1
|
Patel RA, Ungar RA, Pyke AL, Adimoelja A, Chakraborty M, Cotter DJ, Freund M, Goddard P, Gomez-Stafford J, Greenwald E, Higgs E, Hunter N, MacKenzie TMG, Narain A, Gjorgjieva T, Martschenko DO. Increasing equity in science requires better ethics training: A course by trainees, for trainees. CELL GENOMICS 2024; 4:100554. [PMID: 38697124 PMCID: PMC11099339 DOI: 10.1016/j.xgen.2024.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/23/2024] [Accepted: 04/06/2024] [Indexed: 05/04/2024]
Abstract
Despite the profound impacts of scientific research, few scientists have received the necessary training to productively discuss the ethical and societal implications of their work. To address this critical gap, we-a group of predominantly human genetics trainees-developed a course on genetics, ethics, and society. We intend for this course to serve as a template for other institutions and scientific disciplines. Our curriculum positions human genetics within its historical and societal context and encourages students to evaluate how societal norms and structures impact the conduct of scientific research. We demonstrate the utility of this course via surveys of enrolled students and provide resources and strategies for others hoping to teach a similar course. We conclude by arguing that if we are to work toward rectifying the inequities and injustices produced by our field, we must first learn to view our own research as impacting and being impacted by society.
Collapse
Affiliation(s)
- Roshni A Patel
- Department of Genetics, Stanford University, Stanford, CA 94305, USA.
| | - Rachel A Ungar
- Department of Genetics, Stanford University, Stanford, CA 94305, USA.
| | - Alanna L Pyke
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Alvina Adimoelja
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | | | - Daniel J Cotter
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Malika Freund
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Pagé Goddard
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Justin Gomez-Stafford
- Department of Hematology and Oncology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Emily Greenwald
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Emily Higgs
- Department of Cardiovascular Genetics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Naiomi Hunter
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Tim M G MacKenzie
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Anjali Narain
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Tamara Gjorgjieva
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Daphne O Martschenko
- Center for Biomedical Ethics, Stanford University, Stanford, CA 94305, USA; Department of Pediatrics, Stanford University, Stanford, CA 94305, USA
| |
Collapse
|
2
|
Higginbotham DO, Nham FH, Cavazos DR, Chen C, Stoker SK. The Impact of Financial Education on Stress Among Orthopaedic Surgeons. Cureus 2024; 16:e58093. [PMID: 38738142 PMCID: PMC11088749 DOI: 10.7759/cureus.58093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Financial stress has been an increasing area of concern for residents and attendings. The primary goal of this study was to determine the financial education level and differentiate financial outcome measures of orthopaedic surgery residents and attendings. METHODS A survey of all residents and attendings of the 201 Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery programs in the United States. RESULTS Total participation in the study was 118 residents (postgraduate year (PGY) 1-5), three fellows (PGY 6), and 57 attending orthopaedic surgeons. A significant difference existed between average current financial stress scores between residents versus attending (2.32 vs 1.17), but not Doctor of Medicine (MD) versus Doctor of Osteopathic Medicine (DO) attendings (0.96 vs 1.67) and MD versus DO residents (2.25 vs 2.50). There was a significant difference in average future financial stress scores between residents and attendings (1.85 vs 1.44) and MD vs DO residents (1.61 vs 2.25) but no difference between MD vs DO attending (1.31 vs 1.63). Residents' confidence in financial knowledge compared to college graduates had a significantly negative Pearson coefficient with current financial stress score, while the attending group was not significant. CONCLUSIONS Orthopaedic residents and attending physicians' financial stress levels are positively correlated with the amount of student debt they hold. Most residents who currently have no personal finance education offered in their residency would likely attend a personal finance course if offered. Decreasing the amount of debt held by residents, increasing their financial knowledge, and helping them develop good financial habits would likely lead to a decrease in financial stress.
