Does academic practice protect emergency physicians against burnout?

Gender Differences in Domestic Responsibilities of Otolaryngologists-A Mixed-Methods Analysis

OBJECTIVES

Female otolaryngologist-head and neck surgeons (OHNS) confront unique barriers. This study examines the influence of home life, especially gendered division of household labor, on leadership, productivity, and burnout.

METHODS

A survey was distributed through social media and national society list-serv. Demographics, responsibility for household roles, and Maslach Burnout Inventory for Medical Personnel were included. Participants were invited to participate in semi-structured interviews, employing purposive sampling, with qualitative thematic analysis.

RESULTS

Response rate was 26.4% (145 of 550 of eligible participants; 38.7% women, 60.7% men). Significantly fewer women were married (64.3% vs. 92% of men, p < 0.001), and significantly more were childless (21.4% of women vs. 9.1% of men, p = 0.037). More men reported exclusive/major responsibility for five duties, including yard work and home maintenance (all p < 0.03). More women reported exclusive/major responsibility for 15 duties, including meal planning and coordinating childcare (all p < 0.03). Women had higher Emotional Exhaustion on univariate analysis (p = 0.015). Across 27 interviews, two main themes were identified, each with three associated subthemes: Theme one, "division of duties," with subthemes (1) the way household duties were divided, (2) traditional gender norms, and 3. changing duties over time/unexpected circumstances. Theme two, "impact of domestic duties," with subthemes (1) professional, (2) financial, and (3) burnout/life satisfaction.

CONCLUSIONS

Women OHNS disproportionately manage domestic responsibilities, possibly altering career trajectory for some OHNS. Burnout, especially emotional exhaustion, may be elevated due to inequitable labor. Future research should focus on identifying ways to improve equity for this group.

LEVEL OF EVIDENCE

N/A Laryngoscope, 134:S1-S12, 2024.

"Ardor and diligence": Quantifying the faculty effort needed in emergency medicine graduate medical education

Objectives

Regulatory requirements around protected faculty effort to support graduate medical education (GME) programs have changed. The amount of labor required to run a GME program is unknown. We sought to describe the work performed by program leadership and core faculty in emergency medicine (EM).

Methods

We performed a prospective survey study of core faculty in EM. Participants completed a demographic questionnaire followed by quarterly time surveys, covering activities in eight domains: evaluation, teaching and education, scholarly activity, service, interview/recruitment, clinical supervision, student responsibilities, and wellness and administration. We collected data from April 2022 to March 2023. We calculated descriptive statistics and used analyses of variance (ANOVA) to assess differences by faculty role and quarter.

Results

A total of 596 physicians completed the demographic questionnaire and 347 (58.2%) completed at least one quarterly time survey including 142 (41%) females, 48 (14%) program directors (PDs), 84 (24%) assistant/associate program directors (APDs), and 215 (62%) general core faculty (GCF). The mean number of hours per week spent on nonclinical education work was 60 h for PDs, 47 h for APDs, and 44 h for GCF. ANOVA found significant differences in mean hours per week and faculty role in domains of evaluation (p < 0.001), service (p = 0.007), and interview/recruitment (p < 0.001). We detected differences in mean hours per week and quarter in domains of evaluation (p < 0.001), teaching and education (p < 0.001), interview and recruitment (p < 0.001), and clinical supervision (p < 0.001).

Conclusions

Running a residency program requires many hours of faculty work, which can vary based on faculty role and time of year. These results can inform decisions regarding faculty support.

Meaningful Work, Career Fit, and Professional Well-Being of Pediatric Academicians in the United States

OBJECTIVE

Examine associations between time spent in academic activities perceived as meaningful and professional well-being among academic pediatrics faculty.

