Association of Physician Burnout With Suicidal Ideation and Medical Errors

Hobbies, Distractions, Obsessions, and Addictions

A career in cardiothoracic surgery takes a psychological and emotional toll, which is likely increased by recent changes in our health care environment. The benefits of leisure pursuits are severalfold, one of which includes supporting physician wellness. However, we are at risk of relying on unhealthy mechanisms to provide relief. The incidence of addiction and substance abuse is high, particularly among women surgeons. There are a variety of opportunities to help ourselves and support our colleagues. We need to promote healthy activities outside of our profession for the long-term well-being of cardiothoracic surgeons and our specialty.

Characteristics and Habits of Psychiatrists and Neurologists With High Occupational Well-Being: A Mixed Methods Study

Objective

To identify the characteristics that distinguish occupationally well outliers (OWO), a subset of academic psychiatrists and neurologists with consistently high professional fulfillment and low burnout, from their counterparts with lower levels of occupational well-being.

Participants and Methods

Participants included faculty physicians practicing psychiatry and neurology in academic medical centers affiliated with the Professional Well-being Academic Consortium. In this prospective, longitudinal study, a mixed qualitative and quantitative approach was used. Quantitative measures were administered to physicians in a longitudinal occupational well-being survey sponsored by the academic organizations where they work. Four organizations participated in the qualitative study. Psychiatrists and neurologists at these organizations who competed survey measures at 2 consecutive time points between 2019 and 2021 were invited to participate in an interview.

Results

Of 410 (213 psychiatrists and 197 neurologists) who completed professional fulfillment and burnout measures at 2 time points, 84 (20.5%) met OWO criteria. Occupationally well outliers psychiatrists and neurologists had more favorable scores on hypothesized determinants of well-being (values alignment, perceived gratitude, supportive leadership, peer support, and control of schedule). Ultimately, 31 psychiatrists (25% of 124 invited) and 33 neurologists (18.5% of 178 invited) agreed to participate in an interview. Qualitatively, OWO physicians differed from all others in 3 thematic domains: development of life grounded in priorities, ability to shape day-to-day work context, and professional relationships that provide joy and support.

Conclusion

A multilevel approach is necessary to promote optimal occupational well-being, targeting individual-level factors, organizational-level factors, and broader system-level factors.

Tiredness of Life - Conceptualizing a Complex Phenomenon

A phenomenon referred to as 'tiredness of life' or 'weariness of life' appears in current discussions on the legitimacy of euthanasia for relatively healthy older adults as well as in research on suicidality more broadly. However, a consensus conceptualization of the phenomenon is lacking. In the current paper, we offer such a conceptualization by reviewing and integrating knowledge from terminology, available descriptions, and first qualitative findings. Boredom with life, aversion towards life, meaninglessness, and fatigue are identified as central components of the phenomenon. Per component, we describe how the component was identified, our definition of the component and its foundation in descriptions in the literature, and empirical studies on how the component relates to euthanasia requests and suicidality. Moreover, hypotheses on the structure of the phenomenon are outlined, such as on interactions among and the importance of the different components.

Suicidal ideation among non-physician hospital system staff: Prevalence and workplace correlates

BACKGROUND

Research suggests that healthcare workers are at greater risk for suicide than other occupations, but most published studies focus on physicians. This study examines the prevalence of suicidal ideation (SI) and associated occupational factors among a broad group of non-physician healthcare staff.

METHODS

An anonymous online survey was sent to a random sample of 30 % of non-physician healthcare staff at a large urban healthcare system between September and November 2022. Weighted multivariable binary logistic regressions were conducted to determine the workplace and mental health factors associated with SI.

RESULTS

The 1084 respondents included nurses, administrative staff, research staff, medical assistants, nurse practitioners, physician assistants, and other roles. Of the sample, 8.8 % endorsed having SI over the prior two weeks. Results of the regression indicated that, after adjusting for demographic factors, greater odds of SI were associated with physical violence experienced from a patient or visitor (odds ratio [OR] = 2.15, 95 % confidence interval [CI] = 1.06-4.37), lower perceived leadership support (OR = 0.95, 95 % CI = 0.92-0.98), and positive screening for depression (OR = 4.66, 95 % CI = 2.45-8.86). Exploratory analysis suggests that depression may be a mediating factor between workplace stressors and SI.

LIMITATIONS

Limitations include the response rate, the use of a single item to assess SI, and the cross-sectional design.

CONCLUSION

Findings suggest that workplace violence and leadership support are important occupational factors associated with SI among healthcare workers. Reducing and mitigating workplace violence, enhancing leadership support, and improving access to mental health care should be considered targets for interventions to decrease suicide risk in this population.

Physician and Practice Characteristics Influencing Telemedicine Uptake Among Frontline Clinicians in the Early COVID-19 Pandemic Response: National Survey Study

BACKGROUND

 Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability.

OBJECTIVE

 This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response.

METHODS

 We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse.

RESULTS

 Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice.

CONCLUSIONS

 Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies.

Best Practices: Burnout Is More Than Binary

Burnout among radiologists is increasingly prevalent, with potential for substantial negative impact on physician well-being, care delivery, and health outcomes. To evaluate this phenomenon using reliable and accurate means, validated quantitative instruments are essential. Variation in measurement can contribute to wide-ranging findings. This article evaluates radiologist burnout rates globally and dimensions of burnout as reported using different validated instruments and provide guidance on best practices to characterize burnout. Fifty-seven studies between 1990 and 2023 were included in a systematic review, and 43 studies were included in a meta-analysis of burnout prevalence using random effects models. Reported burnout ranged from 5% to 85%. With the Maslach Burnout Inventory (MBI), burnout prevalence varied significantly depending on instrument version. Among MBI subcategories, the prevalence of emotional exhaustion was 54% (95% CI, 45-63%), depersonalization was 52% (95% CI, 41-63%), and low personal accomplishment was 36% (95% CI, 27-47%). Other validated burnout instruments showed less heterogeneous results; studies using the Stanford Professional Fulfillment Index yielded burnout prevalence of 39% (95% CI, 34-45%), whereas the Validated Single-Item instrument yielded 34% (95% CI, 29-39%). Standardized instruments for prevalence alongside multidimensional profiles capturing experiences may better characterize radiologist burnout, including change over time.

Embracing Failure: Nurturing Learning and Well-Being in Anesthesiology and Perioperative Medicine

Failure, ubiquitous in life and medical practice, offers myriad opportunities for learning and growth alongside challenges to overall well-being. In this article, we explore the nature of failure, it's sources and impacts in perioperative medicine, and the specific challenges it brings to trainee well-being. With a deeper understanding of the societal, psychological and cognitive determinants and effects of failure, we propose solutions in order to harness the opportunities inherent in failures to create brave and supportive learning environments conducive to both education and well-being.

Wearable Technologies for Detecting Burnout and Well-Being in Health Care Professionals: Scoping Review

BACKGROUND

The occupational burnout epidemic is a growing issue, and in the United States, up to 60% of medical students, residents, physicians, and registered nurses experience symptoms. Wearable technologies may provide an opportunity to predict the onset of burnout and other forms of distress using physiological markers.

OBJECTIVE

This study aims to identify physiological biomarkers of burnout, and establish what gaps are currently present in the use of wearable technologies for burnout prediction among health care professionals (HCPs).

METHODS

A comprehensive search of several databases was performed on June 7, 2022. No date limits were set for the search. The databases were Ovid: MEDLINE(R), Embase, Healthstar, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science Core Collection via Clarivate Analytics, Scopus via Elsevier, EBSCOhost: Academic Search Premier, CINAHL with Full Text, and Business Source Premier. Studies observing anxiety, burnout, stress, and depression using a wearable device worn by an HCP were included, with HCP defined as medical students, residents, physicians, and nurses. Bias was assessed using the Newcastle Ottawa Quality Assessment Form for Cohort Studies.

RESULTS

The initial search yielded 505 papers, from which 10 (1.95%) studies were included in this review. The majority (n=9) used wrist-worn biosensors and described observational cohort studies (n=8), with a low risk of bias. While no physiological measures were reliably associated with burnout or anxiety, step count and time in bed were associated with depressive symptoms, and heart rate and heart rate variability were associated with acute stress. Studies were limited with long-term observations (eg, ≥12 months) and large sample sizes, with limited integration of wearable data with system-level information (eg, acuity) to predict burnout. Reporting standards were also insufficient, particularly in device adherence and sampling frequency used for physiological measurements.

CONCLUSIONS

With wearables offering promise for digital health assessments of human functioning, it is possible to see wearables as a frontier for predicting burnout. Future digital health studies exploring the utility of wearable technologies for burnout prediction should address the limitations of data standardization and strategies to improve adherence and inclusivity in study participation.