Collapse
Affiliation(s)
- Devan O Higginbotham
- Department of Orthopaedic Surgery, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Fong H Nham
- Department of Orthopaedic Surgery, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Daniel R Cavazos
- Department of Orthopaedic Surgery, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Chaoyang Chen
- Department of Orthopaedic Surgery, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Steven K Stoker
- Department of Orthopaedic Surgery, Granger Medical Clinic, Sandy, USA
| |
Collapse
|
3
|
Dixon G, McGeary D, Silver JK, Washington M, Houle TT, Stampas A, Schappell J, Smith S, Verduzco-Gutierrez M. Trends in gender, race, and ethnic diversity among prospective physical medicine and rehabilitation physicians. PM R 2023; 15:1445-1456. [PMID: 36930949 DOI: 10.1002/pmrj.12970] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND As the proportion of women and individuals who are underrepresented in medicine slowly rises, disparities persist in numerous arenas and specialties. In physical medicine and rehabilitation (PM&R), there is a continued need to focus on diversity among trainees. This study aims to evaluate diversity among PM&R applicants and residents over the past 6 years. OBJECTIVE To describe the demographic trends in PM&R over the last 6 years and compare those findings with trends in other specialties. DESIGN Surveillance. SETTING Analyses of national databases from self-reported questionnaires. PARTICIPANTS The study consists of 126,833 medical school matriculants, 374,185 resident applicants, and 326,134 resident trainees over the last 6 years. MAIN OUTCOME MEASURES Self-reported demographic data from the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education were analyzed for medical school matriculants, PM&R applicants, and current residents for the cycles of 2014-2015 to 2019-2020. The data were then comparatively reviewed between PM&R and other medical specialties. RESULTS In the 6 cycles evaluated, women accounted for 36%-39% of PM&R residents, but 47%-48% in non-PM&R specialties. Women applicants to the PM&R specialty averaged 34.4% over the 6 years analyzed, which was the fourth lowest of the 11 specialties examined. Black or African American and Hispanic, Latino, or of Spanish Origin populations each accounted for only 6% of PM&R residents. PM&R demonstrated a noticeably higher proportion of White (62.1% vs. 60.3%) and an observably lower proportion of Black or African American (6.0% vs. 7.1%) and Hispanic, Latino, or of Spanish Origin (6.3% vs. 7.9%) residents compared with non-PM&R specialties. CONCLUSION There is underrepresentation of women and multiple racial and ethnic minority groups in the field of PM&R from applicants to trainees demonstrating a need to improve recruitment efforts.
Collapse
Affiliation(s)
- Grant Dixon
- Department of Rehabilitation Medicine, Long School of Medicine at the University of Texas Health Science Center, San Antonio, Texas, USA
| | - Donald McGeary
- Department of Rehabilitation Medicine, Long School of Medicine at the University of Texas Health Science Center, San Antonio, Texas, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mariam Washington
- Department of Rehabilitation Medicine, Long School of Medicine at the University of Texas Health Science Center, San Antonio, Texas, USA
| | - Tim T Houle
- Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Argyrios Stampas
- Department of PM&R, McGovern Medical School at UTHealth, Houston, Texas, USA
| | | | - Sarah Smith
- University of Washington PM&R Program, Seattle, Washington, DC, USA
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, Long School of Medicine at the University of Texas Health Science Center, San Antonio, Texas, USA
| |
Collapse
|
4
|
Steffey MA, Griffon DJ, Risselada M, Buote NJ, Scharf VF, Zamprogno H, Winter AL. A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors. Front Vet Sci 2023; 10:1184525. [PMID: 37465277 PMCID: PMC10351608 DOI: 10.3389/fvets.2023.1184525] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.
Collapse
Affiliation(s)
- Michele A. Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Dominique J. Griffon
- Western University of Health Sciences, College of Veterinary Medicine, Pomona, CA, United States
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West-Lafayette, IN, United States
| | - Nicole J. Buote
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - Valery F. Scharf
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
| | | | | |
Collapse
|
5
|
Dickson T, Mulligan EP, Hegedus EJ. Impacts of educational debt on physical therapist employment trends. BMC MEDICAL EDUCATION 2023; 23:459. [PMID: 37340406 DOI: 10.1186/s12909-023-04454-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/15/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Newly graduated physical therapists have high amounts of educational debt. Educational debt may negatively affect job satisfaction, aspirations for professional development, and choice of workplace setting. Research has not shown this association directly, yet it is conceptually supported by the Labor-Search Model. The purpose of this study was to understand the role that educational debt has on additional factors related to job choice in the Labor-Search Model. METHODS Retrospective data were captured through the Virginia Longitudinal Data System (VLDS) for 12,594 licensed physical therapists within the Commonwealth of Virginia from 2014 to 2020. A fixed effects panel analysis, with inflation-adjusted educational debt as the variable of interest, was conducted to assess whether patterns of professional certifications, volume of work, workplace setting, and job satisfaction were related to educational debt. RESULTS Educational debt was positively correlated with higher professional degrees (p = 0.009), the number of hours worked per week (p = 0.049), and expected number of years until retirement (p = 0.013). Job satisfaction was statistically significant (p = 0.042) and negatively correlated with educational debt. CONCLUSIONS Those with higher educational debt appear to have the habit of working more hours per week and have a longer time horizon until retirement. Newly licensed physical therapists with higher amounts of educational debt are more likely to experience this trend. Income and job satisfaction demonstrated an interaction effect on educational debt, such that those with lower levels of income had a stronger, negative relationship between their debt and job satisfaction, as compared to those with higher income.
