Burnout Levels and Patterns in Postgraduate Medical Trainees: A Systematic Review and Meta-Analysis

PURPOSE

Postgraduate medical trainees experience high rates of burnout; however, inconsistencies in definitions of burnout characterize this literature. The authors conducted a systematic review and meta-analysis examining burnout levels and patterns in postgraduate medical trainees, using a continuous conceptualization of burnout, consistent with the Maslach Burnout Inventory (MBI) framework.

METHOD

The authors searched 5 electronic databases (Cochrane Library, Embase, ERIC, Ovid MEDLINE, Ovid PsycINFO) between January 1981 and July 2019 for studies reporting postgraduate medical trainees' burnout levels using the MBI-Human Services Survey. They examined study reporting quality using the QualSyst quality appraisal tool and calculated standardized mean differences (Hedges' g), comparing trainees' data with MBI norms for medicine and the overall population using a random effects model. They explored between-study heterogeneity using subgroup analyses (i.e., by training level and specialty). Finally, they studied the combined contribution of these 2 variables (and year of study publication) to burnout levels, using meta-regression.

RESULTS

The authors identified 2,978 citations and included 89 independent studies in their review. They pooled the data for the 18,509 postgraduate trainees included in these studies for the meta-analyses. Reporting quality was generally high across the included studies. The meta-analyses revealed higher burnout levels among trainees compared with medicine and overall population norms, particularly for the depersonalization subscale. The authors also identified statistically significant differences between nonsurgical and surgical registrars (specialty trainees), with trainees from 12 individual specialties exhibiting unique burnout patterns.

CONCLUSIONS

There is a need to reduce and prevent burnout early in medical training. Given the differences in burnout levels and patterns across specialties, interventions must focus on the unique patterns exhibited by each specialty in the target population using a multidimensional approach. Standardizing the definition of burnout in accordance with the MBI framework will facilitate progression of this work.

The Relationship Between Residents' Perceptions of Residency Program Leadership Team Behaviors and Resident Burnout and Satisfaction

PURPOSE

To explore the relationship between residents' perceptions of residency program leadership team behaviors and resident burnout and satisfaction.

METHOD

In February 2019, the authors surveyed all residents across the 77 graduate medical education training programs at Mayo Clinic's multiple sites. Survey items measured residents' perceptions of program director and associate program director behaviors (using a composite residency program leadership team score), resident burnout, and resident satisfaction with the program and organization. Multivariable logistic regression was performed to evaluate relationships between these variables at the individual resident (adjusting for age, sex, postgraduate training year, program location, and specialty) and program (including only programs with at least 5 respondents) levels.

RESULTS

Of the 1,146 residents surveyed, 762 (66.5%) responded. At the individual resident level, higher composite leadership team scores were associated with lower emotional exhaustion and depersonalization and higher overall satisfaction with the residency program and organization (all P < .001). In adjusted logistic regression models, each 1-point gain in composite leadership team score was associated with 9% lower odds of burnout, 20% higher odds of program satisfaction, and 19% higher odds of satisfaction with the organization (all P < .001). At the residency program level, higher mean composite leadership team scores were associated with a lower rate of burnout (r = -0.35, P = .03) and higher program and organization satisfaction (r = 0.67 and 0.74, respectively, both P < .001).

CONCLUSIONS

The behaviors of residency program leadership teams influence residents' burnout and satisfaction. Additional studies are needed to determine if leadership training results in improved resident well-being and satisfaction.

Disparities in Burnout and Satisfaction With Work-Life Integration in U.S. Physicians by Gender and Practice Setting

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 WLI using previously validated and/or standardized tools. They conducted multivariable logistic regression to determine the interaction between the included variables.

RESULTS

Of the 3,603 participants in the final analysis, female physicians reported a higher prevalence of burnout than male physicians in both AP (50.7% vs 38.2%, P < .0001) and PP (48.1% vs 40.7%, P = .001). However, the multivariable analysis found no statistically significant gender-based differences in burnout (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.76-1.17, P = .60). Women and men in AP were less likely to report burnout than men in PP (OR 0.70, 95% CI 0.52-0.94, P = .01 and OR 0.69, 95% CI 0.53-0.90, P < .01, respectively); women in PP did not report different burnout rates from men in PP (OR 0.89, 95% CI 0.68-1.16, P = .38). Women in both AP and PP were less likely to be satisfied with WLI than men in PP (OR 0.62, 95% CI 0.47-0.83, P < .01 and OR 0.75, 95% CI 0.58-0.97, P = .03, respectively); men in AP did not report different satisfaction with WLI than men in PP (OR 1.05, 95% CI 0.82-1.33, P = .71).

