Christine A. Sinsky's research while affiliated with American Medical Association and other places
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Publications (143)
Artificial intelligence (AI) has tremendous potential to improve the cognitive and work burden of clinicians across a range of clinical activities, which could lead to reduced burnout and better clinical care. The recent explosion of generative AI nicely illustrates this potential. Developers and organizations deploying AI have a responsibility to...
Background
Hospitalist physician stress was exacerbated by the pandemic, yet there have been no large scale studies of contributing factors.
Objective
Assess remediable components of burnout in hospitalists.
Participants, Study Design and Measures
In this Coping with COVID study, we focused on assessment of stress factors among 1022 hospital-base...
This essay discusses how the deep work of doctoring leveraged with technology can bring us close to the quadruple aim of better care, better health, lower cost, and fulfilling work.
Objective:
Physicians of all specialties experienced unprecedented stressors during the COVID-19 pandemic, exacerbating preexisting burnout. We examine burnout's association with perceived and actionable electronic health record (EHR) workload factors and personal, professional, and organizational characteristics with the goal of identifying lever...
Accurately quantifying clinician time spent on electronic health record (EHR) activities outside the time scheduled with patients is critical for understanding occupational stress associated with ambulatory clinic environments. We make 3 recommendations regarding EHR workload measures that are intended to capture time working in the EHR outside tim...
This cohort study examines changes in physician electronic health record (EHR) documentation time before and after changes in Centers for Medicare & Medicaid evaluation and management requirements.
Introduction:
Systematic reviews by the WHO have shown an increased risk of morbidity and mortality related to ischemic heart disease and stroke among individuals working an average of ≥55 hours/week.
Methods:
A cross-sectional survey of U.S. physicians and a probability-based sample of the general U.S. working population (n=2,508) was conducted...
This book provides a scoping summary review of the evidence related to medical student and graduate medical trainee well-being, enabling readers to make use of a variety of tools and instruments believed to have impact on reducing burnout and promoting the development of a resilient and professionally fulfilled physician work force. Areas of focus...
Importance:
Understanding of the interplay between the electronic health record (EHR), health care team relations, and physician well-being is currently lacking. Approaches to cultivate interpersonal interactions may be necessary to complement advancements in health information technology with high-quality team function.
Objective:
To examine wa...
Background:
Clinician burnout is a longstanding national problem threatening clinician health, patient outcomes, and the health care system. The aim of this study is to determine the proportion of hospitals and Federally Qualified Health Centers (FQHCs) that are measuring and taking system actions to promote clinician well-being.
Methods:
This c...
Background
Burnout has risen across healthcare workers during the pandemic, contributing to workforce turnover. While prior literature has largely focused on physicians and nurses, there is a need to better characterize and identify actionable predictors of burnout and work intentions across healthcare role types.
Objective
To characterize the ass...
This Viewpoint discusses the need for public funding for research that supports health workforce well-being and addresses occupational burnout among health care practitioners.
Background
Physician burnout is a major problem in the United States. Small studies suggest scribes can improve clinician satisfaction, but scribe programs have not been evaluated using separate control groups or structured measures of electronic health record (EHR) use.
Methods
We conducted a pre-post, non-randomized controlled evaluation of a re...
Importance
Physician burnout is an ongoing epidemic; electronic health record (EHR) use has been associated with burnout, and the burden of EHR inbasket messages has grown in the context of the COVID-19 pandemic. Understanding how EHR inbasket messages are associated with physician burnout may uncover new insights for intervention strategies.
Obje...
Importance
The COVID-19 pandemic has affected clinician health and retention.
Objective
To describe trends in burnout from 2019 through 2021 with associated mitigating and aggravating factors.
Design, Setting, and Participants
Cross-sectional surveys were sent to physicians and advanced practice clinicians throughout 120 large US health care orga...