Collapse
Affiliation(s)
- Tara Dickson
- Department of Rehabilitation Sciences, Tufts University School of Medicine, 101 E Washington Street, Suite 950, Phoenix, AZ, 85004, USA.
| | - Edward P Mulligan
- Department of Rehabilitation Sciences, Tufts University School of Medicine, 101 E Washington Street, Suite 950, Phoenix, AZ, 85004, USA
| | - Eric J Hegedus
- Department of Rehabilitation Sciences, Tufts University School of Medicine, 101 E Washington Street, Suite 950, Phoenix, AZ, 85004, USA
| |
Collapse
|
6
|
Makowski MS, Trockel M, Paganoni S, Weinstein S, Verduzco-Gutierrez M, Kinney C, Kennedy DJ, Sliwa J, Wang H, Knowlton T, Stautzenbach T, Shanafelt TD. Occupational Characteristics Associated With Professional Fulfillment and Burnout Among US Physiatrists. Am J Phys Med Rehabil 2023; 102:379-388. [PMID: 37076955 DOI: 10.1097/phm.0000000000002216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Multiple national studies suggest that among physicians, physiatrists are at increased risk for occupational burnout. OBJECTIVE The aim of the study is to identify characteristics of the work environment associated with professional fulfillment and burnout among US physiatrists. DESIGN Between May and December 2021, a mixed qualitative and quantitative approach was used to identify factors contributing to professional fulfillment and burnout in physiatrists. SETTING Online interviews, focus groups, and survey were conducted. PARTICIPANTS The participants are physiatrists in the American Academy of Physical Medicine and Rehabilitation Membership Masterfile. MAIN OUTCOME MEASURES Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index. RESULTS Individual interviews with 21 physiatrists were conducted to identify domains that contributed to professional fulfillment followed by focus groups for further definition. Based on themes identified, scales were identified or developed to evaluate: control over schedule (6 items, Cronbach α = 0.86); integration of physiatry into patient care (3 items, Cronbach α = 0.71); personal-organizational values alignment (3 items, Cronbach α = 0.90); meaningfulness of physiatrist clinical work (6 items, Cronbach α = 0.90); teamwork and collaboration (3 items, Cronbach α = 0.89). Of 5760 physiatrists contacted in the subsequent national survey, 882 (15.4%) returned surveys (median age, 52 yrs; 46.1% women). Overall, 42.6% (336 of 788) experienced burnout and 30.6% (244 of 798) had high levels of professional fulfillment. In multivariable analysis, each one-point improvement in control over schedule (odds ratio = 1.96; 95% confidence interval = 1.45-2.69), integration of physiatry into patient care (odds ratio = 1.77; 95% confidence interval = 1.32-2.38), personal-organizational values alignment (odds ratio = 1.92; 95% confidence interval = 1.48-2.52), meaningfulness of physiatrist clinical work (odds ratio = 2.79; 95% confidence interval = 1.71-4.71), and teamwork and collaboration score (odds ratio = 2.11; 95% confidence interval = 1.48-3.03) was independently associated with higher likelihood of professional fulfillment. CONCLUSIONS Control over schedule, optimal integration of physiatry into clinical care, personal-organizational values alignment, teamwork, and meaningfulness of physiatrist clinical work are strong and independent drivers of occupational well-being in US physiatrists. Variation in these domains by practice setting and subspecialty suggests that tailored approaches are needed to promote professional fulfillment and reduce burnout among US physiatrists.
