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Iyer MS, Bradford C, Gottlieb AS, Kling DB, Jagsi R, Mangurian C, Marks L, Meltzer CC, Overholser B, Silver JK, Way DP, Spector ND. Gender Differences in the Path to Medical School Deanship. JAMA Netw Open 2024; 7:e2420570. [PMID: 38967920 PMCID: PMC11227086 DOI: 10.1001/jamanetworkopen.2024.20570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/16/2024] [Indexed: 07/06/2024] Open
Abstract
Importance Women account for only 28% of current US medical school deans. Studying the differences between women and men in their preparation to becoming deans might help to explain this discrepancy. Objective To identify differences in the leadership development experiences between women and men in their ascent to the medical school deanship. Design, Setting, and Participants In this qualitative study, volunteers from the roster of the Association of American Medical Colleges Council of Deans were solicited and interviewed from June 15 to November 9, 2023. Women deans were recruited first, then men who had been appointed to their deanships at a similar time to their women counterparts were recruited. Deans were interviewed on topics related to number of applications for deanships, prior leadership roles, leadership development, personal factors, and career trajectories. Interviews were coded, and themes were extracted through conventional content analysis. Main Outcome and Measures Career and leadership development experiences were elicited using a semistructured interview guide. Results We interviewed 17 women and 17 men deans, representing 25.8% (34 of 132) of the total population of US medical school deans. Most deans (23 [67.6%]) practiced a medicine-based specialty or subspecialty. No statistically significant differences were found between women and men with regard to years to attain deanship (mean [SD], 2.7 [3.4] vs 3.7 [3.7] years), years as a dean (mean [SD], 5.7 [5.2] vs 6.0 [5.0] years), highest salary during career (mean [SD], $525 769 [$199 936] vs $416 923 [$195 848]), or medical school rankings (mean [SD], 315.5 [394.5] vs 480.5 [448.9]). Their reports indicated substantive gender differences in their paths to becoming a dean. Compared with men, women deans reported having to work harder to advance, while receiving less support and opportunities for leadership positions by their own institutions. Subsequently, women sought leadership development from external programs. Women deans also experienced gender bias when working with search firms. Conclusions and Relevance This qualitative study of US medical school deans found that compared with men, women needed to be more proactive, had to participate in external leadership development programs, and had to confront biases during the search process. For rising women leaders, this lack of support had consequences, such as burnout and attrition, potentially affecting the makeup of future generations of medical school deans. Institutional initiatives centering on leadership development of women is needed to mitigate the gender biases and barriers faced by aspiring women leaders.
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Affiliation(s)
- Maya S. Iyer
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Carol Bradford
- Department of Otolaryngology, The Ohio State University College of Medicine, Columbus
| | - Amy S. Gottlieb
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles
| | - David B. Kling
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Christina Mangurian
- Department of Psychiatric and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco
| | - Lilly Marks
- University of Colorado and Anschutz Medical Campus, Aurora, Colorado
| | - Carolyn C. Meltzer
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Barbara Overholser
- Executive Leadership in Academic Medicine (ELAM) Program, Philadelphia, Pennsylvania
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - David P. Way
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Nancy D. Spector
- Executive Leadership in Academic Medicine (ELAM) Program, Philadelphia, Pennsylvania
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Malacon K, Touponse G, Yoseph E, Li G, Wei P(J, Kicielinski K, Massie L, Williamson T, Han S, Zygourakis C. Gender Differences in Electronic Health Record Usage Among Surgeons. JAMA Netw Open 2024; 7:e2421717. [PMID: 39042410 PMCID: PMC11267410 DOI: 10.1001/jamanetworkopen.2024.21717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/02/2024] [Indexed: 07/24/2024] Open
Abstract
Importance Understanding gender differences in electronic health record (EHR) use among surgeons is crucial for addressing potential disparities in workload, compensation, and physician well-being. Objective To investigate gender differences in EHR usage patterns. Design, Setting, and Participants This cross-sectional study examined data from an EHR system (Epic Signal) at a single academic hospital from January to December 2022. Participants included 224 attending surgeons with patient encounters in the outpatient setting. Statistical analysis was performed from May 2023 to April 2024. Exposures Surgeon's gender. Main Outcomes and Measures The primary outcome variables were progress note length, documentation length, time spent in medical records, and time spent documenting patient encounters. Continuous variables were summarized with median and IQR and assessed via the Kruskal-Wallis test. Categorical variables were summarized using proportion and frequency and compared using the χ2 test. Multivariate linear regression was used with primary EHR usage variables as dependent variables and surgeon characteristics as independent variables. Results This study included 222 529 patient encounters by 224 attending surgeons, of whom 68 (30%) were female and 156 (70%) were male. The median (IQR) time in practice was 14.0 (7.8-24.3) years. Male surgeons had more median (IQR) appointments per month (78.3 [39.2-130.6] vs 57.8 [25.7-89.8]; P = .005) and completed more medical records per month compared with female surgeons (43.0 [21.8-103.9] vs 29.1 [15.9-48.1]; P = .006). While there was no difference in median (IQR) time spent in the EHR system per month (664.1 [301.0-1299.1] vs 635.0 [315.6-1192.0] minutes; P = .89), female surgeons spent more time logged into the system both outside of 7am to 7pm (36.4 [7.8-67.6] vs 14.1 [5.4-52.2] min/mo; P = .05) and outside of scheduled clinic hours (134.8 [58.9-310.1] vs 105.2 [40.8-214.3] min/mo; P = .05). Female surgeons spent more median (IQR) time per note (4.8 [2.6-7.1] vs 2.5 [0.9-4.2] minutes; P < .001) compared with male surgeons. Male surgeons had a higher number of median (IQR) days logged in per month (17.7 [13.8-21.3] vs 15.7 [10.7-19.7] days; P = .03). Female surgeons wrote longer median (IQR) inpatient progress notes (6025.1 [3692.1-7786.7] vs 4307.7 [2808.9-5868.4] characters/note; P = .001) and had increased outpatient document length (6321.1 [4079.9-7825.0] vs 4445.3 [2934.7-6176.7] characters/note; P < .001). Additionally, female surgeons wrote a higher fraction of the notes manually (17% vs 12%; P = .006). After using multivariable linear regression models, male gender was associated with reduced character length for both documentations (regression coefficient, -1106.9 [95% CI, -1981.5 to -232.3]; P = .01) and progress notes (regression coefficient, -1119.0 [95% CI, -1974.1 to -263.9]; P = .01). Male gender was positively associated with total hospital medical records completed (regression coefficient, 47.3 [95% CI, 28.3-66.3]; P < .001). There was no difference associated with gender for time spent in each note, time spent outside of 7 am to 7 pm, or time spent outside scheduled clinic hours. Conclusions and Relevance This cross-sectional study of EHR data found that female surgeons spent more time documenting patient encounters, wrote longer notes, and spent more time in the EHR system compared with male surgeons. These findings have important implications for understanding the differential burdens faced by female surgeons, including potential contributions to burnout and payment disparities.
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Affiliation(s)
- Karen Malacon
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
| | - Gavin Touponse
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
| | - Ezra Yoseph
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
| | - Guan Li
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
| | | | | | - Lara Massie
- Department of Neurosurgery, Allegheny Health Network, Monroeville, Pennsylvania
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Summer Han
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
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Liddell SS, Tomasi AG, Halvorsen AJ, Stelling BEV, Leasure EL. Gender Disparities in Electronic Health Record Usage and Inbasket Burden for Internal Medicine Residents. J Gen Intern Med 2024:10.1007/s11606-024-08861-0. [PMID: 38926324 DOI: 10.1007/s11606-024-08861-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Studies have demonstrated patients hold different expectations for female physicians compared to male physicians, including higher expectations for patient-centered communication and addressing socioeconomic or emotional needs. Recent evidence indicates this gender disparity extends to the electronic health record (EHR). Similar studies have not been conducted with resident physicians. OBJECTIVE This study seeks to characterize differences in EHR workload for female resident physicians compared to male resident physicians. DESIGN This study evaluated 12 months of 156 Mayo Clinic internal medicine residents' inbasket data from July 2020 to June 2021 using Epic's Signal and Physician Efficiency Profile (PEP) data. Excel, BlueSky Statistics, and SAS analytical software were used for analysis. Paired t-tests and analysis of variance were used to compare PEP data by gender and postgraduate year (PGY). "Male" and "female" were used in substitute for "gender" as is precedent in the literature. SUBJECTS Mayo Clinic internal medicine residents. MAIN MEASURES Total time spent in EHR per day; time in inbasket and notes per day; time in notes per appointment; number of patient advice requests made through the portal; message turnaround time. KEY RESULTS Female residents received more patient advice requests per year (p = 0.004) with an average of 86.7 compared to 68, resulting in 34% more patient advice requests per day worked (p < 0.001). Female residents spent more time in inbasket per day (p = 0.002), in notes per day (p < 0.001), and in notes per appointment (p = 0.001). Resident panel comparisons revealed equivocal sizes with significantly more female patients on female (n = 55) vs male (n = 34) resident panels (p < 0.001). There was no difference in message turnaround time, total messages, or number of results received. CONCLUSIONS Female resident physicians experience significantly more patient-initiated messages and EHR workload despite equivalent number of results and panel size. Gender differences in inbasket burden may disproportionally impact the resident educational experience.
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Affiliation(s)
- Savannah S Liddell
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Andrew J Halvorsen
- Office of Educational Innovations, Internal Medicine Residency Program, Mayo Clinic, Rochester, MN, USA
| | - Brianna E Vaa Stelling
- Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA
| | - Emily L Leasure
- Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA.
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Temkin SM, Salles A, Barr E, Leggett CB, Reznick JS, Wong MS. "Women's work": Gender and the physician workforce. Soc Sci Med 2024; 351 Suppl 1:116556. [PMID: 38825379 DOI: 10.1016/j.socscimed.2023.116556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 06/04/2024]
Abstract
Historically, the physician professional identity and the organizational structure of Western medicine have been defined by masculine norms such as authority and assertiveness. The past five decades have seen a rapid shift in the demographics of attendees as medical schools, with equal numbers of women and men matriculants for nearly twenty years. Gender as a social, cultural, and structural variable continues to influence the physician workforce. The entry of women into medicine, has had far reaching effects on the expectations of patients, the interactions of physicians with other members of the healthcare team, and the delivery of care. Redefining the culture of medicine to accommodate the diversity of the modern workforce may benefit all physician and improve the delivery of healthcare.