Physicians facing the COVID-19 pandemic are likely to experience acute and chronic, and often unpredictable, occupational stressors that can incur post-traumatic stress symptoms (PTSS), prevention of which is of utmost importance to enhance healthcare workforce efficiency. Unlike previous studies, in this paper we developed a generalized data-drive...
Objective
To evaluate the prevalence of burnout and satisfaction with work-life integration (WLI) in US physicians at the end of 2021, roughly 21 months into the COVID-19 pandemic, with comparison to 2020, 2017, 2014, and 2011.
Methods
Between December 9, 2021, and January 24, 2022, we surveyed US physicians using methods similar to our prior stud...
Objective
To determine the prevalence of imposter phenomenon (IP) experiences among physicians and evaluate their relationship to personal and professional characteristics, professional fulfillment, burnout, and suicidal ideation.
Participants and Methods
Between November 20, 2020, and February 16, 2021, we surveyed US physicians and a probability...
Importance:
Childcare stress (CCS) is high during the COVID-19 pandemic because of remote learning and fear of illness transmission in health care workers (HCWs). Associations between CCS and burnout, intent to reduce (ITR) hours, and intent to leave (ITL) are not known.
Objective:
To determine associations between CCS, anxiety and depression, b...
Undivided attention is a clinician's superpower. Often called deep work, being in the flow, or being in the zone-- when health professionals are able to perform their responsibilities with full focus and presence, the care itself is safer and the care process is more satisfying to patients and clinicians alike. The opposite of this state is split a...
Importance:
Burnout is common among physicians and is associated with suboptimal patient outcomes. Little is known about how experiences with patients, families, and visitors differ by physician characteristics or contribute to the risk of burnout.
Objective:
To examine the occurrence of mistreatment and discrimination by patients, families, and...
This cross-sectional study assesses gender differences in time spent on documentation and electronic health records in a large ambulatory care network.
Objective
To evaluate the prevalence of burnout and satisfaction with work-life integration (WLI) among physicians and US workers in 2020 relative to 2011, 2014, and 2017.
Methods
Between November 20, 2020, and March 23, 2021, we surveyed US physicians and a probability-based sample of the US working population using methods similar to our prior s...
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 A...
To describe relationships between compromised integrity (CI), burnout, and intent-to-leave (ITL) practice in critical care (CC) and noncritical care (non-CC) nurses and physicians.
Design:
CC nurses (RNs) and physicians (MDs) from the American Medical Association Coping with COVID survey were matched by gender, race, years in practice, and role w...
Objective
To evaluate relationships between coronavirus disease 2019 (COVID-19)–related stress and work intentions in a sample of US health care workers.
Patients and Methods
Between July 1 and December 31, 2020, health care workers were surveyed for fear of viral exposure or transmission, COVID-19–related anxiety or depression, work overload, bur...
Background:
Electronic health records (EHRs) have become ubiquitous in United States office-based physician practices. However, the different ways users engage with EHRs remains poorly characterized.
Objective:
The objective of this paper is to explore EHR usage phenotypes amongst ambulatory care physicians.
Methods:
In this retrospective coho...
BACKGROUND
Electronic health records (EHRs) have become ubiquitous in United States office-based physician practices. However, the different ways users engage with EHRs remains poorly characterized.
OBJECTIVE
The objective of this paper is to explore EHR usage phenotypes amongst ambulatory care physicians.
METHODS
We applied affinity propagation,...
This study evaluated post traumatic stress disorder (PTSD) among frontline US physicians (treating COVID-19 patients) in comparison with second-line physicians (not treating COVID-19 patients), and identified the significance and patterns of factors associated with higher PTSD risk. A cross-sectional, web-based survey was deployed during August and...
Importance:
Physician turnover takes a heavy toll on patients, physicians, and health care organizations. Survey research has established associations of electronic health record (EHR) use with professional burnout and reduction in professional effort, but these findings are subject to response fatigue and bias.
Objective:
To evaluate the associ...
This cross-sectional study compares patient electronic health record (EHR) inbox message volume in an ambulatory practice network in New England during the COVID-19 pandemic with prepandemic levels.