Calcium and vitamin D supplements and burnout of anesthesiologists: National cross-sectional study from China

OBJECTIVE

Job burnout among anesthesiologists has been consistently high. This study evaluated the association of calcium and vitamin D supplementation with burnout among Chinese anesthesiologists.

METHOD

A cross-sectional online survey was conducted during April and May 2023. Burnout was evaluated using the Maslach Burnout Inventory, which assesses emotional exhaustion, depersonalization, and low personal accomplishment. Data on calcium and vitamin D supplementations were self-reported. Sociodemographic information and medical history were also assessed. Binary and ordinal logistic regression were used to evaluate the risk of burnout and burnout levels, respectively. The relative excess risk due to interaction and the attributable proportion due to interaction were examined to determine the synergistic effects of calcium and vitamin D supplementations on burnout risk.

RESULTS

Among the 4222 invited anesthesiologists, 3766 submitted eligible questionnaires. Approximately 49.8% met the criteria for general burnout. Among anesthesiologists with burnout, 58.4% experienced emotional exhaustion, 35.8% depersonalization, and 61.2% low personal accomplishment. Anesthesiologists receiving calcium supplementation had a decreased risk of emotional exhaustion (OR = .83, 95% CI = .70-.99). Supplementation of vitamin D with or without calcium was not associated with overall burnout and any of its dimensions. No additive interaction of calcium and vitamin D on burnout was observed.

CONCLUSIONS

Job burnout among anesthesiologists is of concern in China. Burnout is negatively associated with calcium supplementation but not with vitamin D. Further research is warranted to confirm the mechanism and causal relationship.

Normative Perceptions and Medical Providers' Help-Seeking Behavior in a Rural Health Setting

Healthcare providers experience greater work stress and mental health concerns compared to the general population. This study aimed to better understand factors that promote engagement in help-seeking behaviors among rural medical providers. Considering a social norms perspective, this study examined: (a) the accuracy of medical providers' perceptions of injunctive (i.e., approval of) norms related to seeking time off for their own medical, mental, and social health care (b) determine whether greater self-other differences (SODs) predict a greater likelihood of help-seeking behavior, and (c) examine associations between self-valuation, SODs, and self-care behaviors. Electronic surveys were emailed to 805 rural medical providers (17.8% response rate). Findings suggested that providers believed that their coworkers were less approving of help-seeking behavior for a psychosocial or mental health reason than they actually were. Furthermore, self-other differences (SODs) of injunctive norms predicted help-seeking behavior, such that those with greater SODs reported less help-seeking behavior. Although this research provides some foundational evidence for the role of normative perceptions in self-care behaviors, larger systemic and organizational problems continue to drive these struggles and contribute to burnout. Future research might examine the interplay of normative interventions and organizational changes to enhance help-seeking behaviors among medical providers.

Associations between workplace violence and suicidal ideation among Chinese medical staff: a propensity score matching analysis

Physical and mental health problems had been identified as the negative outcomes of workplace violence (WPV) against medical staff. Considering the proven associations between physical and mental health and suicidal ideation, it is reasonable to assume that WPV may associate with suicidal ideation. However, few studies were conducted to explore the relationship between WPV and their suicidal ideation against medical staff. Based on a cross-sectional design, 3, 426 medical staff working in general hospitals were interviewed in Shandong Province, China. Socio-demographic characteristics, work-related factors, psychological variables, WPV, and suicidal ideation were evaluated. Propensity score matching (PSM) was performed to explore the association between WPV and suicidal ideation. The prevalence of suicidal ideation among medical staff was 9.1% (312/3426), and 52.2% (1788/3426) of medical staff reported the WPV experience. Before PSM, we found that the association between WPV and suicidal ideation was statistically significant (aOR = 1.606, p < 0.01). After PSM, there was a statistically significant correlation between WPV and suicidal ideation (aOR = 1.525, p < 0.01). This study supported the correlations between WPV against medical staff and their suicidal ideation. The results of PSM further implied that WPV might cause suicidal ideation among medical staff. Psychological health, especially for suicidal ideation, should be paid attention for medical staff with WPV experiences.

Suicide and depressive symptoms possible correlates among a sample of Egyptian physicians: observational cross-sectional study (online survey)

BACKGROUND

Compared to other occupations, physicians are more susceptible to depression and suicide. Suicide among physicians in some countries reached up to 1.5- to threefold higher than the general population. However, this rate was not homogenous in all countries. Most of the Egyptian studies were related to the stressful pandemic event, but the actual prevalence of depression among physicians is still under research. To the best of the researcher's knowledge, no other study has been conducted to evaluate the risk of suicide among Egyptian physicians.

AIM

The study aimed to screen for depressive symptoms and suicide among Egyptian physicians and to investigate the correlates associated with suicide ideations.

METHODS

This cross-sectional survey included Egyptian physicians recruited online by Google Forms. Depressive symptoms were screened using the Beck Depression Scale (BDI-II), while suicidal ideas were assessed using the Suicidal Ideation Attributes Scale (SIDAS).

RESULTS

Six hundred sixty Egyptian physicians completed the survey following a two-week pilot study between January 10 and July 16, 2023. The average age was 39.1 years, and 71.4% were married. 49.1% were medical specialists. The median daily working hours were eight, and 27.7% of the physicians attended night shifts. 22.3% had a psychiatric illness, and 34.3% had a chronic disease. Younger and single physicians of both sexes were more prone to suicide risk (p-value = 0.019 and 0.021, respectively). Those with psychiatric or chronic medical disorders had a higher suicidal risk (p-values < 0.001 and 0.004, respectively). Physicians with fewer academic degrees and those who work longer hours or night shifts had more depressive symptoms (p-values < 0.001 and 0.009, respectively). The risk of depression and suicide is almost the same in all medical specialties. The SIDAS suicide score and the Beck depression score revealed a statistically significant association (r = 0.288, p-value < 0.001).

CONCLUSION

Suicide risk is higher among younger, single physicians of both sexes, as well as those with psychiatric or chronic medical disorders. More depressive symptoms are seen in physicians who have more extended hours or night shifts and who have fewer academic degrees. Almost all medical specialties carry the same risk of depression and suicide. Longitudinal research is recommended for regular follow-up of suicidal thoughts and depressive symptoms.

Physical and Psychological Impact of the Covid-19 Pandemic on Healthcare Workers, Including End of Life Care Providers

Background

The COVID-19 pandemic has not only caused unprecedented distress in the community but has also resulted in significant physical and psychological exhaustion among healthcare workers (HCWs). This exhaustion could potentially lead to serious effects on our healthcare system.

Objective

The aim of this study was to gain more insight on the effect of COVID-19 on burnout among oncologists and other healthcare professionals at a large academic center.

Methods

A 10-minute electronic questionnaire was distributed to actively employed physicians, APRNs, and PAs affiliated with the University of Miami. The survey encompassed a range of personal and professional characteristics, including stress related to COVID-19.

Results

The survey was distributed to a total of 739 HCWs, with 182 respondents (24.6%) completing the entire survey. The impact of the pandemic on these professionals included increased workload (59.5%), reduced leadership opportunities (32.2%), job insecurity (28.6%), and rescheduling of professional activities (22.2%). Out of the 182 respondents, 70 were primarily from the fields of Oncology and Palliative Care.

Conclusions

Several factors have contributed to increased physical and psychological stress among HCWs, such as extended working hours, sleep deprivation, job insecurity, the shift to telemedicine, the risk of contracting the virus and endangering their families, lack of childcare options, and the added pressure of homeschooling. This study serves as a foundation for more comprehensive research aimed at elucidating and guiding the development of wellness programs crucial for the overall well-being of HCWs.

Psychiatry Resident Physicians Experience Personal and Professional Grief, Burnout and Depression: Results From a National Survey

BACKGROUND

Resident physicians experience personal and professional stressors throughout training. These experiences may increase levels of burnout, depression, and grief. Understanding how these stressors impact trainees is essential for improving wellbeing during residency.

OBJECTIVE

We examined the prevalence and associations between burnout, depression, and grief among a national sample of psychiatry resident physicians.

METHODS

A survey including validated scales for burnout (Modified Maslach Burnout Inventory-Health Services Survey [MBI]), depression (Patient Health Questionnaire-9 [PHQ-9]), and grief (Traumatic Grief Inventory Self Report [TGSIR]) was distributed to 296 psychiatry program directors in January 2023 for dispersal to their respective residents.