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Affiliation(s)
- Sarah M Temkin
- NIH Office of Research on Women's Health, Bethesda, MD, USA.
| | - Arghavan Salles
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Elizabeth Barr
- NIH Office of Research on Women's Health, Bethesda, MD, USA
| | - Cecilia B Leggett
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey S Reznick
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Melissa S Wong
- NIH Office of Research on Women's Health, Bethesda, MD, USA; Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Richards S, Wang T, Abel ED, Linzer M, Romberger D. Sustainable. Am J Med 2024; 137:552-558. [PMID: 38492767 DOI: 10.1016/j.amjmed.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/01/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Sarah Richards
- Department of Medicine, University of Nebraska Medical Center, Omaha
| | | | | | - Mark Linzer
- Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis.
| | - Debra Romberger
- Department of Medicine, University of Nebraska Medical Center, Omaha
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Heymann EP, Romann V, Lim R, Van Aarsen K, Khatib N, Sauter T, Schild B, Mueller S. Physician wellbeing and burnout in emergency medicine in Switzerland. Swiss Med Wkly 2024; 154:3421. [PMID: 38753467 DOI: 10.57187/s.3421] [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: 05/18/2024] Open
Abstract
Emergency physicians are the most at-risk medical specialist group for burnout. Given its consequences for patient care and physician health and its resulting increased attrition rates, ensuring the wellbeing of emergency physicians is vital for preserving the integrity of the safety net for the healthcare system that is emergency medicine. In an effort to understand the current state of practicing physicians, this study reviews the results of the first national e-survey on physician wellbeing and burnout in emergency medicine in Switzerland. Addressed to all emergency physicians between March and April 2023, it received 611 complete responses. More than half of respondents met at least one criterion for burnout according to the Maslach Burnout Inventory - Human Services Survey (59.2%) and the Copenhagen Burnout Inventory (54.1%). In addition, more than half reported symptoms suggestive of mild to severe depression, with close to 20% screening positively for moderate to severe depression, nearly 4 times the incidence in the general population, according to the Patient Health Questionnaire-9. We found that 10.8% of respondents reported having considered suicide at some point in their career, with nearly half having considered this in the previous 12 months. The resulting high attrition rates (40.6% of respondents had considered leaving emergency medicine because of their working conditions) call into question the sustainability of the system. Coinciding with trends observed in other international studies on burnout in emergency medicine, this study reinforces the fact that certain factors associated with wellbeing are intrinsic to emergency medicine working conditions.
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Affiliation(s)
- Eric P Heymann
- Swiss Society of Emergency and Rescue Medicine, Switzerland
- Department of Emergency Medicine, Cantonal Hospital of Neuchâtel, Neuchâtel, Switzerland
- Department of Emergency Medicine, Faculty of Medicine, University of Bern, Switzerland
| | - Valerie Romann
- Swiss Society of Emergency and Rescue Medicine, Switzerland
- Department of Emergency Medicine, Tiefenau Hospital, Bern, Switzerland
| | - Rod Lim
- Canadian Association of Emergency Physicians, Canada
- Department of Paediatric Emergency Medicine, London Health Sciences Centre, Ontario, Canada
| | - Kristine Van Aarsen
- Department of Paediatric Emergency Medicine, London Health Sciences Centre, Ontario, Canada
| | - Nour Khatib
- Canadian Association of Emergency Physicians, Canada
- University of Toronto, Faculty of Medicine, Toronto, Canada
| | - Thomas Sauter
- Swiss Society of Emergency and Rescue Medicine, Switzerland
- Department of Emergency Medicine, Faculty of Medicine, University of Bern, Switzerland
- Department of Emergency Medicine, Bern University Hospital, Bern, Switzerland
| | - Barbara Schild
- Swiss Society of Emergency and Rescue Medicine, Switzerland
- Croce verde Bellinzona e di Tre Valli, Bellinzona, Switzerland
| | - Stefan Mueller
- Swiss Society of Emergency and Rescue Medicine, Switzerland
- Department of Anaesthesiology, Stadtspital, Zurich, Switzerland
- Schutz und Rettung Zürich, Zürich
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7
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Linzer M, Mallick S, Shah P, Becker A, Nankivil N, Poplau S, Patel SK, Nosal C, Sinsky CA, Goelz E, Stillman M, Alexandrou M, Sullivan EE, Brown R. Resident worklife and wellness through the late phase of the pandemic: a mixed methods national survey study. BMC MEDICAL EDUCATION 2024; 24:484. [PMID: 38698362 PMCID: PMC11064291 DOI: 10.1186/s12909-024-05480-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND System contributors to resident burnout and well-being have been under-studied. We sought to determine factors associated with resident burnout and identify at risk groups. METHODS We performed a US national survey between July 15 2022 and April 21, 2023 of residents in 36 specialties in 14 institutions, using the validated Mini ReZ survey with three 5 item subscales: 1) supportive workplace, 2) work pace/electronic medical record (EMR) stress, and 3) residency-specific factors (sleep, peer support, recognition by program, interruptions and staff relationships). Multilevel regressions and thematic analysis of 497 comments determined factors related to burnout. RESULTS Of 1118 respondents (approximate median response rate 32%), 48% were female, 57% White, 21% Asian, 6% LatinX and 4% Black, with 25% PGY 1 s, 25% PGY 2 s, and 22% PGY 3 s. Programs included internal medicine (15.1%) and family medicine (11.3%) among 36 specialties. Burnout (found in 42%) was higher in females (51% vs 30% in males, p = 0.001) and PGY 2's (48% vs 35% in PGY-1 s, p = 0.029). Challenges included chaotic environments (41%) and sleep impairment (32%); favorable aspects included teamwork (94%), peer support (93%), staff support (87%) and program recognition (68%). Worklife subscales were consistently lower in females while PGY-2's reported the least supportive work environments. Worklife challenges relating to burnout included sleep impairment (adjusted Odds Ratio (aOR) 2.82 (95% CIs 1.94, 4.19), absolute risk difference (ARD) in burnout 15.9%), poor work control (aOR 2.25 (1.42, 3.58), ARD 12.2%) and chaos (aOR 1.73 (1.22, 2.47), ARD 7.9%); program recognition was related to lower burnout (aOR 0.520 (0.356, 0.760), ARD 9.3%). These variables explained 55% of burnout variance. Qualitative data confirmed sleep impairment, lack of schedule control, excess EMR and patient volume as stressors. CONCLUSIONS These data provide a nomenclature and systematic method for addressing well-being during residency. Work conditions for females and PGY 2's may merit attention first.
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Affiliation(s)
- Mark Linzer
- Institute for Professional Worklife, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA.
| | - Sanjoyita Mallick
- Department of Medicine, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Purva Shah
- American Medical Association, 330 N. Wabash Avenue, Chicago, IL, 60611, USA
| | - Anne Becker
- Department of Medicine, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Nancy Nankivil
- American Medical Association, 330 N. Wabash Avenue, Chicago, IL, 60611, USA
| | - Sara Poplau
- Institute for Professional Worklife, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Shivani K Patel
- American Medical Association, 330 N. Wabash Avenue, Chicago, IL, 60611, USA
| | - Caitlin Nosal
- American Medical Association, 330 N. Wabash Avenue, Chicago, IL, 60611, USA
| | - Christine A Sinsky
- American Medical Association, 330 N. Wabash Avenue, Chicago, IL, 60611, USA
| | - Elizabeth Goelz
- Institute for Professional Worklife, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Martin Stillman
- Institute for Professional Worklife, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | | | - Erin E Sullivan
- Sawyer School of Business, Harvard Medical School and Suffolk University, 73 Tremont St, Boston, MA, 02108, USA
| | - Roger Brown
- School of Nursing, University of Wisconsin, 701 Highland Avenue, Madison, WI, 53705, USA
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Anderson LN, Anaya YB, Gilchrist V. Supporting Our Women Colleagues. Fam Med 2024; 56:219-221. [PMID: 38748630 PMCID: PMC11189125 DOI: 10.22454/fammed.2024.754708] [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: 06/22/2024]
Abstract
Burnout is a challenge for all of us. Many of us experience burnout and know the toll it can take on our health and well-being. This editorial focuses on the experiences of women physicians and learners by highlighting the lived experience of one woman physician, briefly examining the extensive research into women physicians' practice, and identifying solutions that all genders can leverage to support women physicians and learners.
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Affiliation(s)
- LaKesha N Anderson
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Yohualli B Anaya
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Valerie Gilchrist
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, WI
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Nguyen MLT, Honcharov V, Ballard D, Satterwhite S, McDermott AM, Sarkar U. Primary Care Physicians' Experiences With and Adaptations to Time Constraints. JAMA Netw Open 2024; 7:e248827. [PMID: 38687477 PMCID: PMC11061766 DOI: 10.1001/jamanetworkopen.2024.8827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/29/2024] [Indexed: 05/02/2024] Open
Abstract
Importance The primary care workforce shortage is significant and persistent, with organizational and policy leaders urgently seeking interventions to enhance retention and recruitment. Time constraints are a valuable focus for action; however, designing effective interventions requires deeper understanding of how time constraints shape employees' experiences and outcomes of work. Objective To examine how time constraints affect primary care physicians' work experiences and careers. Design, Setting, and Participants Between May 1, 2021, and September 31, 2022, US-based primary care physicians who trained in family or internal medicine were interviewed. Using qualitative analysis of in-depth interviews, this study examined how participants experience and adapt to time constraints during a typical clinic day, taking account of their professional and personal responsibilities. It also incorporates physicians' reflections on implications for their careers. Main Outcomes and Measures Thematic analysis of in-depth interviews and a measure of well-being (American Medical Association Mini-Z survey). Results Interviews with 25 primary care physicians (14 [56%] female and 11 [44%] male; median [range] age, 43 [34-63] years) practicing in 11 US states were analyzed. Two physicians owned their own practice, whereas the rest worked as employees. The participants represented a wide range of years in practice (range, 1 to ≥21), with 11 participants (44%) in their first 5 years. Physicians described that the structure of their work hours did not match the work that was expected of them. This structural mismatch between time allocation and work expectations created a constant experience of time scarcity. Physicians described having to make tradeoffs between maintaining high-quality patient care and having their work overflow into their personal lives. These experiences led to feelings of guilt, disillusionment, and dissatisfaction. To attempt to sustain long-term careers in primary care, many sought ways to see fewer patients. Conclusions and Relevance These findings suggest that organizational leaders must align schedules with work expectations for primary care physicians to mitigate physicians' withdrawal from work as a coping mechanism. Specific strategies are needed to achieve this realignment, including incorporating more slack into schedules and establishing realistic work expectations for physicians.