In Reply We thank Dr O’Hanlon for the thoughtful commentary on our Research Letter.¹ We agree that clinical practice guidelines are not the same as performance measures (PMs) and that there may be nuances of clinical care that influence screening practices beyond PM specifications. The literal implementation of recommended screening intervals withi...
Objective
To evaluate the prevalence of suicidal ideation (SI) and attitudes regarding help seeking among US physicians relative to the general US working population.
Participants and Methods
A secondary analysis of a cross-sectional survey of US physicians and a probability-based sample of the US working population was conducted between October 1...
Federal funders and managed care insurers often provide financial incentives for health care clinicians to perform standardized screening questionnaires. The goal of rapidly identifying patients who may have depression, anxiety, or substance use disorders or who may need extra help in understanding medical terms is noble. However, the financial inc...
Objective:
To compare physicians with workers in other fields on measures of self-valuation (SV) and determine the effect of adjusting for SV on the relationship between being a physician and risk for burnout.
Patients and methods:
A random sample of physicians from the American Medical Association Physician Masterfile and a probability sample f...
Importance
Poor work-life integration (WLI) occurs when career and personal responsibilities come in conflict and may contribute to the ongoing high rates of physician burnout. The characteristics associated with WLI are poorly understood.
Objective
To identify personal and professional factors associated with WLI in physicians and identify factor...
Background
COVID-19 has put extraordinary stress on healthcare workers. Few studies have evaluated stress by worker role, or focused on experiences of women and people of color.
Methods
The “Coping with COVID” survey assessed US healthcare worker stress. A stress summary score (SSS) incorporated stress, fear of exposure, anxiety/depression and wor...
Objective:
To derive 7 proposed core electronic health record (EHR) use metrics across 2 healthcare systems with different EHR vendor product installations and examine factors associated with EHR time.
Materials and methods:
A cross-sectional analysis of ambulatory physicians EHR use across the Yale-New Haven and MedStar Health systems was perfo...
Background: Physician burnout is often assessed by healthcare organizations. Yet, scores from different burnout measures cannot currently be directly compared, limiting the interpretation of results across organizations or studies.
Objective: To link common measures of burnout to a single metric in psychometric analyses such that group-level score...
There is an inherent tension between standardization and customization of care delivery processes. The challenge for health care systems is to achieve the right balance. At its best, standardized work can create efficiencies that generate the additional time needed for personalized care. Similarly, at its best, customization allows the people withi...
Objective
To assess the impact of the COVID-19 crisis on physician stress and mental health.
Participants and Methods
The 10-item “Coping with COVID” survey assessed stress among 2373 physicians from April 4 to May 27, 2020. A stress summary score (SSS) with four items (a single item (overall) stress measure, fear of exposure, perceived anxiety/de...
The COVID-19 pandemic accelerated adoption of telemedicine visits into American medicine. It is commonly believed that, within a matter of weeks, telemedicine was widely and successfully implemented and that medicine is forever changed. The experience on the ground, however, is more nuanced, with both positive and negative experiences for patients...
In a New Yorker article, Atul Gawande¹ examined reasons “why doctors hate their computers.” A better question might be, “why do US doctors hate their computers?” In this issue of JAMA Internal Medicine, the study by Holmgren et al² points to a portion of the answer, presenting data on the differences in physician time costs between US and non-US cl...
Importance
Addressing physician suicide requires understanding its association with possible risk factors such as burnout and depression.
Objective
To assess the association between burnout and suicidal ideation after adjusting for depression and the association of burnout and depression with self-reported medical errors.
Design, Setting, and Par...
Electronic health record (EHR) log data capture clinical workflows and are a rich source of information to understand variation in practice patterns. Variation in how EHRs are used to document and support care delivery is associated with clinical and operational outcomes, including measures of provider well-being and burnout. Standardized measures...
Background
Cognitive task load can affect providers’ ability to perform their job well and may contribute to burnout.