RESULTS

Fifty-seven participants completed the survey out of 245 participants who opened and started the survey (23.3%). All participants were current psychiatry residents. MBI scores averaged 21.2 (SD 6.5, range 11-40); 11 participants reported high levels of burnout (scores >27; 19.3%). PHQ-9 scores averaged 3.42 (SD 3.0, range 0-14), with 8 responses meeting the criteria for moderate depressive symptoms (scores >10-14; 14.0%). Suicidal ideation was reported by 5 of 57 participants (8.7%). TGISR scores averaged 12.2 (SD 11, range 0-43); no participants met the criteria for pathologic grief. TGISR scores were correlated with MBI (r = .30; P = .02) and PHQ-9 scores (r = .53; P < .0001). MBI scores were also correlated with PHQ-9 scores (r = .54; P < .0001).

CONCLUSIONS

Non-pathological grief was correlated with burnout and depression. 14% to 20% of psychiatry residents reported clinically significant levels of burnout and depression. Future studies should aim to further characterize burnout, depression, and grief in larger samples of trainees.

Effectiveness of mindfulness-based interventions on the well-being of healthcare workers: a systematic review and meta-analysis

Background

Growing evidence attests to the efficacy of mindfulness-based interventions (MBIs), but their effectiveness for healthcare workers remains uncertain.

Aims

To evaluate the evidence for MBIs in improving healthcare workers' psychological well-being.

Methods

A systematic literature search was conducted on Medline, Embase, Cumulative Index for Nursing and Allied Health Literature, PsycINFO and Cochrane Central Register of Controlled Trials up to 31 August 2022 using the keywords 'healthcare worker', 'doctor', 'nurse', 'allied health', 'mindfulness', 'wellness', 'workshop' and 'program'. Randomised controlled trials with a defined MBI focusing on healthcare workers and quantitative outcome measures related to subjective or psychological well-being were eligible for inclusion. R V.4.0.3 was used for data analysis, with the standardised mean difference as the primary outcome, employing DerSimonian and Laird's random effects model. Grading of Recommendations, Assessment, Development and Evaluation framework was used to evaluate the quality of evidence. Cochrane's Risk of Bias 2 tool was used to assess the risk of bias in the included studies.

Results

A total of 27 studies with 2506 participants were included, mostly from the USA, involving various healthcare professions. MBIs such as stress reduction programmes, apps, meditation and training showed small to large effects on anxiety, burnout, stress, depression, psychological distress and job strain outcomes of the participants. Positive effects were also seen in self-compassion, empathy, mindfulness and well-being. However, long-term outcomes (1 month or longer postintervention) varied, and the effects were not consistently sustained.

Conclusions

MBIs offer short-term benefits in reducing stress-related symptoms in healthcare workers. The review also highlights limitations such as intervention heterogeneity, reduced power in specific subgroup analyses and variable study quality.

PROSPERO registration number

CRD42022353340.

Burnout Among Physicians With Disabilities

This survey study examines reported experiences of burnout, including emotional exhaustion and depersonalization, among physicians with disability.

Lebanese medical students' attitudes towards patient safety and medical error disclosure: A cross-sectional study

OBJECTIVE

To assess Lebanese medical students' attitudes towards patient safety and medical error disclosure.

METHODS

This was a cross-sectional study involving medical students from seven different medical schools in Lebanon. The participants completed the Attitudes to Patient Safety Questionnaire (APSQ-III) online, which consists of 26 items across nine key patient safety domains. Items were scored from 1 (strongly disagree) to 5 (strongly agree). Demographic data were also collected.

RESULTS

Of the 549 students enrolled in the study, 325 (59%) were female and 224 (41%) were male. More than half (287, 52%) were aged between 20 and 22 years and 95% were Lebanese. The overall attitude of students towards patient safety was positive (3.59 ± 0.85) with the most positive attitudes in the domains of 'Team functioning' followed by 'Working hours as an error cause'. More positive attitudes were perceived among male students in the domains of 'Professional incompetence as an error cause' and 'Disclosure responsibility' whereas more positive attitudes were seen in female students in the domain of 'Working hour as an error cause'. Older medical students had more positive attitudes in the domain of 'Team functioning' than younger students.

CONCLUSION

Medical students in Lebanon had an overall positive attitude towards patient safety. These findings may be used to guide improvements in patient safety education and enhance patient-centred care in medical institutions in Lebanon.

Fruit and Vegetable Intake, Food Security, Barriers to Healthy Eating, and Empowerment among Dietetic Interns and Physician Assistant Interns: A Cross-Sectional Pilot Study

Students are required to complete supervised practice hours prior to becoming Registered Dietitians and Physician Assistants. Research suggests that environmental and social factors affect dietetic interns' diets during their internship, although these factors have not been studied among physician assistant interns. This cross-sectional study utilized an online survey to compare dietetic interns' (n = 81) and physician assistant interns' (n = 79) fruit and vegetable intake, food security, barriers to healthy eating, and empowerment for making healthy dietary choices during an internship. Differences were assessed via independent t-tests and chi-square distributions. The significance was set at p < 0.05. Dietetic interns had a higher vegetable intake (p = 0.002) while physician assistant interns had higher rates of food insecurity (p = 0.040). Dietetic interns reported a greater impact on their dietary choices due to mental fatigue (p = 0.006), while physician assistant interns' dietary choices were more heavily impacted by peer influence, interactions with patients, and interactions with preceptors (p < 0.05). There was not a group difference in overall empowerment (p = 0.157), although both groups rated empowerment for asking for help with food and nutrition challenges the lowest of the empowerment sub-items. Addressing interns' unique needs may support students' educational success and wellbeing once they are professionals, promote a diverse workforce, and ensure optimal care for patients.

Differential effects of healthcare worker burnout on psychotropic medication use and misuse by occupational level

PURPOSE

Burnout has been well examined among physicians and other high-wage, high-autonomy healthcare positions. However, lower-wage healthcare workers with less workplace autonomy (e.g., medical assistants, nurses' aides) represent a substantial proportion of the workforce, but remain understudied. We aimed to examine the effects of burnout on psychotropic medication use and misuse and whether these effects differed by occupational level.

METHODS

In March 2022, we collected data from a diverse sample of US healthcare workers (N = 200) and examined the cross-sectional relationship between burnout and changes in prescribed psychotropic medication (i.e., starting, stopping, and/or having a change in the dose/frequency) during the COVID-19 pandemic. We also separately examined the relationship between burnout and psychotropic medication misuse (i.e., without a prescription, in greater amounts, more often, longer than prescribed, and/or for a reason other than prescribed). We stratified models by occupational level (prescribers/healthcare administrators vs. other healthcare workers).

RESULTS

Greater burnout was associated with higher odds of changes in prescribed psychotropic medication among prescribers/healthcare administrators (aOR = 1.23, 95% CI 1.01, 1.48), but not among other healthcare workers (aOR = 1.04, 95% CI 0.98, 1.10). Greater burnout was not associated with psychotropic medication misuse among prescribers/healthcare administrators (aOR = 0.96, 95% CI 0.82, 1.12) but was associated with increased odds of psychotropic medication misuse among other healthcare workers (aOR = 1.07, 95% CI 1.01, 1.14).

CONCLUSIONS

Potential disparities in help-seeking and healthcare access might manifest in non-medical use of prescription drugs among some healthcare workers, which has implications for worker safety and well-being.

Clinician Burnout and Effectiveness of Guideline-Recommended Psychotherapies

Importance

Clinician burnout has been associated with clinician outcomes, but the association with patient outcomes remains unclear.

Objective

To evaluate the association between clinician burnout and the outcomes of patients receiving of guideline-recommended trauma-focused psychotherapies for posttraumatic stress disorder (PTSD).

Design, Setting, and Participants

This cohort study was set at the US Veterans Affairs Health Care System and included licensed therapists who provided trauma-focused psychotherapies and responded to an online survey between May 2 and October 8, 2019, and their patients who initiated a trauma-focused therapy during the following year. Patient data were collected through December 31, 2020. Data were analyzed from May to September 2023.

Exposures

Therapists completing the survey reported burnout with a 5-point validated measure taken from the Physician Worklife Study. Burnout was defined as scores of 3 or more.

Main Outcomes and Measures

The primary outcome was patients' clinically meaningful improvement in PTSD symptoms according to the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Patient dropout, therapist adherence, and session spacing was assessed through electronic health records. Multivariable random-effects logistic regression examined the association of therapist burnout and clinically meaningful improvement, adjusted for case-mix.