CONCLUSIONS

Gender differences in rates of burnout are related to practice setting and other differences in physicians' personal and professional lives. These results highlight the complex relationships among gender, practice setting, and other personal and professional factors in their influence on burnout and satisfaction with WLI.

Distinguishing burnout from depression: An exploratory qualitative study

Whether depression and burnout are synonymous or not has been a longstanding debate. Many studies have examined for similarities and differences, but findings have overall been inconclusive, with most studies being quantitative in design. We therefore undertook a qualitative study in which participants who self-identified as having experienced both burnout and depression were asked how they distinguished between the two conditions. Thematic qualitative analysis was undertaken and while a fifth of the sample stated that their burnout and depression experiences were indistinguishable or were very similar, we also identified 11 key themes of difference. The most prevalent themes captured differences in the perceived cause of each condition, in experiencing hopelessness as against helplessness, and impacts on levels of functioning, sadness, anger, anxiety and emotional lability. We also identified differences in suicidal ideation between the two conditions. While some differences identified could be dimensional and suggest that burnout is simply synonymous with or a developmental phase of depression, the several categorical symptom differences nominated by participants suggest that most sufferers who have experienced both conditions perceive them as distinct. Such 'lived experience' reports are therefore intrinsically informative and should shape further quantitative analyses.

Assessment of Burnout: A Pilot Study of International Women Physicians

INTRODUCTION

Physician burnout, wellness, and resilience have become increasingly important topics of discussion worldwide. While studies have assessed burnout globally in various individual countries, few studies directly compare or analyze gender-based physician burnout among different global regions.

METHODS

Female physicians attending the Medical Women's International Association (MWIA) Centennial Congress completed the Copenhagen Burnout Inventory (CBI) which evaluates personal-, work-, and patient-related burnout using a scale of 0 to 100. Results were analyzed using descriptive statistics and 1-way ANOVA to compare burnout scores amongst women physicians from different global regions.

RESULTS

Of 100 physicians invited to participate, 76 provided responses and 71 met the inclusion criteria. Mean burnout scores were highest amongst women from Africa in all categories. Mean work-related, patient-related, and personal-related burnout scores were significantly lower for physicians in Europe compared to Africa (p = 0.05) when evaluated using a 1-way ANOVA, with no statistically significant differences between other regions.

DISCUSSION

The data suggests that there may be regional differences in the prevalence of burnout in women physicians. Various factors could play a role in explaining the higher burnout scores in female physicians in Africa, including younger average age, establishing practice during childbearing years, and significant physician shortage. Through this study, we have begun to explore the cultural and geographical context related to women's mental and physical wellbeing in the medical field. Further research should focus on the gender-specific contributors to burnout among different global regions, so that methods can be implemented on a systemic level to alleviate burnout.

An Analysis of Burnout among Military General Surgery Residents

OBJECTIVES

Resident burnout is an increasing issue in graduate medical education programs. Military graduate medical education is unique in numerous ways and may have different rates of burnout as well as different causes. This study aims to assess resident burnout rates and contributing factors among military general surgery residents.

DESIGN, SETTING, AND PARTICIPANTS

Using Department of Defense approved software, an anonymous survey was created and distributed to all general surgery residents (n = 180) in 6 US medical centers where there are general surgery residency programs. The survey contained an Abbreviated Maslach Burnout Index questionnaire, multiple choice questions including several military-specific questions, and 2 open ended questions. Rates of burnout and potential risk factors associated with burnout were analyzed.

RESULTS

After the collection period, 92 of 180 (51%) residents completed all Abbreviated Maslach Burnout Index questions, demographics, and military specific questions with an opportunity for written comments. Notable demographic findings of the respondents were that 64% were male, 65% were married or engaged, 40% had children, and 69% had no student loan debt. Overall, there was a 66% rate of burnout in any tertile. Variables found to be significant for overall burnout included the likelihood the resident plans to stay beyond their active duty service obligation and the perceived level of autonomy. Of the written responses, the most commonly cited contributing factor was the work burden from nonclinical and/or administrative tasks while the most common protective factor was resident camaraderie.

CONCLUSIONS

Overall, burnout rates are similar among military general surgery residents compared to published reports of civilians. The close association with resident burnout and anticipation of early withdrawal from military service demonstrates this topic is potentially important to retention of the military medical force. The topics of increased resident autonomy, decreased non-clinical duties, and efforts to increase resident camaraderie should be more closely evaluated.