METHODS

The sample comprised 248 full-time pediatric faculty (76% female, 81% white, non-Hispanic, 41% instructor or assistant professor) across the United States who completed an online survey in November 2019. Survey items included sociodemographic and professional characteristics, professional well-being measures (Stanford Professional Fulfillment Index; Maslach Burnout Inventory; Intention to Leave Academic Medicine), perceived meaningfulness of academic activities and assigned time to those activities. We defined global career fit as total percentage time assigned to professional activities considered meaningful by individuals, and activity-specific career fit as percentage time assigned to each meaningful professional activity.

RESULTS

As global career fit scores increased, professional fulfillment increased (r = 0.45, P < .001), whereas burnout (r = -0.29, P < .001) and intention to leave (r = -0.22, P < .001) decreased. Regarding activity-specific career fit, for individuals who considered patient care meaningful, as assigned time to patient care increased, professional fulfillment decreased (r = -0.14, P = .048) and burnout (r = 0.16, P = .02) and intention to leave (r = 0.26, P < .001) increased. There was no significant correlation between assigned time for teaching, research, or advocacy and professional well-being. Faculty were less likely to intend to leave academic medicine as assigned time increased for administrative or leadership activities if considered meaningful (r = -0.24, P = .01).

CONCLUSIONS

Time assigned to meaningful work activities may relate to professional well-being of academic pediatrics faculty. More time assigned to patient care, despite being meaningful, was associated with poor self-reported professional well-being. Effort allocation among diverse academic activities needs to be optimized to improve faculty well-being.

The high cost of healing and teaching: a cross-sectional survey of burnout among academic physicians in Nigeria

BACKGROUND

Globally, the medical and teaching professions are two major professions with the highest prevalence of burnout, and academic physicians bestride the two professions. This study investigated the prevalence and associated factors of burnout among academic physicians working in tertiary hospitals in Nigeria.

METHODOLOGY

This was a self-administered online survey. Burnout was measured using the Maslach Burnout Inventory for Educators (MBI-ES) on Google Form and sent to 256 academic physicians in tertiary hospitals across Nigeria using the WhatsApp broadcast feature. MBI-ES was categorized into two categories (Burnout and No Burnout), and binary logistic regression was used to test the influence of 13 predictors on the three dimensions of MBI-ES as well as MBI in its entirety.

FINDINGS

A total of 155 academic physicians responded, resulting in a response rate of 60.5%. There were 121 (80.7%) males and 29 (19.3%) females (five cases respondents omitted this detail). Eighty-seven respondents exhibited moderate to high burnout in at least one of the dimensions of the MBI, translating to a prevalence rate of 57.7% in our study. Five variables, number of peer reviewed articles published, hours of weekly teaching, enjoyment of academic writing, apathy to teaching and religion were all significantly associated with burnout. Moderate to high emotional exhaustion was reported by 30.8% (45 respondents), moderate to high depersonalization by 5.5% (8 respondents),, and low to moderate personal accomplishment by 43.5% (67 respondents).Eight variables: religion, geopolitical zone of practice, enjoyment of academic writing, apathy toward teaching, university ownership, number of published peer-reviewed articles, salary, and supplementary income were significantly associated with emotional exhaustion, while the number of weeks spent teaching in a year and teaching hours/week were significantly associated with depersonalization and personal accomplishment, respectively. Age (OR 1.302, CI 1.080-1.570), Teaching hours/week (OR 0.924, CI 0.854-0.999), Salary (OR 0.996, CI 0.993-1.0), and supplementary salary (OR 0.996, CI 0.993-0.999) were found to significantly predict emotional exhaustion.

CONCLUSION

The study reveals a high prevalence of burnout (57.7%) among academic physicians in Nigeria, highlighting an urgent need for targeted interventions and policy changes. Given the significant role these professionals play in healthcare and medical education, immediate action is essential to address this issue. Future research should focus on evaluating the effectiveness of preventive measures and exploring the long-term impacts of burnout.

Emergency medicine physician burnout before and during the COVID-19 pandemic

Background

Burnout is a common issue among physicians, and the rate among emergency medicine physicians (EPs) appears to be higher than those of other medical specialties. The COVID-19 pandemic presents unprecedented challenges to the medical community worldwide, but its effects on EP burnout has not yet been determined.