Results

In this study, 165 of 180 (91.7%) therapists (89 [53.9%] female) completed the burnout measure and provided trauma-focused psychotherapies to 1268 patients (961 [75.8%] male) with outcome data. Fifty-eight (35.2%) therapists endorsed burnout. One third of patients (431 [34.0%]) met criterion for clinically meaningful improvement. Clinically meaningful improvement in PTSD symptoms was experienced by 120 (28.3%) of the 424 patients seen by therapists who reported burnout and 311 (36.8%) of the 844 patients seen by therapists without burnout. Burnout was associated with lower odds of clinically meaningful improvement (adjusted odds ratio [OR],0.63; 95% CI, 0.48-0.85). The odds of clinically meaningful improvement were reduced for patients who dropped out (OR, 0.15; 95% CI, 0.11-0.20) and had greater session spacing (OR, 0.80; 95% CI, 0.70-0.92). Therapist adherence was not associated with therapy effectiveness. Adjusting for dropout or session spacing did not meaningfully alter the magnitude of the association between burnout and clinically meaningful improvement.

Conclusions and Relevance

In this prospective cohort study, therapist burnout was associated with reduced effectiveness of trauma-focused psychotherapies. Studying when and how burnout affects patient outcomes may inform workplace interventions.

From magical thinking to suicide: Understanding emergency physicians' psychological struggle

Recent literature has explored the psychological well-being of physicians, addressing conditions like perfectionism, imposter phenomenon/syndrome (IP), depression, burnout, and, less frequently, magical thinking. But recognizing the connections among these psychological factors is vital for developing targeted interventions to prevent or alleviate their impact. This article examines the often-sequential emergence of these five conditions within a physician's career, with a specific emphasis on their prevalence among emergency physicians (EPs), who must manage a diverse array of acute illnesses and injuries. The descent into psychological distress initiates with magical thinking-in this case, the belief that perfection is possible despite evidence to the contrary-leading to the pursuit of maladaptive perfectionism. If unaddressed, this trajectory may lead to depression, burnout, and in some cases, suicide. Understanding this continuum lays the groundwork for devising a systematic approach to enhance physicians' mental health. The article delves into detailed descriptions of these psychological conditions, encompassing their prevalence, individual impact, how they are integrated into this continuum and potential preventive or corrective methods. Recognizing unrealistic expectations as a major contributor to burnout, depression, and even suicide within the medical profession, the article advocates for the development of targeted interventions and support structures to assist medical students and professionals in managing IP. Practical strategies involve acknowledging unrealistic expectations, setting attainable goals, seeking support, taking breaks, and prioritizing self-care. Addressing this pervasive issue aims to cultivate a culture where medical professionals can thrive, ensuring optimal care for patients.

Physician Coaching by Professionally Trained Peers for Burnout and Well-Being: A Randomized Clinical Trial

Importance

Physician burnout is problematic despite existing interventions. More evidence-based approaches are needed.

Objective

To explore the effect of individualized coaching by professionally trained peers on burnout and well-being in physicians.

Design, Setting, and Participants

This randomized clinical trial involved Mass General Physician Organization physicians who volunteered for coaching from August 5 through December 1, 2021. The data analysis was performed from February through October 2022.

Interventions

Participants were randomized to 6 coaching sessions facilitated by a peer coach over 3 months or a control condition using standard institutional resources for burnout and wellness.

Main Outcomes and Measures

The primary outcome was burnout as measured by the Stanford Professional Fulfillment Index. Secondary outcomes included professional fulfillment, effect of work on personal relationships, quality of life, work engagement, and self-valuation. Analysis was performed on a modified intention-to-treat basis.

Results

Of 138 physicians enrolled, 67 were randomly allocated to the coaching intervention and 71 to the control group. Most participants were aged 31 to 60 years (128 [93.0%]), women (109 [79.0%]), married (108 [78.3%]), and in their early to mid career (mean [SD], 12.0 [9.7] years in practice); 39 (28.3%) were Asian, 3 (<0.1%) were Black, 9 (<0.1%) were Hispanic, 93 were (67.4%) White, and 6 (<0.1%) were of other race or ethnicity. In the intervention group, 52 participants underwent coaching and were included in the analysis. Statistically significant improvements in burnout, interpersonal disengagement, professional fulfillment, and work engagement were observed after 3 months of coaching compared with no intervention. Mean scores for interpersonal disengagement decreased by 30.1% in the intervention group and increased by 4.1% in the control group (absolute difference, -0.94 poimys [95% CI, -1.48 to -0.41 points; P = .001), while mean scores for overall burnout decreased by 21.6% in the intervention group and increased by 2.5% in the control group (absolute difference, -0.79 points; 95% CI, -1.27 to -0.32 points; P = .001). Professional fulfillment increased by 10.7% in the intervention group compared with no change in the control group (absolute difference, 0.59 points; 95% CI, 0.01-1.16 points; P = .046). Work engagement increased by 6.3% in the intervention group and decreased by 2.2% in the control group (absolute difference, 0.33 points; 95% CI, 0.02-0.65 points; P = .04). Self-valuation increased in both groups, but not significantly.

Conclusions and Relevance

The findings of this hospital-sponsored program show that individualized coaching by professionally trained peers is an effective strategy for reducing physician burnout and interpersonal disengagement while improving their professional fulfillment and work engagement.

Trial Registration

ClinicalTrials.gov Identifier: NCT05036993.

Parental leave and family building experiences among head and neck surgeons in the United States: Career impact and opportunities for improvement

BACKGROUND

The availability of paid parental leave is an important factor for retention and wellness. The experiences of head and neck surgeons with parental leave have never been reported.

METHODS

A survey was electronically distributed to head and neck subspecialty surgeons in the United States. Responses were collected and analyzed.

RESULTS

Male surgeons had more children and took significantly less parental leave than women. Thirty percent of respondents reported that parental leave negatively impacted compensation, and 14% reported a delay in promotion due to leave, which impacted women more than men. The vast majority reported they are happy or neutral about covering those on leave. Most respondents utilized paid childcare, and approximately one quarter of respondents spending 11%-20% of their income on childcare.

CONCLUSIONS

This study illuminates the current disparities regarding parental leave-taking within the subspecialty of head and neck surgery in the United States. Women surgeons are more likely to be impacted professionally and financially.

Factors associated with suicidal ideation among medical residents in Tehran during the COVID-19 pandemic: A multicentric cross-sectional survey

BACKGROUND

The mental health of medical residents, challenged by their intensive training, is of utmost concern. In light of reported suicides among Iranian medical residents in 2021, this study investigates the factors behind suicidal ideation among medical residents during the COVID-19 pandemic in Tehran.

METHODS

This study conducted a cross-sectional online survey among medical residents in various specialties in Tehran, Iran, amidst the COVID-19 pandemic. Suicidal ideation was assessed using the Beck Scale for Suicidal Ideation (BSSI), while depression, anxiety, and stress were measured using the DASS-21. It also collected demographic and clinical data from the participants. The data were analyzed using descriptive statistics, the Chi-square test, and multiple linear regression to examine the prevalence and determinants of suicidal ideation among medical residents.

RESULTS

The study enrolled 353 medical residents and found that 34.3% of them had suicidal ideation, with 10.2% indicating a high risk. The study also found high levels of depression, anxiety, and stress among the participants. The variables that significantly predicted suicidal ideation were depression, history of alcohol/substance use, personal history of suicide attempts, history of self-mutilation, family history of suicide attempts, number of shifts in a month, death of close persons because of COVID-19, and income. Depression was the strongest predictor of suicidal ideation.

CONCLUSION

These findings underscore the urgent need for effective interventions and support systems to address the mental health needs of medical residents in Iran. The strategies should prioritize destigmatizing mental health, promoting access to mental health services, fostering a supportive training environment, and enhancing income opportunities.

Unspoken Truths: Mental Health Among Academic Surgeons

OBJECTIVE

To characterize the current state of mental health within the surgical workforce in the United States.

BACKGROUND

Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown.

METHODS

Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed.

RESULTS

Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4%-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. In all, 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P <0.001), anxiety (31.6% vs. 16.2%, P =0.001), PTSD (12.8% vs. 5.6%, P =0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P =0.022). Overall, 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past 2 weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P =0.033) and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P <0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P =0.002) were associated with increased odds of suicidal ideation over the past 12 months.

CONCLUSIONS

Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the United States.

Paying attention to attention: a program evaluation of faculty-delivered mindfulness-based attention training to optimize wellness and professionalism in medical students

BACKGROUND

As physician distress rises, medical schools must provide programs to counter such distress at the earliest stages of training. Mindfulness training (MT) is one intervention that can alleviate stress during medical school. However, framing MT around wellness alone misses the opportunity to connect core cognitive and psychological capacities strengthened by MT to professional goals and skill acquisition inherent to successful medical training. Here, we highlight how the attentional components of MT align with students' goals of becoming attending physicians while promoting academic, psychological, and interpersonal flourishing. MT courses that focus on strengthening attentional capacities can intuitively link academic and professional development with wellness, appealing to a wide array of students.