Collapse
Affiliation(s)
- Maryam S Makowski
- From the Stanford University, Stanford, California (MSM, MT, HW, TDS); Spaulding Rehabilitation Hospital, Boston, Massachusetts (SP); Association of Academic Physiatrists, Owing Mills, Maryland (SP, MV-G, TK); University of Washington, Seattle, Washington (SW); American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois (SW, DJK, TS); University of Texas Health Science Center at San Antonio, San Antonio, Texas (MV-G); Mayo Clinic, Minneapolis, Minnesota (CK); American Board of Physical Medicine and Rehabilitation, Rochester, Minnesota (CK, JS); Vanderbilt University, Nashville, Tennessee (DJK); and Northwestern University Feinberg School of Medicine: Shirley Ryan Ability Lab, Chicago, Illinois (JS)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Beltràn Ponce S, Small CJ, Amini A, Johnstone C, Parikh JR, Rosenthal SA, Salerno KE, Schechter NR, Small W. Overcoming Burnout and Promoting Wellness in Radiation Oncology: A Report From the ACR Commission on Radiation Oncology. J Am Coll Radiol 2023; 20:487-493. [PMID: 36925094 PMCID: PMC10149602 DOI: 10.1016/j.jacr.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
Burnout, defined by the presence of emotional exhaustion, depersonalization, and decreased sense of personal accomplishment, impacts a significant portion of radiation oncologists. This has been exacerbated by the COVID-19 pandemic, is notably worse for women, and has been identified as an international concern. Key contributors to burnout within radiation oncology include inadequate clinical and administrative support, imbalanced personal and professional lives including time with family and for self-care, decreased job satisfaction secondary to increased electronic medical record and decreased patient time, unsupportive organizational culture, lack of transparency from leadership and inclusion in administrative decisions, emotionally intensive patient interactions, challenges within the radiation oncology workforce, financial security related to productivity-based compensation and increasing medical training-related debt, limited education on wellness, and fear of seeking mental health services due to stigma and potential negative impacts on the trajectory of one's career. Limited data exist to quantify the impacts of these factors on the overall levels of burnout within radiation oncology specifically, and additional efforts are needed to understand and address root causes of burnout within the field. Strategies should focus on improving the systems in which physicians work and providing the necessary skills and resources to thrive in high-stress, high-stakes work environments.
Collapse
Affiliation(s)
- Sara Beltràn Ponce
- Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, Wisconsin and Chair, Society for Women in Radiation Oncology
| | - Christina J Small
- Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, Wisconsin, and Events and Outreach Chair, Society for Women in Radiation Oncology
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Candice Johnstone
- Medical Director Radiation Oncology Froedtert West Bend Hospital, The Medical College of Wisconsin, Milwaukee, Wisconsin, Trustee of the American Registry of Radiologic Technologists, and President-elect, American Association of Women Radiologists
| | - Jay R Parikh
- Professor of Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seth A Rosenthal
- Department of Radiation Oncology, Sutter Medical Group, Sacramento, California
| | - Kilian E Salerno
- Associate Research Physician, Clinical Director, Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Naomi R Schechter
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California, Chair, American College of Radiology Practice Parameters Committee Radiation Oncology, and Chair, American Society of Radiation Oncology Patient Safety Scientific Committee
| | - William Small
- Professor and Chairman, Department of Radiation Oncology, Stritch School of Medicine, and Director, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois, Chair, American College of Radiology Radiation Oncology Commission, and Executive Committee, American Joint Commission on Cancer.