Methods

We conducted a three-stage nationwide study between July 2019 and June 2021. First, we evaluated the responses to burnout questionnaires that had been filled in by EP before the COVID-19 pandemic. We then re-sent the same questionnaires, with an addition of pandemic-specific questions. The third step involved a small group of EPs who participated in a burnout reduction workshop and re-took the questionnaires after a 3-month interval. The Maslach Burnout Inventory measured three burnout scales and a Work and Meaning Inventory predicts job satisfaction. Descriptive, univariate, and multivariate statistical tests were used to analyze the data.

Results

In the first stage, 240 questionnaires were sent by email to all Israeli EPs listed in emergency departments nationwide, and 84 out of 88 submitted questionnaires were completed in full before the pandemic. 393 questionnaires were sent in the second stage during the pandemic and 93 out of 101 submitted questionnaires were completed in full. Twenty EPs participated in the workshop and 13 out of 20 submitted questionnaires were completed in full. Burnout levels were high (Maslach) among EPs before the pandemic and increased during the pandemic. The feelings of personal accomplishment and work meaning—both protective factors from burnout—were significantly higher in the second (pandemic) stage. The pandemic-specific burnout factors were fear of infecting family members, lack of care centers for the physician’s children, increased workload, and insufficient logistic support. The physician-oriented intervention had no significant impact on burnout levels (p < 0.412, Friedman test).

Conclusions

Physician burnout is a major global problem, and it is now being aggravated by the challenges of the COVID-19 pandemic. Healthcare administrators should be alerted to pandemic-specific stress factors in order to help teams cope better and to prevent further worsening of the burnout. Further research is warranted to determine the lasting effect of the pandemic on EM physician burnout and the best means for reducing it.

Factors driving burnout and professional fulfillment among emergency medicine residents: A national wellness survey by the Society for Academic Emergency Medicine

Objectives

This study aimed to identify rates of and contributors to burnout and professional fulfillment among emergency medicine (EM) resident physicians.

Methods

This was a cross-sectional, national survey of resident members of the Society for Academic Emergency Medicine (SAEM). Primary outcomes were burnout and professional fulfillment measured using a previously validated instrument with additional domains pertaining to the academic environment. The survey included question domains examining organizational factors (e.g., academic work environment, satisfaction with training, electronic health records, values alignment, and control over schedule) and individual factors (e.g., self-compassion, meaningfulness of clinical work, impact of work on health and personal relationships, perceived appreciation, thoughts of attrition, and expectations of the field of EM). Logistic regression was performed to determine the relationships between the primary outcomes and each domain.

Results

The survey was sent electronically to 2641 SAEM resident members. A total of 275 residents completed the survey with a response rate of 10.4%. A total of 151 (55%) respondents were male, and 210 (76%) were White. A total of 132 (48%) residents reported burnout, and 75 (28%) reported professional fulfillment. All organizational and individual factors were significantly associated with both primary outcomes. EM residents reported that meaningfulness of clinical work had the most significant positive association with professional fulfillment (adjusted odds ratio [OR] 2.2 [95% confidence interval {CI} 1.8-2.7]) and negative association with burnout (adjusted OR 0.46 [95% CI 0.37-0.56]). Thoughts of attrition from academics and accurate expectations of EM were also associated with both primary outcomes, with adjusted ORs (95% CIs) of 0.40 (0.21-0.72) and 5.6 (1.9-23.8) for professional fulfillment and 4.1 (2.5-7.1) and 0.19 (0.08-0.40) for burnout, respectively.

Conclusions

This study found a high prevalence of burnout and a low prevalence of professional fulfillment among EM residents. Multiple factors were significantly associated with each occupational phenomenon, with meaningfulness of clinical work demonstrating the strongest relationships with burnout and professional fulfillment.