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Affiliation(s)
| | - Vlad Honcharov
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Dawna Ballard
- Department of Communication Studies, University of Texas at Austin, Austin
| | - Shannon Satterwhite
- Department of Family and Community Medicine, UC Davis Health, Sacramento, California
| | - Aoife M. McDermott
- School of Public Health, University of California, Berkeley
- Aston Business School, Aston University, Birmingham, UK
| | - Urmimala Sarkar
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
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10
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Li H, Rotenstein L, Jeffery MM, Paek H, Nath B, Williams BL, McLean RM, Goldstein R, Nuckols TK, Hoq L, Melnick ER. Quantifying EHR and Policy Factors Associated with the Gender Productivity Gap in Ambulatory, General Internal Medicine. J Gen Intern Med 2024; 39:557-565. [PMID: 37843702 DOI: 10.1007/s11606-023-08428-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The gender gap in physician compensation has persisted for decades. Little is known about how differences in use of the electronic health record (EHR) may contribute. OBJECTIVE To characterize how time on clinical activities, time on the EHR, and clinical productivity vary by physician gender and to identify factors associated with physician productivity. DESIGN, SETTING, AND PARTICIPANTS This longitudinal study included general internal medicine physicians employed by a large ambulatory practice network in the Northeastern United States from August 2018 to June 2021. MAIN MEASURES Monthly data on physician work relative value units (wRVUs), physician and practice characteristics, metrics of EHR use and note content, and temporal trend variables. KEY RESULTS The analysis included 3227 physician-months of data for 108 physicians (44% women). Compared with men physicians, women physicians generated 23.8% fewer wRVUs per month, completed 22.1% fewer visits per month, spent 4.0 more minutes/visit and 8.72 more minutes on the EHR per hour worked (all p < 0.001), and typed or dictated 36.4% more note characters per note (p = 0.006). With multivariable adjustment for physician age, practice characteristics, EHR use, and temporal trends, physician gender was no longer associated with productivity (men 4.20 vs. women 3.88 wRVUs/hour, p = 0.31). Typing/dictating fewer characters per note, relying on greater teamwork to manage orders, and spending less time on documentation were associated with higher wRVUs/hour. The 2021 E/M code change was associated with higher wRVUs/hour for all physicians: 10% higher for men physicians and 18% higher for women physicians (p < 0.001 and p = 0.009, respectively). CONCLUSIONS Increased team support, briefer documentation, and the 2021 E/M code change were associated with higher physician productivity. The E/M code change may have preferentially benefited women physicians by incentivizing time-intensive activities such as medical decision-making, preventive care discussion, and patient counseling that women physicians have historically spent more time performing.
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Affiliation(s)
- Huan Li
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
- Computational Biology and Bioinformatics, Yale School of Medicine, New Haven, CT, USA
| | - Lisa Rotenstein
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Molly M Jeffery
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Hyung Paek
- Information Technology Services, Yale New Haven Health System, New Haven, CT, USA
| | - Bidisha Nath
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Robert M McLean
- Northeast Medical Group, Stratford, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Teryl K Nuckols
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lalima Hoq
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward R Melnick
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
- Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, CT, USA.
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11
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Rotenstein LS, Melnick ER, Jeffery M, Zhang J, Sinsky CA, Gitomer R, Bates DW. Association of Primary Care Physicians' Electronic Inbox Activity Patterns with Patients' Likelihood to Recommend the Physician. J Gen Intern Med 2024; 39:150-152. [PMID: 37731135 PMCID: PMC10817856 DOI: 10.1007/s11606-023-08417-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Lisa S Rotenstein
- Brigham and Women's Hospital Division of General Internal Medicine, Boston, USA.
- Harvard Medical School, Boston, USA.
| | | | - Molly Jeffery
- Mayo Clinic Department of Emergency Medicine, Rochester, USA
| | - Jianyi Zhang
- Brigham and Women's Hospital Division of General Internal Medicine, Boston, USA
| | | | - Richard Gitomer
- Brigham and Women's Hospital Division of General Internal Medicine, Boston, USA
- Harvard Medical School, Boston, USA
| | - David W Bates
- Brigham and Women's Hospital Division of General Internal Medicine, Boston, USA
- Harvard Medical School, Boston, USA
- Harvard School of Public Health, Boston, USA
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12
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Hoff T, Trovato K, Kitsakos A. Burnout Among Family Physicians in the United States: A Review of the Literature. Qual Manag Health Care 2024; 33:1-11. [PMID: 37817317 DOI: 10.1097/qmh.0000000000000439] [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: 10/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Burnout among physicians who work in primary care is an important problem that impacts health care quality, local communities, and the public's health. It can degrade the quality of primary care services in an area and exacerbate workforce shortages. This study conducted a review of the published research on burnout among family physicians working in the United States. METHODS We used a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided approach and several article databases to identify, filter, and analyze published research on US family physician burnout that uses data collected from 2015 onward. RESULTS Thirty-three empirical studies were identified with findings that included US family physician burnout prevalence and/or associations between burnout and specific personal and contextual drivers. Mean family physician burnout prevalence across studies that measured it was 35%. Almost half of the studies classified one-third or more of their family physician samples as burned out. Physician gender (being female), age (being younger), and job/work-related factors (workload, time pressures) were the most commonly identified correlates of family physician burnout. The vast majority of studies were cross-sectional and used secondary data. CONCLUSIONS The extant research literature on family physician burnout in the United States shows that burnout is currently a meaningful problem. Several important correlates of the problem can be identified, some of which managers and health care organizations can proactively address. Other correlates require managers and health care organizations also viewing family physicians in differentiated ways. The collective literature can be improved through a more consistent focus on similar burnout correlates across studies; inclusion of interventions aimed at lessening the effects of key burnout correlates; employment of more robust longitudinal and quasi-experimental research designs; and additional pandemic-era data collection on burnout.
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Affiliation(s)
- Timothy Hoff
- D'Amore-McKim School of Business, Northeastern University, Boston, Massachusetts (Dr Hoff); School of Public Policy and Urban Affairs, Northeastern University, Boston, Massachusetts (Dr Hoff); Green-Templeton College, University of Oxford, Oxford, England, United Kingdom (Dr Hoff); Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts (Ms Trovato); and School of Public Policy and Urban Affairs, Northeastern University, Boston, Massachusetts (Ms Kitsakos)
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13
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Prignano F, Argenziano G, Bardazzi F, Borroni RG, Brunasso AMG, Burlando M, Cagni AE, Campione E, Cinotti E, Colonna F, Cuccia A, Dastoli S, De Pasquale R, De Simone C, Di Lernia V, Dini V, Fabbrocini G, Galluzzi C, Giacchetti A, Giofrè C, Lasagni C, Lembo S, Loconsole F, Montesu MA, Pella P, Piaserico S, Pigatto P, Richetta AG, Scuotto A, Stroppiana E, Venturini M, Vinci AS, Zichichi L, Fargnoli MC. Understanding Barriers Impacting upon Patient Wellbeing: A Nationwide Italian Survey and Expert Opinion of Dermatologists Treating Patients with Moderate-to-Severe Psoriasis. J Clin Med 2023; 13:101. [PMID: 38202108 PMCID: PMC10779771 DOI: 10.3390/jcm13010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
A nationwide cross-sectional online survey was administered to dermatologists managing patients with moderate-to-severe plaque psoriasis across Italy to obtain real-world dermatologists' perspectives on the impact of psoriasis and its treatment on patients' daily lives and quality of life (QoL). A total of 91 dermatologists (aged 39.1 ± 11.2 years) completed a 31-question survey and workshop sessions were undertaken in order to identify the best management approach to achieve patient wellbeing. Social (4.2 ± 0.1), physical (4.26 ± 0.2) and mental components (4.1 ± 0.3) were rated by dermatologists as contributing to patient wellbeing to similar extents. While a high proportion (85.4%; rating of 4.3 out of 5) of dermatologists felt that they considered the QoL of patients, a lower proportion (69.6%; rating of 3.7 out of 5) felt that patients were satisfied in this regard. The psoriasis area and severity index and body surface area were the instruments most frequently used to assess the physical domain, while interviews/questions and the dermatology life quality index were used to assess social and mental domains, with only 60% of dermatologists following up on these aspects. The importance of investigating the presence of comorbidities was recognized but not always carried out by many dermatologists, (>70%), particularly for obesity and anxiety/depression. This survey identified key components contributing to barriers impacting on the QoL of patients with moderate-to-severe psoriasis from the perspective of the dermatologist.
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Affiliation(s)
- Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy
| | | | - Federico Bardazzi
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy;
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Riccardo G. Borroni
- Department of Biomedical Sciences, Humanitas University, 20089 Milan, Italy;
- Dermatology Unit, Humanitas Research Hospital, IRCCS, 20089 Milan, Italy
| | | | - Martina Burlando
- Dermatologic Clinic, DISSAL, San Martino Policlinico San Martino Hospital, 16132 Genova, Italy;
| | - Anna Elisabetta Cagni
- Unità Operativa Dipartimentale di Dermatologia e Venereologia, IRCCS San Gerardo, 20900 Milan, Italy;
| | - Elena Campione
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (E.C.); (C.G.)
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy;
| | - Fabrizio Colonna
- Dipartimento di Psicologia, Università di Torino, 10124 Turin, Italy;
| | - Aldo Cuccia
- Unit of Dermatology, San Donato Hospital, 52100 Arezzo, Italy;
| | - Stefano Dastoli
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | | | - Clara De Simone
- Institute of Dermatology, Catholic University, 00185 Rome, Italy;
- Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale S. Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Valentina Dini
- Unit of Dermatology, University of Pisa, 56126 Pisa, Italy;
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical, Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Claudia Galluzzi
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (E.C.); (C.G.)
| | | | - Claudia Giofrè
- Dermatology Complex Operative Unit, Papardo Hospital, 98158 Messina, Italy;
| | - Claudia Lasagni
- AOU Policlinico di Modena, Department of Specialized Medicine, University of Modena, 41121 Modena, Italy;
| | - Serena Lembo
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84084 Fisciano, Italy;
| | - Francesco Loconsole
- Clinica Dermatologica, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy;
| | - Maria Antonia Montesu
- Department of Surgical, Microsurgical and Medical Sciences, Dermatology, University of Sassari, 07100 Sassari, Italy;
| | - Paolo Pella
- Dermatologia, Ospedale degli Infermi, 13875 Biella, Italy;
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padova, 35122 Padova, Italy;
| | - Paolo Pigatto
- Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, Istituto Ortopedico Galezzi, University of Milan, 20122 Milan, Italy;
| | - Antonio Giovanni Richetta
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, 00185 Rome, Italy;
| | - Adriana Scuotto
- Department of Advanced Biomedical Science, Legal Medicine Section, University of Naples Federico II, 80131 Naples, Italy;
| | - Elena Stroppiana
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10124 Turin, Italy;
| | - Marina Venturini
- Dermatology Department, University of Brescia, ASST Spedali Civili, 25121 Brescia, Italy;
| | | | - Leonardo Zichichi
- Unit of Dermatology, San Antonio Abate Hospital, 80057 Trapani, Italy;
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
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14
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See C, Wheelock KM, Caraballo C, Khera R, Annapureddy A, Mahajan S, Lu Y, Krumholz HM, Murugiah K. Patterns of Digoxin Prescribing for Medicare Beneficiaries in the United States 2013-2019. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 10:100048. [PMID: 38213879 PMCID: PMC10783702 DOI: 10.1016/j.ajmo.2023.100048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Background Studies show that digoxin use is declining but is still prevalent. Recent data on digoxin prescription and characteristics of digoxin prescribers are unknown, which can help understand its contemporary use. Methods Using Medicare Part D data from 2013 to 2019, we studied the change in number and proportion of digoxin prescriptions and digoxin prescribers, overall and by specialty. Using logistic regression, we identified prescriber characteristics associated with digoxin prescription. Results From 2013 to 2019, total digoxin prescriptions (4.6 to 1.8 million) and proportion of digoxin prescribers decreased (9.1% to 4.3% overall; 26.6% to 11.8% among General Medicine prescribers and 65.4% to 48.9% among Cardiology). Of digoxin prescribers from 2013 practicing in 2019 (91.2% remained active), 59.1% did not prescribe digoxin at all, 31.7% reduced, and 9.2% maintained or increased prescriptions. The proportion of all digoxin prescriptions that were prescribed by General Medicine prescribers declined from 59.7% to 48.2% and increased for Cardiology (29% to 38.5%). Among new prescribers in 2019 (N = 85,508), only 1.9% prescribed digoxin. Digoxin prescribers when compared to non-digoxin prescribers were more likely male, graduated from medical school earlier, were located in the Midwest or South, and belonged to Cardiology (all P < .001). Conclusions Digoxin prescriptions continue to decline with over half of 2013 prescribers no longer prescribing digoxin in 2019. This may be a result of the increasing availability of newer heart failure therapies. The decline in digoxin prescription was greater among general medicine physicians than cardiologists, suggesting a change in digoxin use to a medication prescribed increasingly by specialists.
