhood of the physician as a human being. The nuances of person-centered medicine require the presence of the integrated, well-adjusted physician, capable of flexibility and fortitude. Therefore, the literature regarding burnout (as an occupational syndrome recognized by the WHO ICD-11) and the inter-related concepts of compassion fatigue, moral distress, and vicarious traumatization (or secondary traumatic stress) among physicians and healthcare professionals should be taken into careful consideration. The significant negative consequences of these conditions impact not only patient satisfaction and health outcomes but also the biopsychosocial health and quality of life of physicians. The corporatization and concomitant technological advances of medicine threaten its humanistic underpinnings as respect for patients and the physician is compromised.
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The dynamic and complex nature of care provision predisposes healthcare workers to stress, including physical, emotional, or psychological fatigue due to individual, interpersonal, or organizational factors. We conducted a convergent mixed-methods study with maternity providers to understand their sources of stress and coping mechanisms they adopt. Data were collected in Migori County in western Kenya utilizing quantitative surveys with n=101 maternity providers and in-depth interviews with a subset of n=31 providers. We conducted descriptive analyses for the quantitative data. For qualitative data, we conducted thematic analysis, where codes were deductively developed from interview guides, iteratively refined based on emergent data, and applied by a team of five researchers using Dedoose software. Code queries were then analysed to identify themes and organized using the socioecological (SE) framework. Providers reported stress due to high workloads (61%); lack of supplies (37%), poor salary (32%), attitudes of colleagues and superiors (25%), attitudes of patients (21%), and adverse outcomes (16%). Themes from the qualitative analysis mirrored the quantitative analysis with more detailed information on the factors contributing to each and how these sources of stress affect providers and patient outcomes. Coping mechanisms adopted by providers are captured under three themes: addressing stress by oneself, reaching out to others, and seeking help from a higher power. Findings underscore the need to address organizational, interpersonal, and individual level stressors. Strategies are needed to support staff retention, provide adequate resources and incentives for providers, and ultimately improve patient outcomes. Interventions should support and leverage the positive coping mechanisms identified.
Article
Objective To estimate the excess health care expenditures due to US primary care physician (PCP) turnover, both overall and specific to burnout. Methods We estimated the excess health care expenditures attributable to PCP turnover using published data for Medicare patients, calculated estimates for non-Medicare patients, and the American Medical Association Masterfile. We used published data from a cross-sectional survey of US physicians conducted between October 12, 2017, and March 15, 2018, of burnout and intention to leave one’s current practice within 2 years by primary care specialty to estimate excess expenditures attributable to PCP turnover due to burnout. A conservative estimate from the literature was used for actual turnover based on intention to leave. Additional publicly available data were used to estimate the average PCP panel size and the composition of Medicare and non-Medicare patients within a PCP’s panel. Results Turnover of PCPs results in approximately $979 million in excess health care expenditures for public and private payers annually, with $260 million attributable to PCP burnout-related turnover. Conclusion Turnover of PCPs, including that due to burnout, is costly to public and private payers. Efforts to reduce physician burnout may be considered as one approach to decrease US health care expenditures.
Article
Rationale, aims and objectives: Increased incidence of chronic illnesses coupled with physician shortages have yielded strain on primary care provider (PCP) to meet care demands. Interdisciplinary providers have increasingly been embedded into primary care teams to alleviate some workload demand. Little evidence exists about the impact of interdisciplinary PCP care delivery models on provider strain in primary care. To determine the impact of interdisciplinary PCP care delivery on burnout, job satisfaction and intention to leave current position. Methods: We conducted a cross-sectional mail survey using Dillman methodology of primary care practices (e.g., internal medicine) across New York State. A random sample of interdisciplinary PCPs (physicians, nurse practitioners, and physician assistants) (n = 333) responded. The Provider Comanagement Index (α = 0.85) was used to measure how well interdisciplinary dyads comanagement care delivery attributes (effective communication; mutual respect and trust; shared philosophy of care). Provider outcomes were measured with validated Agency for Healthcare Research and Quality and Health Resources and Services Administration items for burnout, job satisfaction and intention to leave position. Descriptive statistics, logistic regression models, crude and adjusted odds ratios were calculated, controlling for participant and practice characteristics. Results: Almost 30% of participants reported burnout with three times the odds of intending to leave their current position within 1 year. With each unit increase in effective comanagement between interdisciplinary dyads there was 15% less burnout and 10% less odds of intention to leave position. Conclusion: Incorporating interdisciplinary specialties in primary care appears promising to alleviate some adverse provider outcomes. Organizations contemplating delivery models to promote well-being and retention may consider comanagement. Cost effectiveness research is needed to determine financial sustainability of interdisciplinary care delivery.