T, Aguayo-Extremera R, Albendín-García L. Study of the Predictive Validity of the Burnout Granada Questionnaire in Police Officers

Professionals with burnout have negative physical and psychological effects, with adverse consequences in their workplace. Burnout mainly affects assisting professions; amongst them, police work is one of the professions at risk of suffering from this syndrome. The aim of this research is to study the adequacy of the Maslach Burnout Inventory and Granada Burnout Questionnaire instruments to measure burnout in police officers through the study of the reliability and validity (concurrent and predictive) of these instruments. A cross-sectional study was carried out. The sample was composed of 1884 police officers, mostly men (85.4%), with an average age of 35.04 (SD = 8.30). The Maslach Burnout Inventory and Granada Burnout Questionnaire were used to measure burnout. The results obtained in this study support the adequacy of both instruments for measuring burnout. The correlation coefficients between the dimensions are significant, with a medium-high magnitude. Participants with burnout had significantly higher scores in emotional exhaustion and depersonalization and lower scores in personal accomplishment in both instruments. The area under the curve estimated for the Granada Burnout Questionnaire provided evidence of the predictive validity of the instrument. The police profession needs validated and sensitive tools to identify police changes in the dimensions of burnout. The Granada Burnout Questionnaire instrument correctly classifies burnout in police professionals.

A cross-sectional self-assessment of burnout amongst a sample of doctors in Ghana

BACKGROUND

The occurrence of burnout amongst African health professionals has been widely anticipated, but there is a dearth of published data, especially amongst doctors. Burnout has been reported to be as high as 53% amongst doctors in the United States. If not detected, it can result in prescription errors, work-related accidents, substance abuse and depression.

AIM

The aim of this study was to determine the prevalence of burnout and its associated factors amongst a sample of physicians in Ghana.

SETTING

This study was conducted in Kumasi amongst physicians attending a conference organised by the West African College of Physicians, Ghana Chapter.

METHOD

A cross-sectional study. Of the 90 physicians who registered for the conference, 60 responded to a self-administered Maslach Burnout Inventory questionnaire. Data were analysed descriptively and inferentially using STATA® version 14.

RESULTS

Approximately 52% of respondents had been in medical practice for 10-19 years (mean 15.4 years). All the major medical specialties were represented. Internal Medicine had the highest number of participants (48.3%). With respect to the components of burnout, 5.5% of respondents experienced depersonalisation, 7.8% had a lack of personal achievement and 10.8% experienced emotional exhaustion. The association between burnout and age, sex, years of practice and clinical specialty was not found to be statistically significant.

CONCLUSION

This pilot study has shown burnout to be common amongst physicians in Ghana. It is recommended that further studies are conducted, involving a larger cross-section of doctors in various parts of Africa.

A national survey on the impact of the COVID-19 pandemic upon burnout and career satisfaction among neurosurgery residents

•

U.S. neurosurgery residents report moderate burnout during the COVID-19 pandemic.

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Neurosurgery residents report uncertainty about future healthcare reform & earnings.

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The COVID-19 pandemic may impair residents’ achievement of surgical milestones.

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Burnout is associated with altered rotation or vacation schedules and lower PGY.

•

Career satisfaction is associated with delivery of neurosurgical patient care.

The coronavirus disease 2019 (COVID-19) pandemic has posed significant changes to resident education and workflow. However, the impact of the pandemic on U.S. neurosurgery residents has not been well characterized. We investigated the impact of the COVID-19 pandemic on U.S. neurosurgery resident workflow, burnout, and career satisfaction. In 2020, a survey evaluating factors related to career satisfaction and burnout was emailed to 1,374 American Association of Neurological Surgeons (AANS) residents. Bivariate and multivariate (logistic) analyses were performed to characterize predictors of burnout and career satisfaction. 167 survey responses were received, with a response rate (12.2%) comparable to that of similar studies. Exclusion of incomplete responses yielded 111 complete responses. Most respondents were male (65.8%) and White (75.7%). Residents reported fewer work hours (67.6%) and concern that COVID-19 would impair their achievement of surgical milestones (65.8%). Burnout was identified in 29 (26.1%) respondents and career satisfaction in 82 (73.9%) respondents. In multivariate analysis, burnout was significantly associated with alterations in elective rotation/vacation schedules (p = .013) and the decision to not pursue neurosurgery again if given the choice (p < .001). Higher post-graduate year was associated with less burnout (p = .011). Residents displayed greater career satisfaction when focusing their clinical work upon neurosurgical care (p = .065). Factors related to COVID-19 have contributed to workflow changes among U.S. neurosurgery residents. We report a moderate burnout rate and a paradoxically high career satisfaction rate among neurosurgery residents. Understanding modifiable stressors during the COVID-19 pandemic may help to formulate interventions to mitigate burnout and improve career satisfaction among residents.