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Affiliation(s)
- Claudia See
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Kevin M. Wheelock
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Amarnath Annapureddy
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Shiwani Mahajan
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Yuan Lu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn
| | - Karthik Murugiah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
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15
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Rotenstein LS, Holmgren AJ, Horn DM, Lipsitz S, Phillips R, Gitomer R, Bates DW. System-Level Factors and Time Spent on Electronic Health Records by Primary Care Physicians. JAMA Netw Open 2023; 6:e2344713. [PMID: 37991757 PMCID: PMC10665969 DOI: 10.1001/jamanetworkopen.2023.44713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
Importance Primary care physicians (PCPs) spend the most time on the electronic health record (EHR) of any specialty. Thus, it is critical to understand what factors contribute to varying levels of PCP time spent on EHRs. Objective To characterize variation in EHR time across PCPs and primary care clinics, and to describe how specific PCP, patient panel, clinic, and team collaboration factors are associated with PCPs' time spent on EHRs. Design, Setting, and Participants This cross-sectional study included 307 PCPs practicing across 31 primary care clinics at Massachusetts General Hospital and Brigham and Women's Hospital during 2021. Data were analyzed from October 2022 to October 2023. Main Outcomes and Measures Total per-visit EHR time, total per-visit pajama time (ie, time spent on the EHR between 5:30 pm to 7:00 am and on weekends), and total per-visit time on the electronic inbox as measured by activity log data derived from an EHR database. Results The sample included 307 PCPs (183 [59.6%] female). On a per-visit basis, PCPs spent a median (IQR) of 36.2 (28.9-45.7) total minutes on the EHR, 6.2 (3.1-11.5) minutes of pajama time, and 7.8 (5.5-10.7) minutes on the electronic inbox. When comparing PCP time expenditure by clinic, median (IQR) total EHR time, median (IQR) pajama time, and median (IQR) electronic inbox time ranged from 23.5 (20.7-53.1) to 47.9 (30.6-70.7) minutes per visit, 1.7 (0.7-10.5) to 13.1 (7.7-28.2) minutes per visit, and 4.7 (4.1-5.2) to 10.8 (8.9-15.2) minutes per visit, respectively. In a multivariable model with an outcome of total per-visit EHR time per visit, an above median percentage of teamwork on orders was associated with 3.81 (95% CI, 0.49-7.13) minutes per visit fewer and having a clinic pharmacy technician was associated with 7.87 (95% CI, 2.03-13.72) minutes per visit fewer. Practicing in a community health center was associated with fewer minutes of total EHR time per visit (5.40 [95% CI, 0.06-10.74] minutes). Conclusions and Relevance There is substantial variation in EHR time among individual PCPs and PCPs within clinics. Organization-level factors, such as team collaboration on orders, support for medication refill functions, and practicing in a community health center, are associated with lower EHR time for PCPs. These findings highlight the importance of addressing EHR burden at a systems level.
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Affiliation(s)
- Lisa S. Rotenstein
- Brigham and Women’s Hospital, Boston, Massachusetts
- University of California at San Francisco
| | | | - Daniel M. Horn
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston
| | - Stuart Lipsitz
- Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Russell Phillips
- Harvard Medical School, Boston, Massachusetts
- Harvard Center for Primary Care, Boston, Massachusetts
| | - Richard Gitomer
- Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - David W. Bates
- Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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16
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Zhou A, Leon C, O’Conor C, Johannesen C, Ranasinghe P. The physician gender pay gap in Maryland: current state and future directions. Ann Med 2023; 55:2258923. [PMID: 37782955 PMCID: PMC10547443 DOI: 10.1080/07853890.2023.2258923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/10/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Over the last few decades, more attention has been paid to the physician gender pay gap and more interventions have been attempted. This paper discusses the physician gender pay gap between 2017 and 2021 in Maryland. METHODS An online cross-sectional survey was distributed to over 10,000 physicians in the Maryland Medical Society, featuring questions regarding employment characteristics, compensation, impact of the COVID-19 pandemic, and educational debt. Using descriptive and regression analyses, we explored cross-sectional associations between gender and employment characteristics. RESULTS Male physicians reported a significantly higher average 2020 pre-tax income ($333,732 per year) than female physicians ($225,473 per year, p < 0.001), amounting to a nearly 50% difference in raw income, consistent with a previously reported pay gap in 2016. Women physicians earned 31.5% less than their male colleagues in 2020 and were projected to earn 28.7% less in 2021. Female physicians were also more likely to have educational debt (33.6% vs.12.9%, p < 0.001) and also more likely to have a high burden of debt, with 36% owing over $200,000 in education loans, compared to 14.7% of men (p < 0.01). CONCLUSION The physician gender pay gap in Maryland has remained relatively stable over four years, including the period of the COVID-19 pandemic.
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Affiliation(s)
- Ashley Zhou
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carlued Leon
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carolyn O’Conor
- Georgetown University School of Medicine, Washington, DC, USA
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17
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León-García M, Wieringa TH, Espinoza Suárez NR, Hernández-Leal MJ, Villanueva G, Singh Ospina N, Hidalgo J, Prokop LJ, Rocha Calderón C, LeBlanc A, Zeballos-Palacios C, Brito JP, Montori VM. Does the duration of ambulatory consultations affect the quality of healthcare? A systematic review. BMJ Open Qual 2023; 12:e002311. [PMID: 37875307 PMCID: PMC10603464 DOI: 10.1136/bmjoq-2023-002311] [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: 02/08/2023] [Accepted: 09/23/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare. METHODS We included experimental studies manipulating the length of outpatient clinical encounters between adult patients and clinicians (ie, therapists, pharmacists, nurses, physicians) to determine their effect on quality of care (ie, effectiveness, efficiency, timeliness, safety, equity, patient-centredness and patient satisfaction). INFORMATION SOURCES Using controlled vocabulary and keywords, without restriction by language or year of publication, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews and Scopus from inception until 15 May 2023. RISK OF BIAS Cochrane Risk of Bias instrument. DATA SYNTHESIS Narrative synthesis. RESULTS 11 publications of 10 studies explored the relationship between encounter duration and quality. Most took place in the UK's general practice over two decades ago. Study findings based on very sparse and outdated evidence-which suggested that longer consultations improved indicators of patient-centred care, education about prevention and clinical referrals; and that consultation duration was inconsistently related to patient satisfaction and clinical outcomes-warrant low confidence due to limited protections against bias and indirect applicability to current practice. CONCLUSION Experimental evidence for a minimal or optimal duration of an outpatient consultation is sparse and outdated. To develop evidence-based policies and practices about encounter length, randomised trials of different consultation lengths-in person and virtually, and with electronic health records-are needed. TRIAL REGISTRATION NUMBER OSF Registration DOI:10.17605/OSF.IO/EUDK8.
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Affiliation(s)
- Montserrat León-García
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Thomas H Wieringa
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University, Leiden, Netherlands
| | - Nataly R Espinoza Suárez
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- VITAM Research Center for Sustainable Health, Quebec Integrated University Health and Social Services; Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - María José Hernández-Leal
- Department of Economics. Research Centre on Economics and Sustainability (ECO-SOS). Research Group on Statistics, Economic Evaluation and Health (GRAEES), Faculty of Business and Economics. Rovira i Virgili University, Reus, Spain
| | - Gemma Villanueva
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
- Cochrane Response, London, UK
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jessica Hidalgo
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudio Rocha Calderón
- Department of Preventive Medicine, University Hospital of Bellvitge, IDIBELL, Barcelona, Catalunya, Spain
| | - Annie LeBlanc
- VITAM Research Center for Sustainable Health, Quebec Integrated University Health and Social Services; Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Claudia Zeballos-Palacios
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Pablo Brito
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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18
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Rotenstein L, Jay Holmgren A. COVID exacerbated the gender disparity in physician electronic health record inbox burden. J Am Med Inform Assoc 2023; 30:1720-1724. [PMID: 37436709 PMCID: PMC10531114 DOI: 10.1093/jamia/ocad141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/19/2023] [Accepted: 07/18/2023] [Indexed: 07/13/2023] Open
Abstract
The COVID-19 pandemic was associated with significant changes to the delivery of ambulatory care, including a dramatic increase in patient messages to physicians. While asynchronous messaging is a valuable communication modality for patients, a greater volume of patient messages is associated with burnout and decreased well-being for physicians. Given that women physicians experienced greater electronic health record (EHR) burden and received more patient messages pre-pandemic, there is concern that COVID may have exacerbated this disparity. Using EHR audit log data of ambulatory physicians at an academic medical center, we used a difference-in-differences framework to evaluate the impact of the pandemic on patient message volume and compare differences between men and women physicians. We found patient message volume increased post-COVID for all physicians, and women physicians saw an additional increase compared to men. Our results contribute to the growing evidence of different communication expectations for women physicians that contribute to the gender disparity in EHR burden.
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Affiliation(s)
- Lisa Rotenstein
- Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - A Jay Holmgren
- Division of Clinical Informatics and Digital Transformation (DoC-IT), University of California San Francisco, San Francisco, California, USA
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19
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Bahr TJ, Ginsburg S, Wright JG, Shachak A. Technostress as source of physician burnout: An exploration of the associations between technology usage and physician burnout. Int J Med Inform 2023; 177:105147. [PMID: 37517300 DOI: 10.1016/j.ijmedinf.2023.105147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/20/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The cause of physician burnout is multifactorial. Health care systems pressures, excessive workloads, fatigue, poor self-care, administrative burdens, work hours, technological advancements, and work-home life conflicts, are all prominent themes throughout the literature. To date, little is known about whether, and to what extent, stressors related to the use of information and communication technology (ICT) use, other than electronic health records, outside of working hours, contribute to physician burnout. PURPOSE The purpose of this study was to explore whether work related ICT use outside of working hours is associated with physician burnout. METHOD A cross-sectional survey delivered online using The Maslach Burnout Inventory (MBI), a Physician Technology Usage Scale (PTUS) (and 7 personal characteristics questions. Data were analyzed using bivariate correlations, analysis of variance (ANOVA) and t-tests, and multiple linear regression. RESULTS Of 2,108 participants invited to complete the survey, 403 responded to and completed the survey (19% response rate). Results identified two significant factors associated with physician burnout: work related technology use outside of working hours, and the number of years in practice. CONCLUSION This research highlights the need for additional in-depth research into areas such as: 1. work-home life issues and how the use of technology outside of work hours may affect or be affected by burnout; 2. physician age and experience and burnout; 3. The differences between specialties and whether and how specialty-specific factors are related to burnout.