Article
Environments that are hostile to one or more marginalized groups are known to have a negative effect on the mental health and well-being of both targets and observers. Anti-fat attitudes have been well documented in medical education, including the use of derogatory humor and discriminatory treatment toward higher-weight patients. However, to date, it is not known what effect observing weight stigma and discrimination during medical school has on medical students’ psychological health and wellbeing, sense of belonging, and medical school burnout. The present study surveyed a total of 3994 students enrolled across 49 US medical schools at the start of their first year and at the end of their fourth year. Participants reported the frequency with which they had observed stigmatizing and discriminatory behaviors targeted at both higher-weight patients and higher-weight students during their four years of medical school. Observed weight stigma was prevalent, and was associated with worse psychological and general health, reduced medical school belonging and increased medical school burnout. The indirect effects of observed weight stigma on medical school burnout, via belonging, psychological health, and general health, were statistically significant in the sample as a whole, but were more pronounced in higher-weight students. This effect may be explained, in part, by the relationship between observed stigma and medical school belonging. Higher levels of observed stigma were associated with reduced feelings of belonging in higher-weight but not normative-weight students. Top-down institutional culture change is needed to rectify this situation, which is detrimental to both students and patients.
Article
Background: Physician burnout has been a documented problem since the 1970s. This condition is detrimental to physician wellbeing which can lead to quality implication is the provision of care. Objective: To objectively analyze the literature over the last five years for empirical evidence of burnout incident to the EHR and to identify barriers, facilitators, associated patient satisfaction to using the EHR to improve symptoms of burnout. Methods: No human subjects were used in this review, however 100% of participants in studies analyzed were adult physicians. Four research databases and one targeted journal were queried for studies commensurate with the objective statement from January 1, 2016 through January 31st 2021 (n=25). Results: The hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one's schedule, cognitive fatigue, a general loss of autonomy and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes to alleviate the administrative burden of the EHR and decreased symptoms of burnout. Conclusions: The solutions provided in the literature only addressed two of the three factors, workflow and documentation time, but not the third, usability. Practitioners and administrators should focus on the former two factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify usability features with the greatest impact to improve. Researchers should design experiments to explore solutions that address all three factors of the EHR that contribute to burnout. Clinicaltrial: International registered report: RR2-10.2196/15490.
Article
Objective: The Canadian Rheumatology Association (CRA) launched the Workforce and Wellness Survey to update the Canadian rheumatology workforce characteristics. Methods: The survey included demographic and practice information, pandemic impacts, and the Mini-Z questionnaire to assess burnout. French and English survey versions were distributed to CRA members electronically between 10/14/2020-3/5/2021. The number of full-time equivalent (FTE) rheumatologists per 75,000 population was estimated from the median proportion of time in clinical practice multiplied by provincial rheumatologist numbers from the Canadian Medical Association (CMA). Results: Forty-four percent (183/417) of the estimated practicing rheumatologists (149 adult; 34 pediatric) completed the survey. The median age was 47 years, 62% were female, and 28% planned to retire within the next 5-10 years. Respondents spent a median of 65% of their time in clinical practice. FTE rheumatologists per 75,000 ranged between 0 and 0.70 in each province/territory and 0.62 per 75,000 nationally. This represents a deficit of 1 to 78 FTE rheumatologists per province/territory and 194 FTE rheumatologists nationally to meet the CRA's workforce benchmark. Approximately half of survey respondents reported burnout (51%). Women were more likely to report burnout (OR 2.86, 95%CI: 1.42-5.93). Older age was protective against burnout (OR 0.95, 95%CI: 0.92, 0.99). As a result of the pandemic, 97% of rheumatologists reported spending more time engaged in virtual care. Conclusion: There is a shortage of rheumatologists in Canada. This shortage may be compounded by the threat of burnout to workforce retention and productivity. Strategies to address these workforce issues are urgently needed.