METHODS

We iteratively recontextualized an existing short-form mindfulness training program for high-stress pre-professionals, known as Mindfulness Based Attention Training (MBAT), to the medical school context (MBAT-Rx). MBAT-Rx was offered by physician trainers to first-year medical students at Warren Alpert Medical School of Brown University as a tool for improving study habits and focus in addition to the development of both self-care and patient care strategies. MBAT-Rx consists of weekly, two-hour sessions over four weeks, with 10-15 min of daily mindfulness practice between sessions. At the end of the four weeks, students submitted voluntary program evaluation responses detailing their experience of the program.

RESULTS

Optional program evaluation responses (n = 67) highlight that students found the program to be useful for their academic success and ability to pay attention, their interpersonal relationships, and their psychological health. By framing MT as an opportunity to boost core attentional capacities and connecting this to professional and academic goals in addition to wellness, MBAT-Rx appealed to a wide variety of students.

CONCLUSIONS

Our ongoing work suggests that framing MT as both a professional development and wellness promotion tool, taught by physicians themselves, and structured around students' time demands, may be a successful model for medical schools looking to increase the impact of their mindfulness offerings. Such programs are needed to equip medical students to navigate the demands of a challenging healthcare training landscape.

Prevalence and factors associated with professional burnout in Polish oncologists-results of a nationwide survey

BACKGROUND

High rates of burnout are observed among health care professionals worldwide, which could have negative consequences on personal and organizational levels. We aimed to evaluate the burnout prevalence and factors associated with burnout among oncologists in Poland.

MATERIALS AND METHODS

An online survey was conducted using the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and additional work/lifestyle questions. Descriptive statistics, parametric and nonparametric tests, and multivariate logistic regression were used to identify factors associated with burnout.

RESULTS

A total of 228 physicians participated in the survey, including 168 medical oncologists, 43 radiation oncologists, and 17 from other specialties. Data collected from 211 medical and radiation oncologists were included in the final analyses. Most participants were female (71.6%) and ≤40 years of age (70.1%). A self-reported feeling of burnout was present in 65.9% of participants. Based on the MBI-HSS, 74.9% showed evidence of burnout with burnout subdomains as follows: depersonalization 37.0%; emotional exhaustion 64.5%; low accomplishment 43.1%. There were no differences in burnout rates based on specialization (oncology/haematology-75.6%, radiotherapy-72.1%), career stage, gender, or age groups. Lack of work-life balance was the only significant factor associated with the risk of burnout in the logistic regression (relative risk 2.6, 95% confidence interval 1.3-5.4). Only 20.9% of physicians had access to psychological support in their workplace; however, 70.1% desired such support. Three main factors impacting burnout in cancer care workers were: bureaucracy and administrative duties overload, admissions of many patients, and poor work culture.

CONCLUSIONS

Burnout is common among medical and radiation oncologists in Poland. There is a high demand for psychological support and organizational changes in the workplace to reduce risk and mitigate the adverse effects of burnout among health care professionals.

Evaluating the Impact of Annual Resident Retreats on Radiology Resident Wellbeing

RATIONALE AND OBJECTIVES

To investigate the effect of resident-run wellness retreats on measures of stress, resilience, and cohesion amongst radiology residents.

MATERIALS AND METHODS

All diagnostic and interventional radiology residents in a single academic medical center were invited to participate in a wellness-focused off-campus retreat. Three retreats were held on an annual basis from 2018 to 2022 and included physical exercises, nutritional wellness, and team-building activities. Participants were surveyed pre- and post- retreat attendance focusing on the following domains: Perceived Stress Scale, higher scores indicating higher levels of perceived stress; Brief Resilience Scale, higher scores indicating greater resilience; Cohesion Scale, higher scores indicating greater cohesion. Paired t-tests and linear regression models were used to compare mean Perceived Stress, Brief Resilience, and Cohesion Scales pre- and post-retreat across covariates.

RESULTS

Of 78 total retreat attendances, 75 residents (96%) completed pre- and/or post-surveys. Study population was 51% female and 49% male, with mean age 29 ± 2.8 years. Comparing post- with pre-surveys, retreat attendance was associated with a significant reduction in mean Perceived Stress (12.7 vs 16.3; 95% CI 2.1-5.3) and significant increase in Brief Resilience (3.9 vs 3.7; 95% CI 0.05-0.34) and Cohesion (33 vs 27; 95% CI 4.3-6.7). First year residents experienced the greatest increase in Cohesion compared to fourth year residents (p < 0.001). Pre-retreat cohesion was significantly lower in 2022 than in 2018-2019 (26.6 vs 28.7 vs 28.6; p = 0.04), with stress and resilience not significantly different by year.

CONCLUSION

An annual resident retreat decreased stress, while increasing resilience and cohesion within a radiology residency, supporting retreats as a potentially viable intervention to promote physician well-being.

Role of stressful life events and personality traits on the prevalence of wish to die among French physicians

Background

Suicide rates are higher among physicians than in the general population. We aimed to investigate the role of stressful life events (related or not to work conditions) and personality traits on wish to die, a proxy measure of suicidal ideation.

Methods

This cross-sectional study took place in France from March 2018 to September 2018. Physicians completed an online questionnaire. A multiple logistic regression model estimated factors associated with wish to die. Moderated moderation models were used to assess the effect of personality traits on the relationship between stressful events and wish to die.

Results

1,020 physicians completed the questionnaire. Most (75%) had endorsed a work-related stressful event and one in six (15.9%) endorsed a wish to die the year before. Wish to die was associated with burnout (OR = 2.65, 95%CI = 1.82-3.88) and work-related stressful events (OR = 2.18, 95%CI = 1.24-3.85) including interpersonal conflicts, harassment and work-overload. Emotional stability was the only personality trait associated with wish to die in the logistic regression (OR = 0.69, 95%CI = 0.59-0.82). In moderation models, we observed a significant interaction involving three personality traits-emotional stability, extraversion, and agreeableness-along with gender, influencing the impact of stressful events on the wish to die.

Limitations

Our study is limited by the impossibility to control for risk factors associated with suicide like psychiatric comorbidities.

Conclusion

Work-related stressful events significantly contribute to the manifestation of a wish to die among physicians. The impact of stressful events on the wish to die is moderated by factors such as gender and personality traits, including emotional stability and extraversion. These results are overall consistent with prior studies concerning the risk of burnout and suicide among physicians.

Prevalence of sexual dysfunction and pursuit of sexual medicine evaluation among male physicians-a survey

We sought to characterize the prevalence of sexual dysfunction and barriers to treatment among male physicians. Between June and December 2022, male physicians were invited to complete a questionnaire regarding sexual function. Surveys were disseminated electronically via social media and professional medical societies using Qualtrics (Provo, UT). In totla, 235 responses were included in the final analysis. The mean age of respondents was 36.3 ± 7.4 years (range 23-72). 27 (11.5%) reported having seen a doctor for sexual health. Of these 27, 40.7% saw a physician for erectile dysfunction, 29.6% for low libido, 22.2% for premature ejaculation, 7.4% for delayed ejaculation, and 33.3% for other concerns. An additional 29 (12.3%) considered establishing care for sexual issues but didn't, mostly due to being too busy. 46 (19.6%) respondents reported having taken medication to improve erectile function. Therefore, in a cohort of young male physicians, 23.8% had seen or considered seeing a doctor for sexual health concerns, and nearly 1 in 5 had taken medication for erectile dysfunction. Male physicians appear to be at higher risk for sexual dysfunction than the general population and face significant and unique barriers in access to care for sexual dysfunction.

Risk identification and prediction of complaints and misconduct against health practitioners: a scoping review

Identifying the risk and predicting complaints and misconduct against health practitioners are essential for healthcare regulators to implement early interventions and develop long-term prevention strategies to improve professional practice and enhance patient safety. This scoping review aims to map out existing literature on the risk identification and prediction of complaints and misconduct against health practitioners. This scoping review followed Arksey and O'Malley's five-stage methodological framework. A comprehensive literature search was conducted on MEDLINE, EMBASE, and CINAHL databases and finished on the same day (6 September 2021). Articles meeting the eligibility criteria were charted and descriptively analysed through a narrative analysis method. The initial search generated 5473 articles. After the identification, screening, and inclusion process, 81 eligible studies were included for data charting. Three key themes were reported: methods used for identifying risk factors and predictors of the complaints and misconduct, synthesis of identified risk factors and predictors in eligible studies, and predictive tools developed for complaints and misconduct against health practitioners. The findings reveal that risk identification and prediction of complaints and misconduct are complex issues influenced by multiple factors, exhibiting non-linear patterns and being context specific. Further efforts are needed to understand the characteristics and interactions of risk factors, develop systematic risk prediction tools, and facilitate the application in the regulatory environment.