Methods
The researchers evaluated whether task load, measured by the National Aeronautics and Space Administration (NASA) Task Load Index (TLX), correlated with burnout scores in a large national study of US physicians between Octo...
BACKGROUND
Electronic health record (EHR) usability and physician task load both contribute to physician professional burnout. The association between perceived EHR usability and workload has not previously been studied at a national level. Better understanding these interactions could give further information as to the drivers of extraneous task l...
Background
Electronic health record (EHR) usability and physician task load both contribute to physician professional burnout. The association between perceived EHR usability and workload has not previously been studied at a national level. Better understanding these interactions could give further information as to the drivers of extraneous task l...
Importance
Previous research suggests that the prevalence of occupational burnout varies by demographic characteristics, such as sex and age, but the association between physician race/ethnicity and occupational burnout is less well understood.
Objective
To investigate possible differences in occupational burnout, depressive symptoms, career satis...
Clinical care in the United States has been transformed during the coronavirus disease 2019 (COVID-19) pandemic. To support these changes, regulators and payers have temporarily modified long-standing policies, recognizing the need for a trade-off between the costs and benefits of oversight during times of crisis. Specifically, there has been a hei...
Importance
The prevalence of physician burnout is well documented, and resilience training has been proposed as an option to support physician well-being. However, the resilience of physicians compared with that of the US working population is not established, and the association between resilience and physician burnout is not well understood.
Obj...
This cross-sectional survey assesses the association of perceived electronic health record usability with patient interaction and work-life integration among US physicians.
Purpose:
To explore the interaction between practice setting (academic practice [AP], private practice [PP]) and gender in relation to physician burnout and satisfaction with work-life integration (WLI).
Method:
In 2017, the authors administered a cross-sectional survey of U.S. physicians and characterized rates of burnout and satisfaction with...
Electronic health record (EHR) log data have shown promise in measuring physician time spent on clinical activities, contributing to deeper understanding and further optimization of the clinical environment. In this article, we propose 7 core measures of EHR use that reflect multiple dimensions of practice efficiency: total EHR time, work outside o...
Background
Despite the importance of professionalism, little is known about how burnout relates to professionalism among practicing physicians.
Objective
To evaluate the relationship between burnout and professional behaviors and cost-conscious attitudes.
Design and Participants
Cross-sectional study in a national sample of physicians of whom a f...
Objective:
To describe and benchmark physician-perceived electronic health record (EHR) usability as defined by a standardized metric of technology usability and evaluate the association with professional burnout among physicians.
Participants and methods:
This cross-sectional survey of US physicians from all specialty disciplines was conducted...
To assess the impact of organization-directed workplace interventions on physician burnout, including stress or job satisfaction in all settings, we conducted a systematic review of the literature published from January 1, 2007, to October 3, 2018, from multiple databases. Manual searches of grey literature and bibliographies were also performed. O...
Our move away from a traditional practice model has improved quality metrics and enhanced our financial sustainability.
Healthcare information technologies are now a routine component of patient-clinician interactions. Originally designed for operational functions including billing and regulatory compliance, these systems have had unintended consequences including increased exam room documentation, divided attention during the visit, and use of scribes to alleviate...
Physicians can spend more time completing administrative tasks in their electronic health record (EHR) than engaging in direct face time with patients. Increasing rates of burnout associated with EHR use necessitate improvements in how EHRs are developed and used. Although EHR design often bears the brunt of the blame for frustrations expressed by...
Primary care teams are underpowered. Teams do not maximally redistribute team functions when clinicians are diverted from activities where they add the most value. This commentary describes "advanced team care with in-room support" as a way to "power-up" primary care teams. In this core team model, each clinician is paired with 2 or 3 highly traine...
Importance
There is new emphasis on clinician trust in health care organizations but little empirical data about the association of trust with clinician satisfaction and retention.
Objective
To examine organizational characteristics associated with trust.
Design, Setting, and Participants
This prospective cohort study uses data collected from 201...