Article
Background: "Moral distress" describes the psychological strain a provider faces when unable to uphold professional values because of external constraints. Recurrent or intense moral distress risks moral injury, burnout, and physician attrition but has not been systematically studied among neurosurgeons. Objective: To develop a unique instrument to test moral distress among neurosurgeons, evaluate the frequency and intensity of scenarios that may elicit moral distress and injury, and determine their impact on neurosurgical burnout and turnover. Methods: An online survey investigating moral distress, burnout, and practice patterns was emailed to attending neurosurgeon members of the Congress of Neurological Surgeons. Moral distress was evaluated through a novel survey designed for neurosurgical practice. Results: A total of 173 neurosurgeons completed the survey. Half of neurosurgeons (47.7%) reported significant moral distress within the past year. The most common cause was managing critical patients lacking a clear treatment plan; the most intense distress was pressure from patient families to perform futile surgery. Multivariable analysis identified burnout and performing ≥2 futile surgeries per year as predictors of distress (P < .001). Moral distress led 9.8% of neurosurgeons to leave a position and 26.6% to contemplate leaving. The novel moral distress survey demonstrated excellent internal consistency (Cronbach alpha = 0.89). Conclusion: We developed a reliable survey assessing neurosurgical moral distress. Nearly, half of neurosurgeons suffered moral distress within the past year, most intensely from external pressure to perform futile surgery. Moral distress correlated with burnout risk caused 10% of neurosurgeons to leave a position and a quarter to consider leaving.
Article
Importance: Reducing physician occupational distress requires understanding workplace mistreatment, its relationship to occupational well-being, and how mistreatment differentially impacts physicians of diverse identities. Objectives: To assess the prevalence and sources of mistreatment among physicians and associations between mistreatment, occupational well-being, and physicians' perceptions of protective workplace systems. Design, setting, and participants: This survey study was administered in September and October 2020 to physicians at a large academic medical center. Statistical analysis was performed from May 2021 to February 2022. Main outcomes and measures: Primary measures were the Professional Fulfillment Index, a measure of intent to leave, and the Mistreatment, Protection, and Respect Measure (MPR). Main outcomes were the prevalence and sources of mistreatment. Secondary outcomes were the associations of mistreatment and perceptions of protective workplace systems with occupational well-being. Results: Of 1909 medical staff invited, 1505 (78.8%) completed the survey. Among respondents, 735 (48.8%) were women, 627 (47.1%) were men, and 143 (9.5%) did not share gender identity or chose "other"; 12 (0.8%) identified as African American or Black, 392 (26%) as Asian, 10 (0.7%) as multiracial, 736 (48.9%) as White, 63 (4.2%) as other, and 292 (19.4%) did not share race or ethnicity. Of the 1397 respondents who answered mistreatment questions, 327 (23.4%) reported experiencing mistreatment in the last 12 months. Patients and visitors were the most common source of mistreatment, reported by 232 physicians (16.6%). Women were more than twice as likely as men to experience mistreatment (31% [224 women] vs 15% [92 men]). On a scale of 0 to 10, mistreatment was associated with a 1.13 point increase in burnout (95% CI, 0.89 to 1.36), a 0.99-point decrease in professional fulfillment (95% CI, -1.24 to -0.73), and 129% higher odds of moderate or greater intent to leave (odds ratio, 2.29; 95% CI, 1.75 to 2.99). When compared with a perception that protective workplace systems are in place "to a very great extent," a perception that there are no protective workplace systems was associated with a 2.41-point increase in burnout (95% CI, 1.80 to 3.02), a 2.81-point lower professional fulfillment score (95% CI, -3.44 to -2.18), and 711% higher odds of intending to leave (odds ratio, 8.11; 95% CI, 3.67 to 18.35). Conclusions and relevance: This survey study found that mistreatment was common among physicians, varied by gender, and was associated with occupational distress. Patients and visitors were the most frequent source, and perceptions of protective workplace systems were associated with better occupational well-being. These findings suggest that health care organizations should prioritize reducing workplace mistreatment.