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Affiliation(s)
- Tamara J Bahr
- Faculty of Information, University of Toronto, Canada.
| | - Shiphra Ginsburg
- The Wilson Centre for Research in Education, Toronto, Canada; Sinai Health, Toronto, Canada; Department of Medicine, University of Toronto, Canada; Institute of Health Policy, Management and Evaluation (Dalla Lana School of Public Health), University of Toronto, Canada
| | - James G Wright
- Institute of Health Policy, Management and Evaluation (Dalla Lana School of Public Health), University of Toronto, Canada; Ontario Medical Association, Canada; The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Canada
| | - Aviv Shachak
- Faculty of Information, University of Toronto, Canada; The Wilson Centre for Research in Education, Toronto, Canada; Institute of Health Policy, Management and Evaluation (Dalla Lana School of Public Health), University of Toronto, Canada
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Carr DN, Macharia A, Hacker MR, Winkelman WD. Characteristics of providers who prescribed only anticholinergic medications for overactive bladder in 2020. Am J Obstet Gynecol 2023; 229:316.e1-316.e7. [PMID: 37244459 DOI: 10.1016/j.ajog.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/11/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Pharmacologic therapy for overactive bladder typically includes either an anticholinergic or a beta-3 agonist. Based on research that has demonstrated increased risks of cognitive impairment and dementia associated with anticholinergic use, current guidelines support the use of beta-3 agonists rather than anticholinergics in older patients. OBJECTIVE This study aimed to describe the characteristics of providers prescribing only anticholinergics to treat overactive bladder in patients aged ≥65 years. STUDY DESIGN The US Centers for Medicare and Medicaid Services publishes data on medications dispensed to Medicare beneficiaries. Data include the National Provider Identifier of the prescriber and the number of pills prescribed and dispensed for any given medication for beneficiaries aged ≥65 years. We obtained each provider's National Provider Identifier, gender, degree, and primary specialty. National Provider Identifiers were linked to an additional Medicare database that includes graduation year. We included providers who prescribed pharmacologic therapy for overactive bladder in 2020 for patients aged ≥65 years. We calculated the percentage of providers who prescribed only anticholinergics (and did not prescribe beta-3 agonists) for overactive bladder and stratified by provider characteristics. Data are reported as adjusted risk ratios. RESULTS In 2020, 131,605 providers prescribed overactive bladder medications. Of those identified, 110,874 (84.2%) had complete demographic information available. Although only 7% of providers who prescribed medications for overactive bladder were urologists, prescriptions from urologists accounted for 29% of total prescriptions. Among providers prescribing medications for overactive bladder, 73% of female providers prescribed only anticholinergics, whereas 66% of male providers prescribed only anticholinergics (P<.001). The percentage of providers that prescribed only anticholinergics also varied by specialty (P<.001), with providers specialized in geriatric medicine being least likely to prescribe only anticholinergics (40%), followed by urologists (44%). Nurse practitioners (75%) and family medicine physicians (73%) were more likely to prescribe only anticholinergics. The percentage of providers who prescribed only anticholinergics was the highest for recent medical school graduates and decreased with time since graduation. Overall, 75% of providers within 10 years of graduation prescribed only anticholinergics, whereas only 64% of providers who were >40 years of age from graduation prescribed only anticholinergics (P<.001). CONCLUSION This study identified considerable differences in prescribing practices based on provider characteristics. Female physicians, nurse practitioners, physicians trained in family medicine, and those who recently graduated from medical school were the most likely to prescribe only anticholinergic medications and not prescribe any beta-3 agonist for the treatment of overactive bladder. This study identified differences in prescribing practices based on provider demographics that may guide educational outreach programs.
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Affiliation(s)
- Danielle N Carr
- Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, MA; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
| | - Annliz Macharia
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - William D Winkelman
- Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
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21
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Steffey MA, Griffon DJ, Risselada M, Scharf VF, Buote NJ, Zamprogno H, Winter AL. Veterinarian burnout demographics and organizational impacts: a narrative review. Front Vet Sci 2023; 10:1184526. [PMID: 37470072 PMCID: PMC10352684 DOI: 10.3389/fvets.2023.1184526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.
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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
| | - Valery F. Scharf
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
| | - Nicole J. Buote
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
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22
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Bennett PN, Bohm C, Yee-Moon Wang A, Kanjanabuch T, Figueiredo AE, Harasemiw O, Brown L, Gabrys I, Jegatheesan D, Lambert K, Lightfoot CJ, MacRae J, Scholes-Robertson N, Stewart K, Tarca B, Verdin N, Warren M, West M, Zimmerman D, Finderup J, Ford E, Ribeiro HS, Xu Q, Thompson S. An International Survey of Peritoneal Dialysis Exercise Practices and Perceptions. Kidney Int Rep 2023; 8:1389-1398. [PMID: 37441469 PMCID: PMC10334400 DOI: 10.1016/j.ekir.2023.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 03/24/2023] [Accepted: 04/24/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Low activity levels and poor physical function are associated with technique failure and mortality in people receiving peritoneal dialysis (PD). Adequate levels of physical function are required to maintain independence for people choosing this predominantly home-based therapy. The objective of this study was to identify the exercise-related perceptions and practices of PD clinicians globally. Methods We conducted a cross-sectional survey of PD clinicians from English-, Thai-, Spanish-, and Portuguese-speaking PD-prevalent countries exploring clinicians' perceptions and practices of swimming, activity following PD catheter insertion, lifting, and falls prevention. This study was convened by the International Society of Peritoneal Dialysis and Global Renal Exercise Network between July and December 2021. Results Of 100 of the highest PD-prevalent countries, 85 responded and were represented in the findings. A total of 1125 PD clinicians (448 nephrologists, 558 nephrology nurses, 59 dietitians, and 56 others) responded from 61% high-income, 32% upper middle-income and 7% lower middle-income countries. The majority (n = 1054, 94%) agreed that structured exercise programs would be beneficial for people receiving PD. Most respondents believed people on PD could perform more exercise (n = 907, 81%) and that abdominal strengthening exercises could be safely performed (n = 661, 59%). Compared to clinicians in high-income countries, clinicians from lower middle-income status (odds ratio [OR], 5.57; 1.64 to 18.9) are more likely to promote participation in physical activity. Conclusion Clinicians know the importance of physical activity in people receiving PD. Exercise counseling and structured exercise plans could be included in the standard care of people receiving PD to maintain independence.
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Affiliation(s)
- Paul N. Bennett
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
- Satellite Healthcare, USA
| | - Clara Bohm
- Chronic Disease Innovation Center, Manitoba, Canada
- Medicine/Nephrology, University of Manitoba, Manitoba, Canada
| | | | - Talerngsak Kanjanabuch
- Division of Nephrology and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Thailand
| | - Ana Elizabeth Figueiredo
- Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul Escola de Ciências da Saúde e da Vida, Brazil
| | - Oksana Harasemiw
- Chronic Disease Innovation Center, Manitoba, Canada
- Medicine/Nephrology, University of Manitoba, Manitoba, Canada
| | - Leanne Brown
- Queensland University of Technology, Queensland, Australia
| | - Iwona Gabrys
- Alberta Kidney Care North, Alberta Health Services, Alberta, Canada
| | - Dev Jegatheesan
- The University of Queensland, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kelly Lambert
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Courtney J. Lightfoot
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, UK
| | | | | | | | - Brett Tarca
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, South Australia, Australia
| | - Nancy Verdin
- The Global Renal Exercise Network Patient Engagement Council, Canada
| | | | - Mike West
- University of California Davis, California, USA
| | | | | | - Emilie Ford
- Chronic Disease Innovation Center, Manitoba, Canada
- Medicine/Nephrology, University of Manitoba, Manitoba, Canada
| | - Heitor S. Ribeiro
- Research Center in Sports Sciences, Health Sciences and Human Development, University of Maia, Portugal
- University Center ICESP, Brazil
| | - Qunyan Xu
- Clinical and Health Sciences, University of South Australia, South Australia, Australia
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23
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Call M, Qeadan F, Tingey B, Morrow E, Webber D, Hamilton B, Locke A. Measuring provider well-being: initial validation of a brief engagement survey. BMC Health Serv Res 2023; 23:432. [PMID: 37138346 PMCID: PMC10157943 DOI: 10.1186/s12913-023-09449-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/25/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Measurement is one of the critical ingredients to addressing the well-being of health care professionals. However, administering an organization-wide well-being survey can be challenging due to constraints like survey fatigue, financial limitations, and other system priorities. One way to address these issues is to embed well-being items into already existing assessment tools that are administered on a regular basis, such as an employee engagement survey. The objective of this study was to assess the utility of a brief engagement survey, that included a small subset of well-being items, among health care providers working in an academic medical center. METHODS In this cross-sectional study, health care providers, including physicians and advanced clinical practitioners, employed at an academic medical center completed a brief, digital engagement survey consisting of 11 quantitative items and 1 qualitative item administered by Dialogue™. The emphasis of this study was on the quantitative responses. Item responses were compared by sex and degree, domains were identified via exploratory factor analysis (EFA), and internal consistency of item responses was assessed via McDonald's omega. Sample burnout was compared against national burnout. RESULTS Of the 791 respondents, 158 (20.0%) were Advanced Practice Clinicians (APCs), and 633 (80.0%) were Medical Doctors (MDs). The engagement survey, with 11 items, had a high internal consistency with an omega ranging from 0.80-0.93 and was shown, via EFA, to have three domains including communication, well-being, and engagement. Significant differences for some of the 11 items, by sex and degree, in the odds of their agreement responses were found. In this study, 31.5% reported experiencing burnout, which was significantly lower than the national average of 38.2%. CONCLUSION Our findings indicate initial reliability, validity, and utility of a brief, digital engagement survey among health care professionals. This may be particularly useful for medical groups or health care organizations who are unable to administer their own discrete well-being survey to employees.
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Affiliation(s)
- Megan Call
- Department of Psychiatry, University of Utah Health, 501 Chipeta Way, UT, 84108, Salt Lake City, USA.