| |
Collapse
|
8
|
Jacobs JW, Jagsi R, Stanford FC, Sarno D, Spector ND, Silver JK, Booth GS. Gender Representation Among United States Medical Board Leadership. J Womens Health (Larchmt) 2022; 31:1710-1718. [PMID: 36318764 PMCID: PMC9805854 DOI: 10.1089/jwh.2022.0271] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To assess the gender composition of the American Board of Medical Specialties' (ABMS) member boards and evaluate the equitable inclusion of women and a subset of women physicians. Methods: The gender of individuals on 24 boards as of March 1, 2022, was assessed. Two benchmarks-parity (50:50 representation) and equity (compared to the proportion of practicing physicians in each medical specialty)-were utilized to determine if women are equitably represented on medical boards. Results: Four hundred forty individuals hold 449 total positions on the boards examined. Of board the members, 60.7% (267/440) are men, and 92.3% (406/440) are physicians. Physician board members comprised more men (64.0%, 260/406; p < 0.001), whereas more women comprise the 34 nonphysician board members (79.4%, 27/34; p < 0.001). Using specialty representation (equity) as the benchmark, of 22 specialties for which physician gender/sex data are available, women physicians are underrepresented on 36.4% (8/22) of boards. When parity (50%) is the comparator, 72.0% (18/25) of boards comprised less than 50% women. Compared to a 2016 analysis, the proportion of women overall (including non-physicians) increased on 68.0% (17/25), decreased on 24.0% (6/25), and remained unchanged on 8.0% (2/25) of boards in 2022. Conclusions: This study reveals mixed results in the equitable inclusion of women on ABMS boards. Our findings suggest that progress should not be assumed and that it may be subject to setbacks when it occurs. There is a need to continue to monitor the equitable inclusion of women on ABMS boards.
Collapse
Affiliation(s)
- Jeremy W. Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Fatima Cody Stanford
- Neuroendocrine Unit, Department of Medicine, Nutrition Obesity Research Center at Harvard (NORCH), Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Endocrinology, Department of Pediatrics, Nutrition Obesity Research Center at Harvard (NORCH), Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Danielle Sarno
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy D. Spector
- Executive Leadership in Academic Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Garrett S. Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
9
|
Lustik SJ, Stern DH, Eaton MP. Optimum Call Distribution: Market-Based Approach. Anesth Analg 2022; 135:663-666. [PMID: 35977371 DOI: 10.1213/ane.0000000000006041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Stewart J Lustik
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | | |
Collapse
|
10
|
Abstract
OBJECTIVE One potential barrier to optimal healthcare may be provider burnout or occupational-related stress in the workplace. The objective of this study is to conduct a systematic review to identify the predictors of burnout among US. healthcare providers. DESIGN Systematic review using in-depth critical appraisal to assess risk of bias and present the quality of evidence in synthesised results from the prognostic studies. DATA SOURCES We searched 11 databases, registries, existing reviews and contacted experts through 4 October 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included all studies evaluating potential predictors and documenting the presence and absence of associations with burnout assessed as a multidimensional construct. We excluded studies that relied solely on a single continuous subscale of burnout. Data were abstracted from eligible studies and checked for accuracy by a content expert and a methodologist. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened citations and full-text publications using predetermined eligibility criteria. RESULTS The 141 identified studies evaluated a range of burnout predictors. Findings for demographic characteristics were conflicting or show no association. Workplace factors, such as workload, work/life balance, job autonomy and perceived support from leadership, had stronger associations with risk for burnout. Mental health factors, such as anxiety, and physical health risks may increase the risk, although the direction of these associations is unclear as few prospective studies exist to address this question. Factors such as social support appear to have a protective effect. CONCLUSION We found the most evidence for workplace, mental health and psychosocial factors in predicting burnout but limited evidence for other potential predictors. However, more prospective studies are needed to improve our understanding about how to prevent provider burnout. PROSPERO REGISTRATION NUMBER CRD4202014836.