Article
Objective The coronavirus disease 2019 (COVID-19) pandemic rapidly overwhelmed global health care systems in 2020, with New York City (NYC) marking the first epicenter in the United States. High levels of stress amongst health care workers have been reported in pandemics, but less is known about stress amongst Obstetrics and Gynecology (OB/GYN) providers. We sought to describe levels of stress, anxiety, depression, and other aspects of mental health among OB/GYN health care workers during the first wave of the COVID-19 pandemic. Study Design We conducted an anonymous cross-sectional electronic survey of a wide range of OB/GYN clinicians in a large NYC hospital system in the spring of 2020. We used both original survey questions and validated screening tools to assess stress, anxiety, depression, and burnout. We calculated median scores for these tools and compared median score between provider types. We also adapted questions on pandemic-related stressors from the MERS and SARS pandemics to fit the context of the COVID-19 pandemic and OB/GYN providers. Results A total of 464 providers met study inclusion criteria, and 163 providers completed the survey (response rate = 35.1%). Approximately 35% of providers screened positive for anxiety and 21% for depression. Scores for depression, burnout, and fulfillment varied by provider type, with nurses scoring higher than physicians (p <0.05). The majority of respondents reported stress from pandemic and OB-specific stressors, including the possibility of transmitting COVID-19 to friends and family (83.9%, [95% confidence interval or CI 78.0–89.8%]), uncertainty regarding the pandemic's trajectory (91.3% [86.7–95.8%]), and frequent policy changes on labor and delivery (72.7% [65.1–80.3%]). Conclusion OB/GYN providers reported high levels of stress during the COVID-19 pandemic. The stress of caring for laboring patients during a pandemic may disproportionately affect nurses and trainees and highlights the need to provide interventions to ameliorate the negative impact of a pandemic on the mental health of our OB/GYN health care workers. Key Points
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Objective: To comprehensively review the recent published literature to characterize current trends of burnout and well-being among otolaryngology trainees. Methods: Study design: systematic review and meta-analysis. A comprehensive literature review from 2000 to 2021 of studies related to otolaryngology resident burnout and well-being, as well as the general topic of well-being among surgical residents was completed. All included studies were summarized qualitatively. For the quantitative analysis, only articles reporting a Maslach burnout inventory (MBI), modified MBI or Mini-Z- Burnout assessment were included. Results: Twenty-five articles were included in the qualitative summary and nine articles in the quantitative analysis. In the qualitative summary, trainees were reported to have increased levels of distress and emotional hardening compared to attending otolaryngologists. Total hours worked per week and female gender were associated with worsened well-being. Residency program strategies to improve trainee well-being include program-sponsored wellness activities, dedicated wellness champions, and assistance with clerical burden. Implementation of protected nonclinical time has been shown to decrease burnout and increase well-being among trainees. Moreover, formal trainee mentorship programs have also been shown to reduce trainee burnout and stress. In the quantitative analysis, rates of trainee burnout ranged from 29.7% to 86% with an overall trend towards reduced rates of burnout from 2006 to 2021. Utilizing a weighted average, the overall burnout among otolaryngology residents was 58.6%. Conclusions: Rates of burnout remain high among otolaryngology trainees. Implementing formal mentorship programs and providing protected time during regular work hours appear to be effective tools to improve resident well-being.
Article
We examine how physicians’ perceptions of two computerized provider order entry (CPOE) capabilities, standardisation of care protocols and documentation quality, are associated with their perceptions of turnaround time, medical error, and job demand at three phases of CPOE implementation: pre-go-live, initial use, and continued use. Through a longitudinal study at a large urban hospital, we find standardisation of care protocols is positively associated with turnaround time reduction in all phases but positively associated with job demand increase only in the initial use phase. Standardisation also has a positive association with medical error reduction in the initial use phase, but later this effect becomes fully mediated through turnaround time reduction in the continued use phase. Documentation quality has a positive association with medical error reduction in the initial use phase and this association strengthens in the continued use phase. Our findings provide insights to effectively manage physicians’ response to CPOE implementation.