Grit protects medical students from burnout: a longitudinal study

BACKGROUND

Burnout is a serious issue plaguing the medical profession with potential negative consequences on patient care. Burnout symptoms are observed as early as medical school. Based on a Job Demands-Resources model, this study aims to assess associations between specific job resources measured at the beginning of the first year of medical school with burnout symptoms occurring later in the first year.

METHODS

The specific job resources of grit, tolerance for ambiguity, social support and gender were measured in Duke-NUS Medical School students at the start of Year 1. Students were then surveyed for burnout symptoms at approximately quarterly intervals throughout the year. Using high ratings of cynicism and exhaustion as the definition of burnout, we investigated the associations of the occurrence of burnout with student job resources using multivariable logistic regression analysis.

RESULTS

Out of 59 students, 19 (32.2%) indicated evidence of burnout at some point across the first year of medical school. Stepwise multivariable logistic regression analysis identified grit as having a significant protective effect against experiencing burnout (Odds Ratio, 0.84; 95%CI 0.74 to 0.96). Using grit as a single predictor of burnout, area under the ROC curve was 0.76 (95%CI: 0.62 to 0.89).

CONCLUSIONS

Grit was identified as a protective factor against later burnout, suggesting that less gritty students are more susceptible to burnout. The results indicate that grit is a robust character trait which can prognosticate burnout in medical students. These students would potentially benefit from enhanced efforts to develop grit as a personal job resource.

Burnout Among Neurosurgeons and Residents in Neurosurgery: A Systematic Review and Meta-Analysis of the Literature

Background

Burnout syndrome (BS) is a common condition among medical professionals. It is composed of 3 different subdimensions: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). In the last years, interest in BS in the neurosurgical community has increased. Here we investigated burnout among neurosurgeons and residents in neurosurgery.

Methods

A systematic review with meta-analysis was performed following PRISMA guidelines. A search of bibliographic databases was conducted from study inception to February 2020. A total of 16,377 studies were found. Six articles were included in our final analysis. Their references were checked for additional studies, but none were found.

Results

From the initial 16,377 studies identified, only 6 met our inclusion criteria. These studies included a total of 3310 physicians. The general prevalence of BS was 48%. The prevalence in neurosurgeons was 51.1%, higher than that recorded in neurosurgical residents (45.4%). Regarding subdimensions, personal accomplishment seemed to be the most influential factor for burnout development among neurosurgeons (42.57%) and residents (51.56%) alike.

Conclusions

Neurosurgery is a rewarding career choice, but numerous challenges and stressors can lead to lower levels of satisfaction and dangerously increased levels of burnout. We hope that our results will generate discussion, raise awareness, stimulate further studies, and lead to programs designed to mitigate excessive stress and burnout in neurosurgeons.

Burnout in emergency medicine physicians: A meta-analysis and systematic review

BACKGROUND

Physician burnout has been a global problem that affects severely the mental status among doctors, especially in emergency medicine (EM). However, few studies have focused on emergency medicine physicians, and the published data are inconsistent. Thus, this meta-analysis is performed to systematically evaluate the prevalence of burnout among emergency medicine physicians.

METHODS

We systematically searched databases including PubMed, Embase, PsychINFO and the Cochrane Library from inception to September, 2019 for English-language articles. We selected all the original articles those used Maslach Burnout Inventory to assess the prevalence of burnout and its 3 dimensions emotional exhaustion (EE), depersonalization, and personal accomplishment (PA) in emergency medicine physicians. After literature screening, quality evaluation was performed for eligible studies by using the Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting prevalence data; then, Begg test and Egger test was used to assess publication bias. Pooled prevalence rates were assessed by conducting a meta-analysis using random effects models. Then sensitivity analysis followed to test the stability of the result and detected the source of heterogeneity.

RESULTS

A total of 1943 EM physicians provided burnout data. The pooled prevalence rates of high levels of emotional exhaustion, high levels of depersonalization and low levels of PA were 40% (95% CI: 26%-55%; I = 97.4%), 41% (95% CI: 30%-52%; I = 94.5%) and 35% (95% CI: 19%-52%; I = 99.0%), respectively. The mean burnout scores were 23.95 (SD = 11.88) for emotional exhaustion, 11.63 (SD = 6.85) for depersonalization, and 34.69 (SD = 7.71) for PA.