Collapse
Affiliation(s)
| | | | - Joan Chang
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, USA
| | - Jody Larkin
- RAND Corporation, Santa Monica, California, USA
| | - Aneesa Motala
- RAND Corporation, Santa Monica, California, USA
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Susanne Hempel
- RAND Corporation, Santa Monica, California, USA
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
11
|
Farr E, Lee S, Maltser S, Verduzco-Gutierrez M, Shapiro LT. A Rapid Response for Burnout Among Inpatient Physiatrists: A Survey of Leaders of Inpatient Rehabilitation Facilities. PM R 2022; 14:1080-1085. [PMID: 35789206 DOI: 10.1002/pmrj.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/30/2022] [Accepted: 06/20/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Symptoms of burnout are highly prevalent among physiatrists, and prior studies have helped identify key contributors to this epidemic of burnout. Little is known about the physician stressors unique to those providing care in inpatient rehabilitation facilities (IRFs) and what strategies such facilities have utilized to help mitigate burnout among inpatient physiatrists. OBJECTIVE To identify what IRF leaders perceive as stress points contributing to burnout among inpatient rehabilitation physicians and what, if any, interventions their programs have implemented to help mitigate physician burnout. DESIGN 10 item cross-sectional survey study of IRF physician and non-physician leaders in the United States. PARTICIPANTS 104 physicians serving in the roles of IRF Medical Director, Director of Rehabilitation, and/or Executive Leadership and 19 non-physician IRF leaders. RESULTS Regulatory demands, late admissions, understaffing, and on-call responsibilities were the major stress points most identified as contributing to physician burnout among both the physician and non-physician respondents. The utilization of advanced practice providers and hospitalists were the most common system changes reportedly used to help mitigate physician burnout. Although 57.8% of physician leaders felt late admissions were a major stress point for physicians, only 18.2% of those responding reported having implemented admission cut-off times. CONCLUSIONS There are stressors unique to the practice of inpatient rehabilitation that are likely contributing to physiatrist burnout, including late admissions and on-call responsibilities. Many IRFs have begun to implement system changes to help mitigate burnout among inpatient physiatrists. The utilization of non-physiatrist providers is a commonly reported strategy. Future studies are needed to determine the effectiveness of such a strategy on reducing symptoms of burnout among IRF physicians as well as its impact on IRF patient outcomes. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Ellen Farr
- Brain Injury Fellow; Department of Physical Medicine & Rehabilitation, Mayo Clinic College of Medicine and Sciences, 200 First Street SW, Rochester, MN
| | - Sujin Lee
- Department of Physical Medicine & Rehabilitation, University of California Irvine School of Medicine, Orange, CA
| | - Susan Maltser
- Department of Physical Medicine & Rehabilitation, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Monica Verduzco-Gutierrez
- Department of Physical Medicine & Rehabilitation, University of Texas San Antonio Long School of Medicine, San Antonio, TX
| | - Lauren T Shapiro
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
12
|
Bean AC, Schroeder AN, McKernan GP, Mesoros M, Silver JK, Verduzco-Gutierrez M, Cuccurullo S, Franzese K. Factors Associated With Burnout in Physical Medicine and Rehabilitation Residents in the United States. Am J Phys Med Rehabil 2022; 101:674-684. [PMID: 35706120 DOI: 10.1097/phm.0000000000001886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aims of the study were to determine the prevalence of burnout in physical medicine and rehabilitation residents in the United States and to identify the personal- and program-specific characteristics most strongly associated with residents reporting burnout. DESIGN This was a cross-sectional survey of US physical medicine and rehabilitation residents. Emotional exhaustion, depersonalization, and burnout were assessed using two validated items from the Maslach Burnout Inventory. Associations of burnout with demographics and personal factors, residency program characteristics, perceived program support, and work/life balance were evaluated. RESULTS The survey was completed by 296 residents (22.8%), with 35.8% of residents meeting the criteria for burnout. Residents' perception of not having adequate time for personal/family life was the factor most strongly associated with burnout (χ2 = 93.769, P < 0.001). Residents who reported inappropriate clerical burden and working more than 50 hrs/wk on inpatient rotations were most likely to report that they did not have adequate time for personal/family life. Faculty support (χ2 = 41.599, P < 0.001) and performing activities that led residents to choose physical medicine and rehabilitation as a specialty (χ2 = 93.082, P < 0.001) were protective against burnout. CONCLUSIONS Residents reporting having inadequate time for their personal/family life was most strongly associated with physical medicine and rehabilitation resident burnout, although many personal and program characteristics were associated with burnout.