Peer Support to Promote Surgeon Well-being: The APSA Program Experience

BACKGROUND

Peer support programs have evolved to train physicians to provide outreach and emotional first aid to their colleagues when they experience the inevitable challenge of a serious adverse event, whether or not it is related to a medical error. Most pediatric surgeons have experienced the trauma of a medical error, yet, in a survey of APSA membership, almost half said that no one reached out to them, and few were satisfied with their institution's response to the error. Thus, the APSA Wellness Committee developed an APSA-based peer support program to meet this need.

METHODS

Peer supporters were nominated by fellow APSA members, and the group was vetted to ensure diversity in demographics, practice setting, and seniority. Formal virtual training was conducted before the program went live in 2020. Trained supporters were surveyed 6 months after the program launched to evaluate their experiences with providing peer support.

RESULTS

15 referrals were made in the first year, 60 % of which were self-initiated. Most referrals were for distress related to adverse events or toxic work environments (33 % each). While only about 25 % of trained supporters had provided formal support through the APSA program, more than 80 % reported using the skills to support colleagues and trainees within their own institutions.

CONCLUSION

Our experience in the first year of the APSA peer support program demonstrates the feasibility of building and maintaining a national program to provide emotional first aid by a professional society to expand the safety net for surgeons who are suffering.

Association between suicidal ideation and burnout: A meta-analysis

Approximately 700,000 people die by suicide annually worldwide. Researchers have explored a spectrum of experiences that involve stress in academic or work environments and potentially intensify suicidal thoughts or behaviors. However, no meta-analysis has examined the relationship between suicidal ideation (SI) and burnout. This study consisted of a meta-analysis to examine the association between SI and burnout syndrome, utilizing the WoS Core Collection, Scopus, PubMed, PsycINFO, DIALNET, and Google Scholar databases. Twenty-one samples met the study's eligibility criteria for inclusion in the analysis. The results revealed a significant relationship between SI and burnout, with the type of burnout (occupational, academic, and parental) emerging as the most significant moderating variable. Occupational burnout exhibited the lowest correlation, followed by academic and parental burnout. These findings suggest the importance of developing tools to assess SI within the context of the work environment, parenting and academics, and psychoeducational programs for managing stress.

Burnout among public health workers in Canada: a cross-sectional study

BACKGROUND

This study presents the prevalence of burnout among the Canadian public health workforce after three years of the COVID-19 pandemic and its association with work-related factors.

METHODS

Data were collected using an online survey distributed through Canadian public health associations and professional networks between November 2022 and January 2023. Burnout was measured using a modified version of the Oldenburg Burnout Inventory (OLBI). Logistic regressions were used to model the relationship between burnout and work-related factors including years of work experience, redeployment to pandemic response, workplace safety and supports, and harassment. Burnout and the intention to leave or retire as a result of the COVID-19 pandemic was explored using multinomial logistic regressions.

RESULTS

In 2,079 participants who completed the OLBI, the prevalence of burnout was 78.7%. Additionally, 49.1% of participants reported being harassed because of their work during the pandemic. Burnout was positively associated with years of work experience, redeployment to the pandemic response, being harassed during the pandemic, feeling unsafe in the workplace and not being offered workplace supports. Furthermore, burnout was associated with greater odds of intending to leave public health or retire earlier than anticipated.

CONCLUSION

The high levels of burnout among our large sample of Canadian public health workers and its association with work-related factors suggest that public health organizations should consider interventions that mitigate burnout and promote recovery.

"The Cost in the Individual": Longitudinal Burnout Prevalence Among Pediatric Emergency Physicians Through 9 Months of the COVID-19 Pandemic

OBJECTIVES

Emergency medicine (EM) confers a high risk of burnout that may be exacerbated by the COVID-19 pandemic. We aimed to determine the longitudinal prevalence of burnout in pediatric EM (PEM) physicians/fellows working in tertiary PEM departments across Canada and its fluctuation during the pandemic.

METHODS

A national mixed-methods survey using a validated 2-question proxy for burnout was distributed monthly through 9 months. The primary outcome was the trajectory in probability of burnout, which was examined as both emotional exhaustion (EE) and depersonalization (DP), EE alone, and DP alone. Secondary outcomes investigated burnout and its association with demographic variables. Quantitative data were analyzed using logistic regression for primary outcomes and subanalyses for secondary outcomes. Conventional content analysis was used to analyze qualitative data and generate themes.

RESULTS

From February to October 2021, 92 of 98 respondents completed at least 1 survey, 78% completed at least 3 consecutive surveys, and 48% completed at least 6 consecutive surveys. Predicted probability of EE was bimodal with peaks in May (25%) and October (22%) 2021. Rates of DP alone or having both EE and DP were approximately 1% and stable over the study period. Mid-career physicians were at lower risk of EE (odds ratio, 0.02; 95% confidence interval, 0-0.22) compared with early-career physicians. Underlying drivers of burnout were multifaceted.

CONCLUSIONS

Our study suggests that increased COVID-19 case burden was correlated with EE levels during the third and fourth waves of the pandemic. Emotional exhaustion was worsened by systemic factors, and interventions must target common themes of unsustainable workloads and overwhelming lack of control.

Predictors of professional burnout and fulfilment in a longitudinal analysis on nurses and healthcare workers in the COVID-19 pandemic

AIMS AND OBJECTIVES

(1) To investigate the vulnerability of nurses to experiencing professional burnout and low fulfilment across 5 months of the COVID-19 pandemic. (2) To identify modifiable variables in hospital leadership and individual vulnerabilities that may mitigate these effects.

BACKGROUND

Nurses were at increased risk for burnout and low fulfilment prior to the COVID-19 pandemic. Hospital leadership factors such as organisational structure and open communication and consideration of employee opinions are known to have positive impacts on work attitudes. Personal risk factors for burnout include symptoms of depression and anxiety.

METHODS

Healthcare workers (n = 406 at baseline, n = 234 longitudinal), including doctors (n = 102), nurses (n = 94), technicians (n = 90) and non-clinical administrative staff (n = 120), completed 5 online questionnaires, once per month, for 5 months. Participants completed self-report questionnaires on professional fulfilment and burnout, perceptions of healthcare leadership, and symptoms of anxiety and depression. Participants were recruited from various healthcare settings in the southeastern United States. The STROBE checklist was used to report the present study.

RESULTS

Both at baseline and across the 5 months, nurses working during the COVID-19 pandemic reported increased burnout and decreased fulfilment relative to doctors. For all participants, burnout remained largely steady and fulfilment decreased slightly. The strongest predictors of both burnout and fulfilment were organisational structure and depressive symptoms. Leadership consideration and anxiety symptoms had smaller, yet significant, relationships to burnout and fulfilment in longitudinal analyses.

CONCLUSIONS

Burnout and reduced fulfilment remain a problem for healthcare workers, especially nurses. Leadership styles and employee symptoms of depression and anxiety are appropriate targets for intervention.

RELEVANCE TO CLINICAL PRACTICE

Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.

Exploring the administrative burden faced by hematologists: a comprehensive study in Italy

Background

Administrative burdens have been identified as a major issue impacting patient care, professional practice, and the overall efficiency of healthcare systems. The aim of this study is to assess the administrative burden faced by Italian hematologists.

Methods

A cross-sectional survey that included both closed-ended quantitative questions and open-ended free text answer options was administered to 1,570 hematologists working with malignancies and members of Italian GIMEMA Foundation - Franco Mandelli ONLUS and the Italian Linfomi Foundation (FIL). The survey was conducted online from May 24 to June 30, 2023. Descriptive statistics were computed for the quantitative data to clearly summarize the responses and descriptive analysis of free text responses was carried out.

Results

Surveyed hematologists spend an average of 47.07% of their time on administrative tasks, with 63.22% (n = 110) of respondents reporting spending at least half of their time on these activities. More than half (57.47%, n = 100) reported that "Patient care" is the medical task most affected by a lack of time. Additionally, 55.17% (n = 96) reported experiencing burnout in the past 6 months, with filling out "Forms" being identified as the top contributing administrative task by 27.59% (n = 48) of respondents, followed by "Scheduling" (24.71%, n = 43) and "Managing IT system failures" (21.84%, n = 38). Nearly half of the surveyed hematologists (45.40%, n  =  = 79) identified patient care as the top priority requiring more time.

Conclusions

The study confirms that the administrative workload of hematologists has a significant impact on patient care, communication, and burnout risk, reducing the time available for patient care, leading to exhaustion and concern about clinical errors.