CONCLUSIONS

This meta-analysis demonstrate a high level of burnout prevalent in EM physicians that approximately 40% experience high levels of EE and depersonalization. Our findings also suggest that EM physicians are more susceptible to burnout compared with physicians in other departments and other medical staffs in EM. More attention should be payed to mental status of EM physicians and further investigation concerning how to reduce burnout would be beneficial for EM physicians.Registration: INPLASY202060060 in inplasy.com (doi.org/10.37766/inplasy2020.6.0060).

The Burnout Syndrome in Medical Academia: Psychometric Properties of the Serbian Version of the Maslach Burnout Inventory-Educators Survey

The aim of this study was to assess the psychometric properties of the Maslach Burnout Inventory-Educators Survey (MBI-ES). The presence of burnout syndrome, its relationship with personality traits, intention to change career and work abroad were assessed in a cross-sectional multi-center trial conducted among educators at three medical faculties in the Western Balkans during 2019. Translation and cultural adaptation were made based on internationally accepted principles. Personality traits were assessed by the Big Five Plus Two questionnaire. In total, 246 medical faculty members, predominantly females (61%), were enrolled. The three-factor structure of the MBI-ES questionnaire (exhaustion, cynicism, and professional efficacy) was validated. Analysis of internal consistency yielded a Cronbach's alpha of 0.785, indicating scale reliability. The majority of respondents (85.6%) reported moderate level of burnout. Aggressiveness, neuroticism, and negative valence were associated with emotional exhaustion and depersonalization, while extraversion, conscientiousness, openness, and positive valence correlated with personal accomplishment. Emotional exhaustion and depersonalization in a multivariate regression model were significantly associated with intentions to change career and work abroad (p < 0.05). The present study provided evidence for the appropriate metric properties of the Serbian version of MBI-ES. Presence of burnout syndrome, which was identified as a common problem in medical academia, and directly linked to personality traits, affected intention to career change and work abroad.

Burnout, Depression, Career Satisfaction, and Work-Life Integration by Physician Race/Ethnicity

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 satisfaction, and work-life integration by race/ethnicity in a sample of US physicians.

DESIGN, SETTING, AND PARTICIPANTS

In this cross-sectional study, data for this secondary analysis of 4424 physicians were originally collected from a cross-sectional survey of US physicians between October 12, 2017, and March 15, 2018. The dates of analysis were March 8, 2019, to May 21, 2020. Multivariable logistic regression, including statistical adjustment for physician demographic and clinical practice characteristics, was performed to examine the association between physician race/ethnicity and occupational burnout, depressive symptoms, career satisfaction, and work-life integration.

EXPOSURES

Physician demographic and clinical practice characteristics included race/ethnicity, sex, age, clinical specialty, hours worked per week, primary practice setting, and relationship status.

MAIN OUTCOMES AND MEASURES

Physicians with a high score on the emotional exhaustion or depersonalization subscale of the Maslach Burnout Inventory were classified as having burnout. Depressive symptoms were measured using the Primary Care Evaluation of Mental Disorders instrument. Physicians who marked "strongly agree" or "agree" in response to the survey items "I would choose to become a physician again" and "My work schedule leaves me enough time for my personal/family life" were considered to be satisfied with their career and work-life integration, respectively.

RESULTS

Data were available for 4424 physicians (mean [SD] age, 52.46 [12.03] years; 61.5% [2722 of 4424] male). Most physicians (78.7% [3480 of 4424]) were non-Hispanic White. Non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic Black physicians comprised 12.3% (542 of 4424), 6.3% (278 of 4424), and 2.8% (124 of 4424) of the sample, respectively. Burnout was observed in 44.7% (1540 of 3447) of non-Hispanic White physicians, 41.7% (225 of 540) of non-Hispanic Asian physicians, 38.5% (47 of 122) of non-Hispanic Black physicians, and 37.4% (104 of 278) of Hispanic/Latinx physicians. The adjusted odds of burnout were lower in non-Hispanic Asian physicians (odds ratio [OR], 0.77; 95% CI, 0.61-0.96), Hispanic/Latinx physicians (OR, 0.63; 95% CI, 0.47-0.86), and non-Hispanic Black physicians (OR, 0.49; 95% CI, 0.30-0.79) compared with non-Hispanic White physicians. Non-Hispanic Black physicians were more likely to report satisfaction with work-life integration compared with non-Hispanic White physicians (OR, 1.69; 95% CI, 1.05-2.73). No differences in depressive symptoms or career satisfaction were observed by race/ethnicity.