Chapter
Physician and clinician well-being is an increasingly recognized problem. There is mounting evidence that more caregivers are experiencing the signs and symptoms of burnout, and many individuals are finding the profession of caring for people less rewarding. Multiple factors are conspiring to exacerbate the loss of meaning and purpose. Career dissatisfaction significantly impacts the larger healthcare system in the form of increased physician turnover, increased medical error rate, and decreased patient satisfaction. Early retirement, substance abuse, depression, and in the worst cases, suicide are all real problems in healthcare today. Optimal care cannot be provided by healers who have exhausted their reservoirs of resilience. The global coronavirus pandemic has further frayed the bonds of community that have served to tie doctors, nurses, and other healthcare team members together. Individual and organizational strategies have been described to restore a sense of personal and professional satisfaction. Thoughtful and inclusive institutional leadership has been shown to be valuable and effective in establishing a culture that is compassionate to all participants. Intentional application of these strategies and investment of resources at multiple levels is the challenge before the medical community.KeywordsWellnessWell-beingBurnoutPatient safetyPatient careMoral injurySecond victim syndromeOrganizational wellness
Article
OBJECTIVE Burnout and work-life balance have been noted to be problems for residents across all fields of medicine, including neurosurgery. No studies to date have evaluated how these factors may contribute to issues outside of the hospital, specifically residents’ home lives. This study aimed to evaluate the interplay between home life and work life of neurosurgical residents, specifically from the point of view of residents’ significant others. METHODS Online surveys were distributed to the significant others of neurosurgical residents at 12 US neurosurgery residencies. Residents’ partners were asked about relationship dynamics, their views on neurosurgery residency (work-life balance and burnout), and their views of neurosurgery as a career. RESULTS The majority of residents’ significant others (84%) reported being satisfied with their relationship. Significant others who reported dissatisfaction with their relationship were more likely to report frustration with work-life balance and more likely to report their resident partner as having higher levels of burnout. CONCLUSIONS From the perspective of neurosurgery residents’ significant others, higher perceived levels of burnout and lower satisfaction with work-life balance are correlated with lower levels of relationship satisfaction. These findings speak to the complex interplay of work life and home life and can be used to inform future interventions into improving the quality of life for both the resident and the significant other.
Article
Purpose Even though physician burnout can negatively impact physical/mental health, ophthalmologists’ quality of life (QOL) is understudied. While managing high-risk diseases like pediatric glaucoma may lead to “compassion satisfaction” (CS), the responsibility of caring for very sick, demanding patients has been linked to higher burnout. Burnout and secondary traumatic stress (STS) constitute compassion fatigue, the negative effects resulting from helping those who experience stress. We assessed professional QOL, including CS, burnout, and STS, along with associated factors among pediatric glaucoma providers managing potentially blinding disease in children. Design Cross-sectional survey study Participants Pediatric glaucoma providers in the Childhood Glaucoma Research Network, American Glaucoma Society, and Indian Paediatric Glaucoma Society. Methods Participants were sent an electronic survey of a validated instrument (ProQOL-Version 5) designed to measure burnout, STS, and CS, as well as questions related to demographics, lifestyle, training, and practice. Burnout, STS, and CS scores range from 10 to 50 and are classified into low (≤22), moderate (23-41), and high (≥42) subgroups. Main Outcome Measures Burnout, STS, CS Results 76 pediatric glaucoma providers completed the survey with resulting burnout (22.6±6.3), STS (22.7±6.1), and CS (42.3±6.7) scores. Most respondents had low burnout (43, 56.6%), low STS (44, 57.9%) and high CS (48, 63.2%), though more than a third reported moderate burnout (33, 43.4%), STS (31, 40.8%), and CS (27, 35.6%). Older age and more years in practice correlated positively with CS, and age correlated negatively with STS (p<0.05 for all). Frequent workday fatigue correlated positively with burnout and STS and negatively with CS, and frequent caffeine consumption correlated positively with burnout and negatively with CS (p<0.05 for all). Members of a married or unmarried couple had significantly lower CS scores than single, divorced, or separated respondents (p=0.022). Conclusions Pediatric glaucoma providers derive a high level of professional satisfaction from their work, though many report moderate burnout and STS. To comprehensively address provider QOL, CS and both components of compassion fatigue must be considered. Initial efforts may be focused on younger, early-career providers as this group had lower professional QOL scores than their older, late-career counterparts.