From intern to "accepted": A guide to preparing for fellowship in emergency medicine

Introduction

The number of fellowship options for emergency medicine (EM) physicians continues to expand. While guides exist to help residents explore individual fellowship pathways, we aimed to create a comprehensive guide for all residents considering fellowship.

Methods

At the direction of the Society for Academic Emergency Medicine (SAEM) Board, 9 members of the Fellowship Guide Workgroup, including members of the Fellowship Approval Committee, and 2 members of SAEM Residents and Medical Students (RAMS) group collaboratively developed the guide using available evidence and expert opinion when high-quality evidence was unavailable. The guide was reviewed and approved by all members.

Results

The guide offers advice to EM residents on how to conceptualize key aspects of their training with respect to preparation for fellowship, including scholarship, teaching, leadership, and electives. Additionally, it offers perspective on selecting a fellowship that matches the resident's interests and goals and successfully applying.

Conclusion

This fellowship guide for EM residents considering fellowship summarizes the best currently available advice for residents considering fellowship training after residency.

Drivers of professional fulfillment and burnout among emergency medicine faculty: A national wellness survey by the Society for Academic Emergency Medicine

BACKGROUND

Professional fulfillment and the mitigation of burnout can enhance clinician well-being and the resiliency of the health care organization. This study examined the extent to which specific individual and workplace factors are associated with professional fulfillment and burnout among a national sample of academic emergency physicians.

METHODS

This was a cross-sectional survey of faculty members of the Society for Academic Emergency Medicine. Primary outcomes were professional fulfillment and burnout. The survey also examined individual and workplace factors as well as faculty's thoughts of attrition from academic and clinical medicine. Logistic regression was performed to determine the relationships between each outcome and each factor, respectively.

RESULTS

A total of 771 of 3130 faculty completed the survey (response rate 24.6%). A total of 38.7% reported professional fulfillment and 39.1% reported burnout. Meaningfulness of work (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.9-2.5), perceived appreciation (OR 1.9, 95% CI 1.7-2.1), and the academic work environment (OR 1.7, 95% CI 1.5-1.9) had the highest odds of being associated with professional fulfillment. In contrast, low score responses for meaningfulness of work (OR 0.6, 95% CI 0.5-0.6), self-compassion (0.6, 95% CI 0.5-0.6), and control over schedule (OR 0.6, 95% CI 0.6-0.7) were most associated with burnout. Faculty with professional fulfillment were less likely to report plans for attrition from academics (OR 0.1, 95% CI 0.1-0.2) and from clinical medicine (OR 0.2, 95% CI 0.1-0.4). Faculty with burnout were more likely to report plans for attrition from academics (OR 7, 95% CI 4.8-10.4) and clinical medicine (OR 5.7, 95% CI 3.9-8.6).

CONCLUSIONS

Individual and workplace factors that contributed to professional fulfillment and burnout were identified, with meaningfulness of clinical work demonstrating the strongest association with both occupational phenomena. Knowledge of which factors are most impactful in promoting professional fulfillment and mitigating burnout may be useful in guiding efforts to enhance clinician well-being.

Benefits of developing graduate medical education programs in community health systems

The creation of new CMS-funded Graduate Medical Education (GME) cap positions by the Consolidated Appropriations Act 2021 offers a unique opportunity for systems in community and rural settings to develop and expand their training programs. This article provides a review of the evidence behind the value proposition for system administrators to foster the growth of GME in community health systems. The infrastructure needed to accredit GME programs may reduce the cost of care for both the patients and the system through improved patient outcomes and facilitation of system efforts to recognize and mitigate social determinants of health. Residents, fellows and medical students expand the capacity of the current healthcare workforce of a system by providing coverage during healthcare emergencies and staffing services in difficult-to-recruit specialties. Those trainees are the nucleus of succession planning for the current medical staff, can facilitate the creation and expansion of service lines, and may elevate the profile of the system through scholarly work and equity and quality improvement activities. While creating GME programs in a community health system may, at first glance, be perceived as cost-prohibitive, there are robust advantages to a system for their creation.