CONCLUSIONS AND RELEVANCE

Physicians in minority racial/ethnic groups were less likely to report burnout compared with non-Hispanic White physicians. Future research is necessary to confirm these results, investigate factors contributing to increased rates of burnout among non-Hispanic White physicians, and assess factors underlying the observed patterns in measures of physician wellness by race/ethnicity.

Factors Associated With Burnout and Stress in Trainee Physicians: A Systematic Review and Meta-analysis

IMPORTANCE

Evidence suggests that physicians experience high levels of burnout and stress and that trainee physicians are a particularly high-risk group. Multiple workplace- and non-workplace-related factors have been identified in trainee physicians, but it is unclear which factors are most important in association with burnout and stress. Better understanding of the most critical factors could help inform the development of targeted interventions to reduce burnout and stress.

OBJECTIVE

To estimate the association between different stressors and burnout/stress among physicians engaged in standard postgraduate training (ie, trainee physicians).

DATA SOURCES

Medline, Embase, PsycINFO, and Cochrane Database of Systematic reviews from inception until April 30, 2019. Search terms included trainee, foundation year, registrar, resident, and intern.

STUDY SELECTION

Studies that reported associations between stressors and burnout/stress in trainee physicians.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted the data and assessed the quality of the evidence. The main meta-analysis was followed by sensitivity analyses. All analyses were performed using random-effects models, and heterogeneity was quantified using the I2 statistic.

MAIN OUTCOME AND MEASURES

The main outcome was the association between burnout/stress and workplace- or non-workplace-related factors reported as odds ratios (ORs) and their 95% CIs.

RESULTS

Forty-eight studies were included in the meta-analysis (n = 36 266, median age, 29 years [range, 24.6-35.7 years]). One study did not specify participants' sex; of the total population, 18 781 participants (52%) were men. In particular, work demands of a trainee physician were associated with a nearly 3-fold increased odds for burnout/stress (OR, 2.84; 95% CI, 2.26-3.59), followed by concerns about patient care (OR, 2.35; 95% CI, 1.58-3.50), poor work environment (OR, 2.06; 95% CI, 1.57-2.70), and poor work-life balance (OR, 1.93; 95% CI, 1.53-2.44). Perceived/reported poor mental or physical health (OR, 2.41; 95% CI, 1.76-3.31), female sex (OR, 1.34; 95% CI, 1.20-1.50), financial worries (OR, 1.35; 95% CI, 1.07-1.72), and low self-efficacy (OR, 2.13; 95% CI, 1.31-3.46) were associated with increased odds for burnout/stress, whereas younger age and a more junior grade were not significantly associated.

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that the odds ratios for burnout and stress in trainee physicians are higher than those for work-related factors compared with nonmodifiable and non-work-related factors, such as age and grade. These findings support the need for organizational interventions to mitigate burnout in trainee physicians.

The association between doctors' presenteeism and job burnout: a cross-sectional survey study in China

BACKGROUND

It is necessary to examine doctors working with illness from a professional point of view, because it is not only related to their occupational health, but more importantly, will affect the treatment effect of patients and the overall medical level of the hospital. The purpose of this study was to explore the relationship between doctors' presenteeism and job burnout, and to identify other factors that are associated with presenteeism.

METHODS

A cross-sectional survey involving doctors (except for primary doctors) was conducted in China. Using one item measure about presenteeism and a 15-item Chinese version of the BMI-GS questionnaire, this study investigated prevalence of doctors' presenteeism and job burnout, and determined the relationship between presenteeism and job burnout by logistical model.

RESULTS

Relationship between presenteeism and job burnout were explored, and the influence of work factors were evaluated. The survey was completed by 1376/1547 hospital doctors, with a response rate of 88.9%. Presenteeism was reported by 30.7% of participants. Using MBI-GS, 86.8% of all doctors had moderate job burnout and 6.0%(n = 82) were severe job burnout. Logistic regression analysis showed that doctors with medium, high degree of emotional exhaustion and high degree of cynicism were more likely to practice presenteeism (all p < 0.05). In addition, two other work-related factors, including the doctors' department and position, were also likely to relate with presenteeism (all p < 0.05).

CONCLUSIONS

By examining the relationship between presenteeism and job burnout, this study determined that there is indeed a significant correlation between the two. This result has a certain reference value for the development of work health, especially presenteeism and job burnout theory, and also makes a certain contribution to the relevant research literature.