Article
Background: Front-line providers working with people who inject drugs (PWID) are at increased risk of experiencing burnout. Few studies have examined protective factors against burnout incurred in the care of PWID, including harm reduction counseling skills. We measured self-efficacy in harm reduction counseling, burnout, and compassion satisfaction among Internal Medicine (IM) trainees caring for PWID. Methods: In this cross-sectional study, we surveyed IM interns and residents. Self-efficacy was assessed by asking trainees about attitudes, comfort, and knowledge in harm reduction counseling on a five-point Likert scale. Burnout and compassion satisfaction were assessed via an adapted 20-question Professional Quality of Life Scale. We compared self-efficacy in harm reduction counseling, compassion satisfaction, and burnout between interns and residents using ANOVA and Mann-Whitney U tests. We used Spearman's rho correlational analysis to examine the relationship between these three variables. Results: Seventy-nine IM trainees (36 interns, 43 residents) completed the survey for a 52% response rate. Residents reported higher self-efficacy in harm reduction counseling, similar levels of burnout, and higher compassion satisfaction compared to interns. Across training levels, we found a negative correlation between burnout and compassion satisfaction (r = -0.55, p < 0.01) and a positive correlation between compassion satisfaction and comfort counseling PWID on harm reduction (r = 0.30, p < 0.01). Conclusions: Among IM trainees at an urban institution serving a large population of PWID, self-efficacy in harm reduction counseling and compassion satisfaction increase with time in training while burnout remains similar. Strengthening trainees' capacity to counsel PWID on harm reduction may improve their compassion satisfaction in caring for this population, potentially leading to improved care. This relationship should be explored longitudinally in larger cohorts and through evaluations of harm reduction-focused medical education.
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This paper investigates the relationship between defensive communication in perfor- mance appraisal settings by considering the mediating effect of leader� /member exchange relationships. In a study of employees of a US federal fire department, defensive communication was associated with lower quality leader� /member exchange relation- ships, which in turn was related to burnout. We discuss the implications of these findings, particularly as they apply to organizations and their employees, as well as limitations and directions for future research.
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One-hundred-thirty-five university faculties participated in a survey-based study of burnout. This study investigated the role of person-organization value congruence on the experience of burnout. Also, the mediating role of burnout on the relationship between person-organization value congruence and outcomes (in congruence with Maslach, Schaufel and Leiter's theory) was examined. As predicted by a coping/withdrawal framework, burnout was associated with less time spent on teaching, service/administrative tasks, and professional development activities. To a lesser extent, burnout was associated with spending more time on non-work activities. Person-organization value congruence was strongly associated with burnout. Value congruence had direct relationships with several of the outcome variables, and, consistent with the model, burnout partially or fully mediated the relationship between congruence and satisfaction, spending less time on teaching, and on professional development activities.
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Abstract It has been a decade since an international group of scholars came together to discuss and debate the construct of job burnout. That conference, which took place in Krakow, Poland in 1990, was a major turning point in the development of this field. Not only did it bring together a wide range of theoretical perspectives and empirical data, it generated new directions for the work that needed to be done in the future (Schaufeli et al., 1993). Now that we are 10 years into that future, it would be worthwhile to assemble a new group of international scholars and discover what progress has been made. In essence, that is what the editors of this Special Issue have done. They have invited several of the leading burnout researchers from several continents to contribute their newest studies on this important social phenomenon. Thus this Special Issue affords us the opportunity to assess the strides that have been made since that first meeting in Krakow. So what have we now learned about burnout and its relation to health?
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Job burnout has long been recognized as a problem that leaves once-enthusiastic professionals feeling drained, cynical, and ineffective. This article proposes two new approaches to the prevention of burnout that focus on the interaction between personal and situational factors. The first approach, based on the Maslach multidimensional model, focuses on the exact opposite of burnout: increasing engagement with work by creating a better “fit” between the individual and the job. The second approach draws from the decision-making literature and reframes burnout in terms of how perceptions of the risk of burnout may lead to suboptimal choices that actually increase the likelihood of burning out. These new approaches provide a more direct strategy for preventing burnout than typical unidimensional “stress” models because these new approaches (1) specify criteria for evaluating outcomes and (2) focus attention on the relationship between the person and the situation rather than one or the other in isolation.