U.S. Attending Anesthesiologist Burnout in the Postpandemic Era

BACKGROUND

Anesthesiologists are experiencing unprecedented levels of workplace stress and staffing shortages. This analysis aims to assess how U.S. attending anesthesiologist burnout changed since the onset of the COVID-19 pandemic and target well-being efforts.

METHODS

The authors surveyed the American Society of Anesthesiologists' U.S. attending anesthesiologist members in November 2022. Burnout was assessed using the Maslach Burnout Inventory Human Services Survey with additional questions relating to workplace and demographic factors. Burnout was categorized as high risk for burnout (exhibiting emotional exhaustion and/or depersonalization) or burnout syndrome (demonstrating all three burnout dimensions concurrently). The association of burnout with U.S. attending anesthesiologist retention plans was analyzed, and associated factors were identified.

RESULTS

Of 24,680 individuals contacted, 2,698 (10.9%) completed the survey, with 67.7% (1,827 of 2,698) at high risk for burnout and 18.9% (510 of 2,698) with burnout syndrome. Most (78.4%, n = 2,115) respondents have experienced recent staffing shortages, and many (36.0%, n = 970) were likely to leave their job within the next 2 yr. Those likely to leave their job in the next 2 yr had higher prevalence of high risk for burnout (78.5% [760 of 970] vs. 55.7% [651 of 1,169], P < 0.001) and burnout syndrome (24.3% [236 of 970] vs. 13.3% [156 of 1,169], P < 0.001) compared to those unlikely to leave. On multivariable analysis, perceived lack of support at work (odds ratio, 9.2; 95% CI, 7.0 to 12.1), and staffing shortages (odds ratio, 1.96; 95% CI, 1.57 to 2.43) were most strongly associated with high risk for burnout. Perceived lack of support at work (odds ratio, 6.3; 95% CI, 3.81 to 10.4) was the factor most strongly associated with burnout syndrome.

CONCLUSIONS

Burnout is more prevalent in anesthesiology since early 2020, with workplace factors of perceived support and staffing being the predominant associated variables. Interventions focused on the drivers of burnout are needed to improve well-being among U.S. attending anesthesiologists.

EDITOR’S PERSPECTIVE

Maintaining Joy in Orthopaedic Practice

Orthopaedic surgeons may, at times, derive less enjoyment from their work. Limited engagement can arise, on the one hand, from limited autonomy, burdens of care, and reduced reimbursement. On the other hand, surgeons may enjoy their work less if they feel less able to help people. For instance, people with pressing medical, mental, and social health opportunities may place inordinate hope on what an orthopaedic surgeon can do to improve their lives. Pressure to provide tests and treatment with more potential for harm than benefit can, at times, contribute to a sense of futility and emotional exhaustion. There may, at times, be small and large pressures that can induce surgeons to compromise respect for evidence and lapse in adherence to ethical principles, placing them at risk for moral injury. These aspects of orthopaedic practice seem important given the association between limited joy in practice and self-harm, abandoning medical practice, and errors and patient harm. There are things to consider when working on joy in practice, including recognizing and naming the unsavory parts of practice; making improvement in the area for creativity, innovation, and personal growth; and developing strategies to limit and alleviate stress.

Enhancing Patient Safety: A Cross-Sectional Study to Assess Medical Interns' Attitude and Knowledge About Medication Safety in Saudi Arabia

Introduction and aim Medication errors (MEs) pose a severe threat in the medical field. Since such errors are preventable, it is paramount for all healthcare workers to be educated on the matter. This study aimed to assess medical interns' attitudes and knowledge of medication safety and errors. We also aimed to validate current university programs to educate students about medication safety and errors. Methods A cross-sectional study that utilized a self-administered online questionnaire comprised 31 questions. The questionnaire was distributed via social media networks, such as WhatsApp, Twitter, email, Instagram, and Snapchat among 100 medical, pharmacy, and nursing interns in Saudi Arabia. The study population included both Saudi and non-Saudi interns. Results The majority of participants, comprising 92% (n=92), indicated that they were familiar with the definition of medication errors (ME). Additionally, 85% (n=85) expressed their willingness to report instances of MEs when medications were not prescribed but required. Moreover, 90% (n=90) of the surveyed individuals expressed their willingness to report MEs in situations where patients did not receive medications as prescribed. In cases where patients experienced harm and required treatment due to an ME, 91% (n=91) of respondents committed to reporting such incidents. A total of 52 (52%) respondents stated that they would report MEs regardless of whether they reached/harmed the patient. A good ME knowledge level was observed in 48% of respondents. A higher likelihood of good ME knowledge was significantly associated with safety reporting system (SRS) awareness and reporting MEs regardless of whether they reached/harmed the patient (p<0.05). College, awareness/attitude, or other demographic factors were not significantly related to ME knowledge (p>0.05). Conclusion This study showed that although interns in the healthcare field do have some knowledge about MEs, there is still a significant need to improve their knowledge. This can be achieved through various ways, one of which is by implementing this topic into the university curricula.

On the Asymmetric Relationship Between Physician Mental Health Disorders on Quality of Healthcare Under the COVID-19 Pandemic in Taiwan: Quantile on Quantile Regression Analyses

Purpose

When examining the nexus of physician mental health disorders and healthcare quality from the empirical perspective, mental health disorders are frequently associated with cyclical patterns corresponding to cyclic seasonality, mood swings, emission of air pollution and business cycles, the potential asymmetric effects of physician mental health disorders on healthcare quality have not received adequate attention from researchers. Therefore, the purpose of this study is to explore the asymmetric relationship between physician mental health disorders and healthcare quality during the pandemic outbreak in Taiwan.

Methods

Daily data for care quality indicators and physician mental health disorders were collected from the National Insurance Research Database in Taiwan, and the quantile-on-quantile regression model was applied to proceed with our analyses.

Results

Our results indicated that the overall aggregate effects of each quantile of physician mental health disorders on the cumulative quantiles of healthcare quality are negative (positive) for the 14-day readmission rate (preventable hospitalization rate and non-urgent ED-visit rate). Positively (negatively) cumulative effects of each quantile of physician mental health disorders were detected in the middle (low and high) quantiles of the preventable hospitalization rate. The cumulative effects of each quantile of physician mental health disorders on the high (low and middle) quantiles of the 14-day readmission rate are negative (positive), but the cumulative effects on various quantiles of the non-urgent ED-visit rate exhibit the opposite pattern.

Conclusion

The observed variation in the relationship between physician mental health disorders and different quantiles of healthcare quality suggests the need for tailored strategic interventions based on distinct levels of healthcare quality when addressing the higher risk of physician mental health disorders during the pandemic outbreak conditions.

Burnout and depression: Points of convergence and divergence

BACKGROUND

Debate is ongoing as to whether burnout can be differentiated from depression. This study evaluated whether burnout and depression could be distinguished using a new burnout measure and other variables.

METHODS

Scores on the Sydney Burnout Measure (SBM) were compared between participants with self-diagnosed burnout (BO-all group; n = 622) and clinically-diagnosed depression (DEP-all group; n = 90). The latter group was split into melancholic (DEP-mel; n = 56) and non-melancholic (DEP-nonmel; n = 34) depression subgroups for subsequent analyses. Differences in reporting of depressive symptoms and causal attributions were also evaluated.

RESULTS

While total SBM scores showed poor differentiation, the BO-all group had lower social withdrawal and higher empathy loss subscale scores than the depression groups. Odds ratios were significant for several of the depressive symptoms and causal attribution items when comparing the BO-all group to the DEP-all and DEP-mel groups, while only a few items were significant when comparing the BO-all and DEP-nonmel groups.

LIMITATIONS

Participants in the depression group were assigned by clinician-based depression diagnoses, rather than by a standardised diagnostic interview, and the group had a relatively small sample size. Participants in the burnout group were self-diagnosed and not assessed for comorbid psychiatric diagnoses.

CONCLUSIONS

There were some nuanced symptoms differences between burnout and depression, but many of the SBM symptoms were not specific to burnout. Results also suggested that burnout overlaps more with non-melancholic than melancholic depression, and that differentiation of burnout and depression may rely more on weighting causal factors over symptoms.

Adverse Childhood Experiences and Burnout in Athletic Trainers: An Exploratory Study

CONTEXT

Burnout, a state of physical or emotional exhaustion, is a concern within athletic training, as between 17% and 40% of athletic trainers (ATs) report high levels of burnout. Adverse childhood experiences (ACEs) are linked with higher levels of burnout in other health professions.

OBJECTIVE

To compare burnout with ACEs in ATs.

DESIGN

Cross-sectional study.

SETTING

Web-based survey.

PATIENTS OR OTHER PARTICIPANTS

One thousand ATs were selected at random to participate in the study. Of these, 78 ATs started the survey, and 75 ATs completed it.