Interactive role of personal and work related factors in psychological burnout: a study of Pakistani doctors

OBJECTIVE

To evaluate the direct and interactive role of personal and work-related factors in psychological burnout among doctors.

METHODS

The cross-sectional study was conducted in September, 2018, at three hospitals of the twin cities of Rawalpindi/Islamabad, Pakistan, and comprised doctors aged 24-49 years. Data was collected using a demographic questionnaire and the self-reporting Copenhagen Burnout Inventory. Data was analysed using SPSS 23.

RESULTS

Of the 161 doctors, 66(41%) were males and 96(59%) were female. The overall mean age of the sample was 26.44 4.80 years (range: 24-49 years). There was significant direct effect of work setting and indirect effect of gender and work setting on psychological burnout (p<0.05). Doctors experienced more burnout in emergency room settings compared to wards and outpatient departments (p<0.05). Further, young and low-salaried doctors were more prone to psychological burnout, and continuous working hours added to the adversity of burnout (p<0.05)..

CONCLUSIONS

Personal and workplace related factors were found to play a significant role in psychological burnout which may possibly affect the overall efficiency of doctors.

What Is the Prevalence of Burnout, Depression, and Substance Use Among Orthopaedic Surgery Residents and What Are the Risk Factors? A Collaborative Orthopaedic Educational Research Group Survey Study

BACKGROUND

Burnout and depression among healthcare professionals and trainees remain alarmingly common. In 2009, 56% of orthopaedic surgery residents reported burnout. Alcohol and illicit drug use are potential exacerbating factors of burnout and depression; however, these have been scarcely studied in residency populations.

QUESTIONS/PURPOSES

(1) What proportion of orthopaedic residents report symptoms of burnout and depression? (2) What factors are independently associated with an orthopaedic resident reporting emotional exhaustion, depersonalization, low personal accomplishment, and depression? (3) What proportion of orthopaedic residents report hazardous alcohol or drug use? (4) What factors are independently associated with an orthopaedic resident reporting hazardous alcohol or drug use?

METHODS

We asked 164 orthopaedic surgery programs to have their residents participate in a 34-question internet-based, anonymous survey, 28% of which (46 of 164) agreed. The survey was distributed to all 1147 residents from these programs, and 58% (661 of 1147) of these completed the survey. The respondents were evenly distributed among training years. Eighty-three percent (551 of 661) were men, 15% (101 of 661) were women, and 1% (nine of 661) preferred not to provide their gender. The survey asked about demographics, educational debt, sleep and work habits, perceived peer or program support, and substance use, and validated instruments were used to assess burnout (abbreviated Maslach Burnout Inventory), depression (Patient Health Questionnaire-2), and hazardous alcohol use (Alcohol Use Disorder Identification Test-Consumption). The main outcome measures included overall burnout, emotional exhaustion, depersonalization, low personal accomplishment, depression, and hazardous alcohol and drug use. Using the variables gathered in the survey, we performed an exploratory analysis to identify significant associations for each of the outcomes, followed by a multivariable analysis.

RESULTS

Burnout was reported by 52% (342 of 661) of residents. Thirteen percent of residents (83 of 656) had positive screening results for depression. Factors independently associated with high emotional exhaustion scores included early training year (odds ratio 1.15; 95% confidence interval, 1.01-1.32; p = 0.03) unmanageable work volume (OR 3.13; 95% CI, 1.45-6.67; p < 0.01), inability to attend health maintenance appointments (OR 3.23; 95% CI, 1.69-6.25; p < 0.01), lack of exercise (OR 1.69; 95% CI, 1.08-2.70; p = 0.02), and lack of program support (OR 3.33; 95% CI, 2.00-5.56; p < 0.01). Factors independently associated with depersonalization included early training year (OR 1.27; 95% CI, 1.12-1.41; p < 0.01), inability to attend health maintenance appointments (OR 2.70; 95% CI, 1.67-4.35; p < 0.01), and lack of co-resident support (OR 2.52; 95% CI, 1.52-4.18; p < 0.01). Low personal accomplishment was associated with a lack of co-resident support (OR 2.85; 95% CI, 1.54-5.28; p < 0.01) and lack of program support (OR 2.33; 95% CI, 1.32-4.00; p < 0.01). Factors associated with depression included exceeding duty hour restrictions (OR 2.50; 95% CI, 1.43-4.35; p < 0.01) and lack of program support (OR 3.85; 95% CI, 2.08-7.14; p < 0.01). Sixty-one percent of residents (403 of 656) met the criteria for hazardous alcohol use. Seven percent of residents (48 of 656) reported using recreational drugs in the previous year. Factors independently associated with hazardous alcohol use included being a man (OR 100; 95% CI, 35-289; p < 0.01), being Asian (OR 0.31; 95% CI, 0.17-0.56; p < 0.01), single or divorced marital status (OR 2.33; 95% CI, 1.47-3.68; p < 0.01), and more sleep per night (OR 1.92; 95% CI, 1.21-3.06; p < 0.01). Finally, single or divorced marital status was associated with drug use in the past year (OR 2.30; 95% CI, 1.26-4.18; p < 0.01).