Collapse
Affiliation(s)
- Allison C Bean
- From the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (ACB, ANS, GPM, MM, KF); Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (GPM, MM); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (JKS); Department of Rehabilitation Medicine, Joe R. & Teresa Lozano Long School of Medicine at UT Health San Antonio, San Antonio, Texas (MV-G); and JFK Johnson Rehabilitation Institute/Rutgers RWJ Medical School/Hackensack Meridian School of Medicine, Nutley, New Jersey (SC)
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Verduzco-Gutierrez M, Katz NB, Fleming TK, Silver EM, Hunter TL, El Sayed N, Escalon MX, Lorello GR, Silver JK. Author Diversity on Clinical Practice Guideline Committees. Am J Phys Med Rehabil 2022; 101:493-503. [PMID: 34775456 DOI: 10.1097/phm.0000000000001932] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Reports have demonstrated that women overall and women physicians, in particular, are underrepresented as authors of clinical practice guidelines. This analysis used publicly available information to explore the diversity of rehabilitation-related clinical practice guideline authors by gender, race, and ethnicity. Primary analysis identified authors' gender, race, ethnicity, and visible minority status. Two sets were analyzed: (1) clinical practice guidelines by Department of Veterans Affairs (VA) categorized as "Rehabilitation" or "Pain" (n = 7; VA clinical practice guidelines) and (2) a set (n = 10) published in the United States (US) from 2019 to 2021 that were selected because of low numbers of inclusion at less than 20% women authors. Key findings include that among physician authors, both the VA and US clinical practice guidelines underrepresented women (15 [24.2%] and 27 [16.7%], respectively) and those coded as a racial or ethnic minority were particularly underrepresented. Notably, women authors overall were equally represented (92 [50.0%]) in the VA clinical practice guidelines. The US clinical practice guidelines had women authors who were underrepresented (36 [19.0%]). Secondary analysis of the entire set of VA clinical practice guidelines (n = 21) found gaps in diversity-related content. Clinical practice guidelines have far-reaching health and economic impacts, and addressing disparities in the diversity of author teams and/or gaps in diversity-related content is of paramount importance.
Collapse
Affiliation(s)
- Monica Verduzco-Gutierrez
- From the Department of Rehabilitation Medicine, Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio, San Antonio, Texas (MV-G); Department of Internal Medicine, Mount Auburn Hospital, Cambridge, Massachusetts (NBK); JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, New Jersey (TKF); Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey (TKF); Department of Physical Medicine and Rehabilitation, Hackensack Meridian School of Medicine, Nutley, New Jersey (TKF); Department of Psychology, Integrative Neuroscience, University of Chicago, Chicago, Illinois (EMS); Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California (TLH); Joslin Diabetes Center, Boston, Massachusetts (NES); Department of Medicine, Harvard Medical School, Boston, Massachusetts (NES); Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York (MXE); Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada (GRL); Department of Anesthesia and Pain Management, Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada (GRL); The Wilson Centre, University Health Network, Toronto, Ontario, Canada (GRL); Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada (GRL); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (JKS); Massachusetts General Hospital, Boston, Massachusetts (JKS); Brigham and Women's Hospital, Boston, Massachusetts (JKS); and Spaulding Rehabilitation Hospital, Boston, Massachusetts (JKS)
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Harden JK, Blauwet C, Silver JK, Sholas MG, Rasheed Z, Verduzco-Gutierrez M. Health and Healthcare Disparities Related to Rehabilitation and COVID-19. PM R 2022; 14:273-279. [PMID: 35077011 DOI: 10.1002/pmrj.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Jeannie K Harden
- Department of Rehabilitation Medicine, Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio, University Hospital - University Health, San Antonio, TX, United States
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Brigham and Women's Hospital, Spaulding Rehabilitation Hospital
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, Brigham and Women's Hospital, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Maurice G Sholas
- Sholas Medical Consulting, LLC, New Orleans, Louisiana, United States
| | - Zainab Rasheed
- Central Michigan College of Medicine, Mt. Pleasant, Michigan, United States
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio, University Hospital - University Health, San Antonio, TX, United States
| |
Collapse
|
15
|
The Moderator Role of Financial Well-Being on the Effect of Job Insecurity and the COVID-19 Anxiety on Burnout: A Research on Hotel-Sector Employees in Crisis. SUSTAINABILITY 2021. [DOI: 10.3390/su13169031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), hotel-sector employees attempted to cope with the fear of becoming infected; however, they were also faced with job insecurity. Both the anxiety over COVID-19 and the risk of job insecurity have affected the employees’ economic and social conditions as well as their mental state. The present study examined the effect of COVID-19 anxiety and job insecurity perceptions on the burnout levels of hotel-sector employees and the moderator role of the employees’ financial well-being on this relationship. The study was conducted by collecting data from 396 participants who worked in 17 different five-star hotels in Antalya, Turkey. Because of social isolation and social distancing rules, our research data were obtained using an online questionnaire to avoid close contact with other people. The findings showed that COVID-19 anxiety and perceptions of job insecurity had negative effects on hotel employees in the form of mental burnout. In addition, we determined that as an individual characteristic, financial well-being was a moderator variable that affected the severity of burnout based on COVID-19 anxiety and job insecurity. The research findings exhibited theoretical and practical contributions for decision makers and researchers.
Collapse
|