- Resiliency Center, University of Utah Health, 26 S 2000 E, Salt Lake City, UT, 5775A84112, USA.
| | - Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S. First Avenue, Maywood, IL, 60153, USA
| | - Benjamin Tingey
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S. First Avenue, Maywood, IL, 60153, USA
| | - Ellen Morrow
- Resiliency Center, University of Utah Health, 26 S 2000 E, Salt Lake City, UT, 5775A84112, USA
- Department of Surgery, University of Utah Health, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - David Webber
- University of Utah Health, Medical Group, 50 N. Medical Drive, Salt Lake City, UT, 84132, USA
| | - Blake Hamilton
- Department of Surgery, University of Utah Health, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Amy Locke
- Resiliency Center, University of Utah Health, 26 S 2000 E, Salt Lake City, UT, 5775A84112, USA
- Department of Family & Preventive Medicine, University of Utah Health, 375 Chipeta Way Ste A, UT, 84108, Salt Lake City, USA
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Lakshminrusimha S, Murin S, Lubarsky DA. Low Compensation for Academic Pediatric Medical Specialists: Role of Medicaid, Productivity, Work Hours, and Sex. J Pediatr 2023; 255:1-6. [PMID: 36731717 DOI: 10.1016/j.jpeds.2023.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Affiliation(s)
| | - Susan Murin
- Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA
| | - David A Lubarsky
- Department of Anesthesiology and Pain Medicine, UC Davis Health, Sacramento, CA
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25
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Siraj RA, Alhaykan AE, Alrajeh AM, Aldhahir AM, Alqahtani JS, Bakhadlq S, Alghamdi SM, Alqarni AA, Alqarni MM, Alanazi TM, Alruwaili A, Algarni SS, Alahmadi FH, Alahmari M, Alahmadi RH. Burnout, Resilience, Supervisory Support, and Quitting Intention among Healthcare Professionals in Saudi Arabia: A National Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2407. [PMID: 36767773 PMCID: PMC9915463 DOI: 10.3390/ijerph20032407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED Although personal resilience and supervisory support are known to reduce the impact of burnout and quitting intention, there is limited data available to explore these relationships among healthcare professionals (HCPs) in Saudi Arabia. This study aimed to assess the prevalence of burnout and explore its association with resilience, supervisory support, and intention to quit among Saudi Arabian HCPs. METHODS A cross-sectional survey was distributed to a convenience sample of HCPs between April and November 2022. Participants responded to socio-demographic questions, the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS (MP)), the Connor-Davidson resilience scale 10 (CD-RISC 10), and the Perceived of Supervisor Support Scale (PSS). Descriptive, inferential, correlation, and logistic regression tests were performed for data analyses. RESULTS Of the 1174 HCPs included in the analysis, 77% were presented with high burnout levels: 58% with emotional exhaustion (EE), 72% with depersonalization (DP), and 66% with low personal accomplishment (PA). Females were associated with increased odds of burnout (OR: 1.47; 95% CI: 1.04-2.06) compared to males. Burnout and its subscales were associated with higher intention to leave practice, with 33% of HCPs considering quitting their jobs. Furthermore, HCPs reported a low resilience score overall, and negative correlations were found between EE (r = -0.21; p < 0.001) and DP (r = -0.12; p < 0.01), and positive correlation with low PA (r = 0.38; p < 0.001). In addition, most HCPs perceived supervisory support as low, and it is associated with increased burnout and quitting intention. CONCLUSION Burnout is common among HCPs across all clinical settings and is associated with higher intention to quit and low resilience and supervisory support. Workplace management should provide a supportive workplace to reduce burnout symptoms and promote resiliency.
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Affiliation(s)
- Rayan A. Siraj
- Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahasa 31982, Saudi Arabia
| | - Ahmed E. Alhaykan
- Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahasa 31982, Saudi Arabia
| | - Ahmed M. Alrajeh
- Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahasa 31982, Saudi Arabia
| | - Abdulelah M. Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Samah Bakhadlq
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Saeed M. Alghamdi
- Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 21961, Saudi Arabia
| | - Abdullah A. Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22254, Saudi Arabia
| | - Manal M. Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22254, Saudi Arabia
| | - Turki M. Alanazi
- Department of Respiratory Therapy, King Saud Bin Abdelaziz University for Health Sciences, Al Ahsa 31982, Saudi Arabia
- King Abdullah International Medical Research Center, Al Ahsa 31982, Saudi Arabia
| | - Abdullah Alruwaili
- King Abdullah International Medical Research Center, Al Ahsa 31982, Saudi Arabia
- Emergency Medical Services Program, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa 31982, Saudi Arabia
| | - Saleh S. Algarni
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 12271, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 12271, Saudi Arabia
| | - Fahad H. Alahmadi
- Respiratory Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Madinah 41411, Saudi Arabia
| | - Mushabbab Alahmari
- Department of Respiratory Therapy, Faculty of Applied Medical Sciences, University of Bisha, Bisha 67114, Saudi Arabia
| | - Rashid H. Alahmadi
- Taibah Primary Health Centre, Ministry of Health, Madinah 42353, Saudi Arabia
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Webber SA, Byrne BJ, Starmer AJ, Somberg CA, Frintner MP. Examining Early Career Pediatrician Characteristics, Sacrifices, and Satisfaction. Acad Pediatr 2023; 23:587-596. [PMID: 36682450 DOI: 10.1016/j.acap.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Explore relationships between pediatrician characteristics, sacrifices made for career, and career and life satisfaction. METHODS Surveys of early career pediatricians (ECPs) who recently graduated residency (2016-18), as part of the AAP Pediatrician Life and Career Experience Study (PLACES) were administered in 2019. Logistic regression analyzed association of pediatrician characteristics with personal sacrifices (a lot vs some or no sacrifices) made for one's career and whether career was worth the sacrifices made to become a physician, and association of characteristics and sacrifices with overall career and life satisfaction. RESULTS Of 918 ECPs in the cohort, 90% responded to the 2019 survey. Seventy-seven percent agreed their career was worth the sacrifices and 40% reported they made a lot of personal sacrifices for their career. In multivariable analysis, female sex was associated with lower odds of viewing career as worth the sacrifices made [adjusted odds ratio [aOR] 0.45; 95% confidence interval [CI], 0.28-0.71], a higher odds of delaying starting a family [aOR 2.25; CI, 1.32-3.86] and making sacrifices in having children for career [aOR 2.60; CI, 1.48-4.58]. Those in fellowship training also reported making more sacrifices related to having children for their career [aOR 1.73; CI, 1.08-2.78]. ECPs who reported making a lot of sacrifices for their career were less likely to be satisfied with their overall career and life. CONCLUSIONS Most ECPs believe their sacrifices to become a pediatrician were worth it. Female pediatricians were less likely to feel personal sacrifices were worth it and reported more sacrifices related to having children.
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Affiliation(s)
- Sarah A Webber
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (SA Webber), Madison, Wis.
| | - Bobbi J Byrne
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine (BJ Byrne), Indianapolis, Ind
| | - Amy Jost Starmer
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School (AJ Starmer), Boston, Mass
| | - Chloe A Somberg
- Department of Research, American Academy of Pediatrics (CA Somberg and MP Frintner), Itasca, Ill
| | - Mary Pat Frintner
- Department of Research, American Academy of Pediatrics (CA Somberg and MP Frintner), Itasca, Ill
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Prevalence and determinants of Italian physicians' burnout in the "post-COVID-19" era. Int Arch Occup Environ Health 2023; 96:377-387. [PMID: 36335513 PMCID: PMC9638242 DOI: 10.1007/s00420-022-01929-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/16/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Several studies investigated prevalence and determinants of physicians' burnout during the peak of the COVID-19 pandemic, but only a few during the chronic phase of the pandemic. This study thus aimed to examine this topic referring to the "post-COVID-19 era", defined as a chronic and likely-to-be endemic status quo. METHODS A cross-sectional, online survey (November 2021-January 2022) was addressed to physicians in Lombardia (Northern Italy). Besides socio-demographic and COVID-19-related data, measures of personal, work- and patient-related burnout (Copenhagen Burnout Inventory; CBI), depression (Patient Health Questionnaire-8), anxiety (General Anxiety Disorder-7), and self-efficacy (General Self-Efficacy Scale) were collected. Linear/generalized linear models were run to test associations/predictions of interest. RESULTS Among the 958 respondents, burnout symptoms were clinically significant in 18.5% of them. Predictive models showed that female sex (OR = 0.73, 95% CI 0.42-1.27), younger age (OR = 0.94, 95% CI 0.59-1.48), shorter job tenure (OR = 1.01, 95% CI 0.62-1.65), trainee status (OR = 1.41, 95% CI 1.16-7.10), higher PHQ-8 (OR = 1.260, 95% CI 1.16-1.37), and GAD-7 scores (OR = 1.19, 95% CI 1.10-1.30) increased the risk to suffer from clinical burnout. COVID-19-related variables were mostly not related/associated to burnout levels. CONCLUSION In Italy, physicians' burnout is moderately prevalent also in the chronic phase of the pandemic, with its determinants being more intrinsic than environmental. The development of effective interventions is needed to help physicians cope with the new challenges of their job.
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Ngai J, Capdeville M, Sumler M, Oakes D. A Call for Diversity: Women, Professional Development, and Work Experience in Cardiothoracic Anesthesiology. J Cardiothorac Vasc Anesth 2022; 37:870-880. [PMID: 36599777 DOI: 10.1053/j.jvca.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Jennie Ngai
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, New York, NY.
| | - Michelle Capdeville
- Department of Cardiothoracic Anesthesia, Cleveland Clinic Lerner College of Medicine, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Michele Sumler
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - Daryl Oakes
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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Lee DN, Hutchens MJ, George TJ, Wilson-Howard D, Cooks EJ, Krieger JL. Do they speak like me? Exploring how perceptions of linguistic difference may influence patient perceptions of healthcare providers. MEDICAL EDUCATION ONLINE 2022; 27:2107470. [PMID: 35912473 PMCID: PMC9347466 DOI: 10.1080/10872981.2022.2107470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/21/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
The increased utilization of telehealth has provided patients with the opportunity to interact with racially diverse healthcare providers (HCPs). While evidence of racial stereotypes in healthcare is well documented, less is known about whether linguistic cues increase or decrease racial bias in healthcare interactions. The purpose of this pilot study was to use virtual clinicians (VCs) to examine how varying linguistic features affect patient perceptions of Black-identifying HCPs. Participants (N = 282) were recruited to participate in an online pilot study using a two-arm posttest-only experimental design. Participants were randomly assigned to interact with a Black VC that used vocal cues associated with either Standard American English (SAE) or African American English (AAE) on the topic of colorectal cancer. After the interaction, participants completed a posttest questionnaire. Resulting data were analyzed using mediation.