MAIN OUTCOME MEASURE(S)

Burnout, as measured by the Copenhagen Burnout Inventory (CBI) overall and subscale scores, was compared across groups based on the number of adverse experiences as measured by the ACEs survey. Multiple analysis of variance tests were used to determine the association between ACEs score and overall, personal, work-related, and patient-related burnout.

RESULTS

At least 1 adverse experience was reported by 37 (49.33%) participants. Those with ≥4 ACEs had higher odds of describing overall, personal, and work-related burnout than those with 0 to 3 ACEs. Moderate burnout (CBI score ≥ 50.00) was noted in 27 (36.00%, overall), 44 (58.67%, personal), 34 (45.3%, work related), and 15 (20.00%, patient related) ATs. Participants with 4 ACEs had higher overall burnout (67.11 ± 19.89; F6,68 = 2.59, P = .03) than those with 0 (40.53 ± 17.12, P = .04), 1 (38.42 ± 20.99, P = .04), or 7 (19.08 ± 12.09, P = .03) ACEs. The same pattern existed with personal burnout, as participants with 4 ACEs (76.67 ± 17.33) had higher scores (F6,68 = 3.40, P = .00) than those with 0 (46.60 ± 17.49, P = .02), 1 (42.78 ± 21.48, P = .01), or 7 (27.08 ± 20.62, P = .03) ACEs. No other differences were observed.

CONCLUSIONS

Between 20.00% and 58.67% of ATs surveyed reported some form of burnout. Higher levels of overall and personal burnout were found in those with 4 ACEs. Although we expected to see lower levels of burnout in those with fewer ACEs, it was surprising that those with 7 ACEs had some of the lowest CBI scores. Athletic trainers with childhood trauma may find it beneficial to engage in self-regulation exercises to reduce or limit triggers and burnout. Additionally, employers should explore developing trauma-informed workplaces to better support employees.

[Burnout syndrome in health professionals at a university hospital in Spain]

OBJECTIVE

To evaluate the risk of Burnout in the health professionals of the Huesca University Hospital, 50 years after its inauguration, to investigate the variables related to the work motivation of the hospital health personnel and to assess the predisposing and protective factors of the risk of Burnout.

MATERIAL AND METHODS

An observational, analytical, prospective and unicentric study was conducted from September 2017 to April 2019, evaluating all the health professionals who worked at the Hospital San Jorge de Huesca (n=209).

RESULTS

The mean age was 42.86 years. 72.2% were women. 12.4% had moderate risk of burnout. There was 12.4% of high emotional exhaustion, 36.8% of high depersonalization and 44.5% of low personal accomplishment. Burnout was statistically significant associated with the professional category (P=.010), work experience (P=.026), hours of work per week (P=.036), choice of the same profession (P=.001) and recommendation to the offspring (P<.001).

CONCLUSIONS

One tenth of the sample had a moderate risk of burnout. Almost half of the health workers confirmed a high degree of satisfaction with the work environment and the majority expressed an adequate use of well-being strategies and a high degree of autonomy, recognition and satisfaction at work.

Suicide Risks of Health Care Workers in the US

Importance

Historically elevated risks of suicide among physicians may have declined in recent decades. Yet there remains a paucity of information concerning suicide risks among other health care workers.

Objective

To estimate risks of death by suicide among US health care workers.

Design, Setting, and Participants

Cohort study of a nationally representative sample of workers from the 2008 American Community Survey (N = 1 842 000) linked to National Death Index records through December 31, 2019.

Main Outcomes and Measures

Age- and sex-standardized suicide rates were estimated for 6 health care worker groups (physicians, registered nurses, other health care-diagnosing or treating practitioners, health technicians, health care support workers, social/behavioral health workers) and non-health care workers. Cox models estimated hazard ratios (HRs) of suicide for health care workers compared with non-health care workers using adjusted HRs for age, sex, race and ethnicity, marital status, education, and urban or rural residence.

Results

Annual standardized suicide rates per 100 000 persons (median age, 44 [IQR, 35-53] years; 32.4% female [among physicians] to 91.1% [among registered nurses]) were 21.4 (95% CI, 15.4-27.4) for health care support workers, 16.0 (95% CI, 9.4-22.6) for registered nurses, 15.6 (95% CI, 10.9-20.4) for health technicians, 13.1 (95% CI, 7.9-18.2) for physicians, 10.1 (95% CI, 6.0-14.3) for social/behavioral health workers, 7.6 (95% CI, 3.7-11.5) for other health care-diagnosing or treating practitioners, and 12.6 (95% CI, 12.1-13.1) for non-health care workers. The adjusted hazards of suicide were increased for health care workers overall (adjusted HR, 1.32 [95% CI, 1.13-1.54]), health care support workers (adjusted HR, 1.81 [95% CI, 1.35-2.42]), registered nurses (adjusted HR, 1.64 [95% CI, 1.21-2.23]), and health technicians (adjusted HR, 1.39 [95% CI, 1.02-1.89]), but adjusted hazards of suicide were not increased for physicians (adjusted HR, 1.11 [95% CI, 0.71-1.72]), social/behavioral health workers (adjusted HR, 1.14 [95% CI, 0.75-1.72]), or other health care-diagnosing or treating practitioners (adjusted HR, 0.61 [95% CI, 0.36-1.03) compared with non-health care workers (reference).

Conclusions

Relative to non-health care workers, registered nurses, health technicians, and health care support workers in the US were at increased risk of suicide. New programmatic efforts are needed to protect the mental health of these US health care workers.

Attitudes of undergraduate medical students toward patients' safety in Jordan: a multi-center cross-sectional study

BACKGROUND

Patient safety practices are crucial in healthcare as they aim to reduce harm, medical errors, and ensure favorable outcomes for patients. Therefore, this study aims to examine the attitudes towards patient safety among undergraduate medical students in Jordanian medical schools.

METHODS

A descriptive cross-sectional study was conducted among undergraduate medical students. Participants completed the Attitudes to Patient Safety Questionnaire- III (APSQ-III), which examines students' attitudes in 26 items distributed in nine domains. Results are represented as mean ± standard deviation for all participants and subgroups.

RESULTS

Our study included 1226 medical students. They reported positive attitudes toward patient safety with a mean score of 4.9 (SD ± 0.65). Participants scored the highest score in "Working hours as error cause" followed by "Team functioning". Gender, academic-year, and first-generation student status had a significant association with certain patient safety domains. Females scored significantly higher than males in four domains, while males scored higher in one domain. First-generation medical students had a significantly lower score for "Professional incompetence as error cause". Interestingly, pre-clinical students recorded more positive attitudes in "Patient safety training received" and "Disclosure responsibility" domains.

CONCLUSION

Undergraduate medical students in Jordan demonstrated positive attitudes towards patient safety concepts. Our study provides baseline data to improve current educational programs and enhance the patient safety culture among medical students. Additional studies are needed to delve into actual attitudes toward patient safety and to assess how educational programs contribute to the cultivation of this culture.

Burnout and fatigue amongst internal medicine residents: A cross-sectional study on the impact of alternative scheduling models on resident wellness

BACKGROUND

Fatigue and burnout are prevalent among resident physicians across Canada. Shifts exceeding 24 hours are commonly purported as detrimental to resident health and performance. Residency training programs have employed strategies towards understanding and intervening upon the complex issue of resident fatigue, where alternative resident scheduling models have been an area of active investigation. This study sought to characterize drivers and outcomes of fatigue and burnout amongst internal medicine residents across different scheduling models.

METHODS

We conducted cross-sectional surveys were among internal medicine resident physicians at the University of Alberta. We collected anonymized socioeconomic demographics and medical education background, and estimated associations between demographic or work characteristics and fatigue and burnout outcomes.

RESULTS

Sixty-nine participants competed burnout questionnaires, and 165 fatigue questionnaires were completed (response rate of 48%). The overall prevalence of burnout was 58%. Lower burnout prevalence was noted among respondents with dependent(s) (p = 0.048), who identified as a racial minority (p = 0.018), or completed their medical degree internationally (p = 0.006). The 1-in-4 model was associated with the highest levels of fatigue, reported increased risk towards personal health (OR 4.98, 95%CI 1.77-13.99) and occupational or household harm (OR 5.69, 95%CI 1.87-17.3). Alternative scheduling models were not associated with these hazards.

CONCLUSIONS

The 1-in-4 scheduling model was associated with high rates of resident physician fatigue, and alternative scheduling models were associated with less fatigue. Protective factors against fatigue are best characterized as strong social supports outside the workplace. Further studies are needed to characterize the impacts of alternative scheduling models on resident education and patient safety.