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Major perspectives concerning stress are presented with the goal of clarifying the nature of what has proved to be a heuristic but vague construct. Current conceptualizations of stress are challenged as being too phenomenological and ambiguous, and consequently, not given to direct empirical testing. Indeed, it is argued that researchers have tended to avoid the problem of defining stress, choosing to study stress without reference to a clear framework. A new stress model called the model of conservation of resources is presented as an alternative. This resource-oriented model is based on the supposition that people strive to retain, project, and build resources and that what is threatening to them is the potential or actual loss of these valued resources. Implications of the model of conservation of resources for new research directions are discussed.
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An intervention was developed to increase patient involvement in care. Using a treatment algorithm as a guide, patients were helped to read their medical record and coached to ask questions and negotiate medical decisions with their physicians during a 20-minute session before their regularly scheduled visit. In a randomized controlled trial we compared this intervention with a standard educational session of equal length in a clinic for patients with ulcer disease. Six to eight weeks after the trial, patients in the experimental group reported fewer limitations in physical and role-related activities (p less than 0.05), preferred a more active role in medical decision-making, and were as satisfied with their care as the control group. Analysis of audiotapes of physician-patient interactions showed that patients in the experimental group were twice as effective as control patients in obtaining information from physicians (p less than 0.05). Results of the intervention included increased involvement in the interaction with the physician, fewer limitations imposed by the disease on patients' functional ability, and increased preference for active involvement in medical decision-making.
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Recent research suggests that a better understanding of emotional exhaustion requires the development of new theoretical perspectives. To that end, with the conservation of resources model (COR) as the theoretical framework, the present 1-year longitudinal study was undertaken. Composed of 52 social welfare workers, this research examined the relationship of emotional exhaustion to job satisfaction, voluntary turnover, and job performance. Positive affectivity (PA) and negative affectivity (NA) were used as control variables. Whereas emotional exhaustion was unrelated to job satisfaction, it was associated with both performance and subsequent turnover. In addition, the relationship between emotional exhaustion and performance and also between emotional exhaustion and turnover remained significant above and beyond the effects of PA and NA. Future research directions and implications of the findings are introduced.
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Plans for improving safety in medical care often ignore the patient's perspective. The active role of patients in their care should be recognised and encouraged. Patients have a key role to play in helping to reach an accurate diagnosis, in deciding about appropriate treatment, in choosing an experienced and safe provider, in ensuring that treatment is appropriately administered, monitored and adhered to, and in identifying adverse events and taking appropriate action. They may experience considerable psychological trauma both as a result of an adverse outcome and through the way the incident is managed. If a medical injury occurs it is important to listen to the patient and/or the family, acknowledge the damage, give an honest and open explanation and an apology, ask about emotional trauma and anxieties about future treatment, and provide practical and financial help quickly.
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Using psychometric meta-analysis, the authors present a quantitative and qualitative review (k = 205, total pairwise N = 62,527) of the literature relating trait and state positive affect (PA) and negative affect (NA) to job-related attitudes, including job satisfaction, organizational commitment, turnover intentions, and dimensions of job burnout. Results indicated substantial correlations, ranging in absolute value from -.17 (PA and turnover intentions; NA and personal accomplishment) to.54 (NA and emotional exhaustion). Correlational results largely were consistent across hypothesized and exploratory moderator conditions. Meta-analytic multiple regression results generally supported the unique contribution of each affect to each attitude variable of interest. Implications and suggestions for future research on emotion-related aspects of job attitudes are discussed.
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This study among a sample of 207 general practitioners (GPs) uses a five-year longitudinal design to test a process model of burnout. On the basis of social exchange and equity theory, it is hypothesized and found that demanding patient contacts produce a lack of reciprocity in the GP-patient relationship, which, in turn, depletes GPs' emotional resources and initiates the burnout syndrome. More specifically, structural equation analyses confirmed that - both at T1 and T2 - lack of reciprocity mediates the impact of patient demands on emotional exhaustion. Emotional exhaustion, in turn, evokes negative attitudes toward patients (depersonalization), and toward oneself in relation to the job (reduced personal accomplishment). Moreover, this process model of burnout was confirmed at T2, even after controlling for T1-scores on each of the model components. Finally, T1 depersonalization predicted the intensity and frequency of T2 patient demands, after controlling for T1 patient demands. This major finding suggests that GPs who attempt to gain emotional distance from their patients as a way of coping with their exhaustion, evoke demanding and threatening patient behaviors themselves. The theoretical and practical implications of these findings are discussed. (aut.ref.)
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