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Affiliation(s)
- Donghee N. Lee
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, USA
| | - Myiah J. Hutchens
- Department of Public Relations, College of Journalism and Communications, University of Florida, Gainesville, USA
| | - Thomas J. George
- Department of Medicine, College of Medicine, University of Florida and University of Florida Health Cancer Center, Gainesville, USA
| | - Danyell Wilson-Howard
- Department of Natural Sciences, Bethune-Cookman University, Daytona Beach, USA
- STEM Translational Communication Center, University of Florida and University of Florida Health Cancer Center, Gainesville, USA
| | - Eric J. Cooks
- STEM Translational Communication Center, University of Florida and University of Florida Health Cancer Center, Gainesville, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, University of Florida and University of Florida Health Cancer Center, Gainesville, USA
- Department of Advertising, College of Journalism and Communications, Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, USA
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30
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McClafferty HH, Hubbard DK, Foradori D, Brown ML, Profit J, Tawfik DS. Physician Health and Wellness. Pediatrics 2022; 150:189767. [PMID: 36278292 DOI: 10.1542/peds.2022-059665] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.
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Affiliation(s)
- Hilary H McClafferty
- Department of Pediatrics, Section Chief, Pediatric Emergency Medicine, Tucson Medical Center, Tucson, Arizona
| | - Dena K Hubbard
- Children's Mercy Kansas City, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - Dana Foradori
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Melanie L Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Daniel S Tawfik
- Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Rittenberg E, Liebman JB, Rexrode KM. Primary Care Physician Gender and Electronic Health Record Workload. J Gen Intern Med 2022; 37:3295-3301. [PMID: 34993875 PMCID: PMC9550938 DOI: 10.1007/s11606-021-07298-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prior research indicates that female physicians spend more time working in the electronic health record (EHR) than do male physicians. OBJECTIVE To examine gender differences in EHR usage among primary care physicians and identify potential causes for those differences. DESIGN Retrospective study of EHR usage by primary care physicians (PCPs) in an academic hospital system. PARTICIPANTS One hundred twenty-five primary care physicians INTERVENTIONS: N/A MAIN MEASURES: EHR usage including time spent working and volume of staff messages and patient messages. KEY RESULTS After adjusting for panel size and appointment volume, female PCPs spend 20% more time (1.9 h/month) in the EHR inbasket and 22% more time (3.7 h/month) on notes than do their male colleagues (p values 0.02 and 0.04, respectively). Female PCPs receive 24% more staff messages (9.6 messages/month), and 26% more patient messages (51.5 messages/month) (p values 0.03 and 0.004, respectively). The differences in EHR time are not explained by the percentage of female patients in a PCP's panel. CONCLUSIONS Female physicians spend more time working in their EHR inbaskets because both staff and patients make more requests of female PCPs. These differential EHR burdens may contribute to higher burnout rates in female PCPs.
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Affiliation(s)
- Eve Rittenberg
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02467, USA.
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Martinez KA, Rothberg MB. Physician Gender and Its Association With Patient Satisfaction and Visit Length: An Observational Study in Telemedicine. Cureus 2022; 14:e29158. [PMID: 36258932 PMCID: PMC9572933 DOI: 10.7759/cureus.29158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Female physicians conduct longer visits than male physicians, with negative implications for their compensation. Yet patients often report higher satisfaction with female physicians. It is unknown whether satisfaction scores for female physicians are associated with their visit lengths. Our objective was to characterize the role of the physician and patient gender with respect to visit length and patient satisfaction. Methods We conducted an observational cohort study with patients and physicians of a nationwide telemedicine service between 2016 and 2018. Visit length was measured by the telemedicine system. Patients rated physicians on scales of one to five stars, with five considered “top box” satisfaction. We used logistic regression to estimate differences in patient satisfaction and linear regression to estimate differences in visit length by the physician and patient gender. We tested interactions between physician and patient gender and accounted for clustering by the physician. Results Among 102,664 visits with 405 physicians, the mean visit length was 5.8 minutes. Visits with male physicians were 1.11 minutes shorter than those with female physicians (95% CI:-1.58, -0.65). Controlling for visit length, male physicians were less likely than female physicians to receive top-box satisfaction scores (OR: 0.72; 95% CI: 0.61, 0.85). Visits between female physicians and male patients were the longest and visits between male physicians and female patients were the shortest. Female physicians had longer visits than male physicians but this did not explain their higher satisfaction scores. Conclusions To reduce inequity in compensation resulting from differences in visit length, female physicians could shorten their visits without negative consequences for their satisfaction ratings.
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Martinez KA, Sullivan AB, Linfield DT, Shaker V, Yu PC, Rothberg MB. Change in Physician Burnout between 2013 and 2020 in a Major Health System. South Med J 2022; 115:645-650. [PMID: 35922054 DOI: 10.14423/smj.0000000000001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Assessing changes in physician burnout over time can offer insight into the causes of burnout. Existing studies are limited by using different samples of physicians at each time point. Our objective was to assess changes in burnout between 2013-2014 and 2019-2020 overall and within a cohort of physicians who took the survey twice. METHODS This is a longitudinal cohort and cross-sectional study of physicians in a major health system. They were administered the Maslach Burnout Inventory in 2013-2014 and 2019-2020. We separately assessed differences in odds of burnout and its subscales in 2013-2014 and 2019-2020 by physician characteristics and clinical time. We then assessed differences in the odds of reporting burnout and its subscales in 2019-2020 compared with 2013-2014 overall and by physician sex, race, and change in clinical full-time employment. RESULTS There were 1220 respondents in 2013-2014, 503 in 2019-2020, and 149 who responded at both time points. Burnout increased from 35% to 56%. Compared with 2013-2014, physicians had 2.39 higher odds (95% confidence interval [CI] 1.92-2.98) of burnout in 2019-2020, and this change in burnout was significantly more pronounced for female versus male physicians (odds ratio 1.80; 95% CI 1.57-1.80). Compared with White physicians, non-White physicians had significantly lower odds of burnout at both time points, but their odds increased significantly more over time (odds ratio 1.36; 95% CI 1.05-1.57). CONCLUSIONS We found a substantial increase in burnout over time, which was particularly pronounced for non-White and female physicians. Assessment over time is essential for understanding problematic trajectories of burnout that may be obscured by cross-sectional studies.
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Affiliation(s)
- Kathryn A Martinez
- From the Center for Value-Based Care Research, the Neurological Institute, the Lerner College of Medicine, and the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Amy B Sullivan
- From the Center for Value-Based Care Research, the Neurological Institute, the Lerner College of Medicine, and the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Debra T Linfield
- From the Center for Value-Based Care Research, the Neurological Institute, the Lerner College of Medicine, and the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Victoria Shaker
- From the Center for Value-Based Care Research, the Neurological Institute, the Lerner College of Medicine, and the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Pei-Chun Yu
- From the Center for Value-Based Care Research, the Neurological Institute, the Lerner College of Medicine, and the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Michael B Rothberg
- From the Center for Value-Based Care Research, the Neurological Institute, the Lerner College of Medicine, and the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
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Ganguli I, Mulligan KL, Phillips RL, Basu S. How the Gender Wage Gap for Primary Care Physicians Differs by Compensation Approach : A Microsimulation Study. Ann Intern Med 2022; 175:1135-1142. [PMID: 35849829 PMCID: PMC9982701 DOI: 10.7326/m22-0664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The physician gender wage gap may be due, in part, to productivity-based compensation models that undervalue female practice patterns. OBJECTIVE To determine how primary care physician (PCP) compensation by gender differs when applying existing productivity-based and alternative compensation models. DESIGN Microsimulation. SETTING 2016 to 2019 national clinical registry of 1222 primary care practices. PARTICIPANTS Male and female PCPs matched on specialty, years since medical school graduation, practice site, and sessions worked. MEASUREMENTS Net annual, full-time-equivalent compensation for male versus female PCPs, under productivity-based fee-for-service, panel size-based capitation without or with risk adjustment, and hybrid payment models. Microsimulation inputs included patient and visit characteristics and overhead expenses. RESULTS Among 1435 matched male (n = 881) and female (n = 554) PCPs, female PCP panels included patients who were, on average, younger, had lower diagnosis-based risk scores, were more often female, and were more often uninsured or insured by Medicaid rather than by Medicare. Under productivity-based payment, female PCPs earned a median of $58 829 (interquartile range [IQR], $39 553 to $120 353; 21%) less than male PCPs. This gap was similar under capitation ($58 723 [IQR, $42 141 to $140 192]). It was larger under capitation risk-adjusted for age alone ($74 695 [IQR, $42 884 to $152 423]), for diagnosis-based scores alone ($114 792 [IQR, $49 080 to $215 326] and $89 974 [IQR, $26 175 to $173 760]), and for age-, sex-, and diagnosis-based scores ($83 438 [IQR, $28 927 to $129 414] and $66 195 [IQR, $11 899 to $96 566]). The gap was smaller and nonsignificant under capitation risk-adjusted for age and sex ($36 631 [IQR, $12 743 to $73 898]). LIMITATION Panel attribution based on office visits. CONCLUSION The gender wage gap varied by compensation model, with capitation risk-adjusted for patient age and sex resulting in a smaller gap. Future models might better align with primary care effort and outcomes. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Ishani Ganguli
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts (I.G.)
| | | | - Robert L Phillips
- American Board of Family Medicine Center for Professionalism and Value in Health Care, Lexington, Kentucky (R.L.P.)
| | - Sanjay Basu
- Research and Development, Waymark, San Francisco, California (S.B.)
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Dellasega C, Aruma JF, Sood N, Andreae DA. The Impact of Patient Prejudice on Minoritized Female Physicians. Front Public Health 2022; 10:902294. [PMID: 35865248 PMCID: PMC9294398 DOI: 10.3389/fpubh.2022.902294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/10/2022] [Indexed: 01/14/2023] Open
Abstract
Background Patient bias and prejudice directed against physicians from diverse backgrounds is a frequent occurrence in healthcare. Female physicians have long experienced discrimination in the healthcare system based on their gender alone. The dynamic known as Patient Prejudice toward Providers (PPtP) is disproportionately affecting female physicians because it is frequently compounded by sexism. Aim The goal of this study was to explore the impact of PPtP on female resident and attending physicians. Methods Using transcribed one-on-one interviews from a larger study of PPtP affecting resident and attending physicians, ten interviews with female physicians (resident and attending) from diverse ethnic backgrounds and countries of training at a large academic medical center were analyzed. The authors independently reviewed the interviews using an iterative process within and across interviews to inductively identify repeating words, phrases, and concepts relevant to the study aim. Results Demographics of the ten participants included age (mean 34.6 years), ethnicity (6 Asian, 2 Hispanic, 2 African), and country of training (10% IMG vs. 90% US trained). Four of the interviewees were residents and six were attendings. Themes that emerged from the analysis included experiencing "A Gendered Continuum of Abuse," "Establishing a Higher Standard of Competency," "Overcoming the Stereotype of the White Male Physician," "The Physicality of Self Identity," and "The Need to be Protective of Minoritized Trainees." All participants agreed that these perceptions created an adverse environment at the workplace and impacted on patient care. Conclusions Discrimination of physicians based on their gender or their race/ethnicity has been reported. This study highlights the compounded effects of patient prejudice on female minoritized physicians. Organizations and individuals should identify and implement strategies to address the impact of PPtP and sexism in order to create an environment where all women can thrive professionally.