CONCLUSIONS

The lack of wellness among orthopaedic surgery residents is troubling, especially because most of the associated risk factors are potentially modifiable. Programs should capitalize on the modifiable elements to combat burnout and improve overall wellbeing. Programs should also educate residents on burnout, focus on work volume, protect access to health maintenance, nurture those in the early years of training, and remain acutely aware of the risk of substance abuse. Orthopaedic surgery trainees should strive to encourage peer support, cultivate personal responsibility, and advocate for themselves or peers when faced with challenges. At a minimum, programs and educational leaders should foster an environment in which admitting symptoms of burnout is not seen as a weakness or failure.

LEVEL OF EVIDENCE

Level II, prognostic study.

Burnout and somatic symptoms among frontline healthcare professionals at the peak of the Italian COVID-19 pandemic

Italy is among the most severely hit nations in terms of hospital patients' overload, and its healthcare workforce is struggling to cope with challenges that could threaten their own wellbeing. In this scenario, understanding the health-related consequences of COVID-19 outbreak on Italian frontline healthcare professionals is urgent. Our study provides a first account of the huge psycho-physical impact of COVID-19 outbreak for healthcare workers in Italy. Italian healthcare professionals reported relevant work-related psychological pressure, emotional burnout and somatic symptoms. This result requires attention as previous studies showed that emotional distress is associated with long-lasting effect on professionals' health, including risk of post-traumatic stress disorder.

Compassion, Law and COVID-19

Levels of personal anxiety are inevitably escalating in response to the COVID-19 pandemic, including individual fear of infection, grief at the loss of loved ones and reactive depression related to loss of employment and livelihood. This article considers the importance of compassion in a range of contemporary and emerging contexts during a time of pandemic. These include: exposure of medical and care professionals to the acute demands of overstretched institutions resulting in adverse mental health outcomes and compassion fatigue; attitudes towards the burgeoning cohort of welfare recipients; and particularly vulnerable groups such as the elderly, and those who are homeless. The article considers how we ought to conceive of compassion in these contexts and makes some suggestions for building future compassion interventions and training.

The Effect of COVID-19 on Interventional Pain Management Practices: A Physician Burnout Survey

BACKGROUND

Burnout has been a commonly discussed issue for the past ten years among physicians and other health care workers. A survey of interventional pain physicians published in 2016 reported high levels of emotional exhaustion, often considered the most taxing aspect of burnout. Job dissatisfaction appeared to be the leading agent in the development of burnout in pain medicine physicians in the United States. The COVID-19 pandemic has drastically affected the entire health care workforce and interventional pain management, with other surgical specialties, has been affected significantly. The COVID-19 pandemic has placed several physical and emotional stressors on interventional pain management physicians and this may lead to increased physician burnout.

OBJECTIVE

To assess the presence of burnout specific to COVID-19 pandemic among practicing interventional pain physicians.

METHODS

American Society of Interventional Pain Physicians (ASIPP) administered a 32 question survey to their members by contacting them via commercially available online marketing company platform. The survey was completed on www.constantcontact.com.

RESULTS

Of 179 surveys sent, 100 responses were obtained. The data from the survey demonstrated that 98% of physician practices were affected by COVID and 91% of physicians felt it had a significant financial impact. Sixty seven percent of the physicians responded that in-house billing was responsible for their increased level of burnout, whereas 73% responded that electronic medical records (EMRs) were one of the causes. Overall, 78% were very concerned. Almost all respondents have been affected with a reduction in interventional procedures. 60% had a negative opinion about the future of their practice, whereas 66% were negative about the entire health care industry.

LIMITATIONS

The survey included only a small number of member physicians. Consequently, it may not be generalized for other specialties or even pain medicine. However, it does represent the sentiment and present status of interventional pain management.

CONCLUSION

The COVID-19 pandemic has put interventional pain practices throughout the United States under considerable financial and psychological stress. It is essential to quantify the extent of economic loss, offer strategies to actively manage provider practice/wellbeing, and minimize risk to personnel to keep patients safe.