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Affiliation(s)
- Cheryl Dellasega
- Department of Humanities, Penn State College of Medicine, Hershey, PA, United States
| | | | - Natasha Sood
- Penn State College of Medicine, Hershey, PA, United States
| | - Doerthe A. Andreae
- Division of Allergy and Immunology, Department of Dermatology, University of Utah, Salt Lake, UT, United States,*Correspondence: Doerthe A. Andreae
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Leung TI, Wang KH, Lin TL, Gin GT, Pendharkar SS, Chen CYA. Women Physicians in Transition Learning to Navigate the Pipeline from Early to Mid-Career: Protocol for a Qualitative Study. JMIR Res Protoc 2022; 11:e38126. [PMID: 35653172 PMCID: PMC9204597 DOI: 10.2196/38126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women physicians face unique obstacles while progressing through their careers, navigating career advancement and seeking balance between professional and personal responsibilities. Systemic changes, along with individual and institutional changes, are needed to overcome obstacles perpetuating physician gender inequities. Developing a deeper understanding of women physicians' experiences during important transition points could reveal both barriers and opportunities for recruitment, retention, and promotion, and inform best practices developed based on these experiences. OBJECTIVE The aim is to learn from the experiences and perspectives of women physicians as they transition from early to mid-career, then develop best practices that can serve to support women physicians as they advance through their careers. METHODS Semistructured interviews were conducted with women physicians in the United States in 2020 and 2021. Eligibility criteria included self-identification as a woman who is in the process of transitioning or who recently transitioned from early to mid-career stage. Purposeful sampling facilitated identification of participants who represented diversity in career pathway, practice setting, specialty, and race/ethnicity. Each participant was offered compensation for their participation. Interviews were audio-recorded and professionally transcribed. Interview questions were open-ended, exploring participants' perceptions of this transition. Qualitative thematic analysis will be performed. We will use an open coding and grounded theory approach on interview transcripts. RESULTS The Ethics Review Committee of the Faculty of Health, Medicine, and Life Sciences at Maastricht University approved the study; Stanford University expedited review approved the study; and the University of California, San Diego certified the study as exempt from review. Twelve in-depth interviews of 50-100 minutes in duration were completed. Preliminary analyses indicate one key theme is a tension resulting from finite time divided between demands from a physician career and demands from family needs. In turn, this results in constant boundary control between these life domains that are inextricable and seemingly competing against each other within a finite space; family needs impinge on planned career goals, if the boundary between them is not carefully managed. To remedy this, women sought resources to help them redistribute home responsibilities, freeing themselves to have more time, especially for children. Women similarly sought resources to help with career advancement, although not with regard to time directly, but to first address foundational knowledge gaps about career milestones and how to achieve them. CONCLUSIONS Preliminary results provide initial insights about how women identify or activate a career shift and how they marshaled resources and support to navigate barriers they faced. Further analyses are continuing as of March 2022 and are expected to be completed by June 2022. The dissemination plan includes peer-reviewed open-access journal publication of the results and presentation at the annual meeting of the American Medical Association's Women Physicians Section.
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Affiliation(s)
- Tiffany I Leung
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Internal Medicine (adjunct), Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Karen H Wang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States
| | - Tammy L Lin
- Department of Medicine (voluntary), University of California San Diego Health Sciences, San Diego, CA, United States
| | - Geneen T Gin
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Sima S Pendharkar
- Division of Hospital Medicine, Jersey City Medical Center, Jersey City, NJ, United States
| | - Chwen-Yuen Angie Chen
- Department of Primary Care and Population Health, Stanford University, Palo Alto, CA, United States
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Sedhom JA, Patnaik JL, McCourt EA, Liao S, Subramanian PS, Davidson RS, Palestine AG, Kahook MY, Seibold LK. Physician burnout in ophthalmology: U.S. survey. J Cataract Refract Surg 2022; 48:723-729. [PMID: 34596630 DOI: 10.1097/j.jcrs.0000000000000837] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the prevalence of physician burnout among ophthalmologists in the United States and identify associated risks. SETTING All practice types within the United States. DESIGN Cross-sectional study. METHODS A survey was distributed through email listservs to several national ophthalmology societies. Participants completed a modified Mini Z Burnout Survey, a 10-item questionnaire measured in 5-point Likert scales, followed by demographic questions. The Mini Z Burnout survey assessed 3 main outcomes: stress, burnout, and work satisfaction. The percentage of subgroups experiencing burnout were presented and comparisons made with odds ratios from logistic regression modeling. RESULTS Of the 592 ophthalmologists responding to the survey, 37.8% (224) self-reported symptoms of burnout with a low of 30.8% (12/39) for vitreoretinal specialists to a high of 45.4% (30/66) for uveitis specialists. Most of those reporting burnout were categorized as mild (65.2% [146/224]), followed by moderate (29.5% [66/224]) and severe (5.4% [12/224]). Women had almost twice the odds of reporting burnout (odds ratio [OR] = 1.9 [95% CI: 1.3-2.7]; P = .0005). Physicians employed in academic (OR = 2.0 [95% CI: 1.2-3.2]; P = 0.007) and hospital facilities (OR = 2.4 [95% CI: 1.3-4.6]; P = .008) reported higher rates of burnout compared with those in large private groups. Burnout was associated with self-reported low work control, insufficient time for documentation, and misalignment with departmental leaders (P < .0001). CONCLUSIONS Ophthalmologists exhibited a high degree of self-reported burnout in the U.S. This study highlights sex, employment autonomy, and practice type as major factors associated with burnout.
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Affiliation(s)
- Jessica A Sedhom
- From the Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana (Sedhom); Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado (Patnaik); Department of Ophthalmology, University of Colorado, Aurora, Colorado (McCourt, Liao, Subramanian, Davidson, Palestine, Kahook, Patnaik, Seibold)
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Usta J, Candib LM, Oyola S, Abdul Razzak F, Antoun J. Women family physicians' working conditions and career satisfaction: a multinational study. Fam Pract 2022; 39:323-331. [PMID: 34664064 DOI: 10.1093/fampra/cmab119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND As the proportion of women in family medicine increases, their well-being and job satisfaction become concerns. OBJECTIVES This study aimed to uncover the working conditions and career satisfaction of women family physicians across multiple countries. METHODS A cross-sectional survey of the WONCA Working Party on Women and Family Medicine listserv members to assess working conditions and career satisfaction, with snowballing recruitment. Aspects of physician job satisfaction were measured using the validated Physician Work-Life Survey and calculated as the sum of the scores of each positive item divided by the total number of questions and multiplied by 10. The association between satisfaction and the continent and the country income level was performed using a one-way ANOVA test (P < 0.05). RESULTS A total of 315 participants across 49 countries responded to the survey with 205 complete responses. Women family physicians reported high overall career satisfaction (8.2 ± 2.3) but were less satisfied with some aspects of their career such as pay (5.3 ± 3.4), personal time (3.5 ± 2.6), and administrative tasks (3.2 ± 3.7). Despite the widespread experience of sexism at work, satisfaction with personal career aspects was universal at the continent and income level, while satisfaction with other career aspects relevant to relationships in work environment and resources varied. CONCLUSION Women family physicians around the world are overall satisfied with their careers. However, variation in certain working conditions among countries leaves room for improvement, drawing attention to the need for national review of working environments and pay scales.
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Affiliation(s)
- Jinan Usta
- Department of Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Lucy M Candib
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sonia Oyola
- Department of Family Medicine, University of Chicago, Chicago, IL, USA
| | - Farah Abdul Razzak
- Department of Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Jumana Antoun
- Department of Family Medicine, American University of Beirut, Beirut, Lebanon
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Rowe SG, Stewart MT, Van Horne S, Pierre C, Wang H, Manukyan M, Bair-Merritt M, Lee-Parritz A, Rowe MP, Shanafelt T, Trockel M. Mistreatment Experiences, Protective Workplace Systems, and Occupational Distress in Physicians. JAMA Netw Open 2022; 5:e2210768. [PMID: 35522279 PMCID: PMC9077480 DOI: 10.1001/jamanetworkopen.2022.10768] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Reducing physician occupational distress requires understanding workplace mistreatment, its relationship to occupational well-being, and how mistreatment differentially impacts physicians of diverse identities. OBJECTIVES To assess the prevalence and sources of mistreatment among physicians and associations between mistreatment, occupational well-being, and physicians' perceptions of protective workplace systems. DESIGN, SETTING, AND PARTICIPANTS This survey study was administered in September and October 2020 to physicians at a large academic medical center. Statistical analysis was performed from May 2021 to February 2022. MAIN OUTCOMES AND MEASURES Primary measures were the Professional Fulfillment Index, a measure of intent to leave, and the Mistreatment, Protection, and Respect Measure (MPR). Main outcomes were the prevalence and sources of mistreatment. Secondary outcomes were the associations of mistreatment and perceptions of protective workplace systems with occupational well-being. RESULTS Of 1909 medical staff invited, 1505 (78.8%) completed the survey. Among respondents, 735 (48.8%) were women, 627 (47.1%) were men, and 143 (9.5%) did not share gender identity or chose "other"; 12 (0.8%) identified as African American or Black, 392 (26%) as Asian, 10 (0.7%) as multiracial, 736 (48.9%) as White, 63 (4.2%) as other, and 292 (19.4%) did not share race or ethnicity. Of the 1397 respondents who answered mistreatment questions, 327 (23.4%) reported experiencing mistreatment in the last 12 months. Patients and visitors were the most common source of mistreatment, reported by 232 physicians (16.6%). Women were more than twice as likely as men to experience mistreatment (31% [224 women] vs 15% [92 men]). On a scale of 0 to 10, mistreatment was associated with a 1.13 point increase in burnout (95% CI, 0.89 to 1.36), a 0.99-point decrease in professional fulfillment (95% CI, -1.24 to -0.73), and 129% higher odds of moderate or greater intent to leave (odds ratio, 2.29; 95% CI, 1.75 to 2.99). When compared with a perception that protective workplace systems are in place "to a very great extent," a perception that there are no protective workplace systems was associated with a 2.41-point increase in burnout (95% CI, 1.80 to 3.02), a 2.81-point lower professional fulfillment score (95% CI, -3.44 to -2.18), and 711% higher odds of intending to leave (odds ratio, 8.11; 95% CI, 3.67 to 18.35). CONCLUSIONS AND RELEVANCE This survey study found that mistreatment was common among physicians, varied by gender, and was associated with occupational distress. Patients and visitors were the most frequent source, and perceptions of protective workplace systems were associated with better occupational well-being. These findings suggest that health care organizations should prioritize reducing workplace mistreatment.
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Affiliation(s)
- Susannah G. Rowe
- Office of Equity, Vitality and Inclusion, Boston University Medical Group, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Miriam T. Stewart
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Sam Van Horne
- Center for WorkLife Wellbeing, ChristianaCare, Wilmington, Delaware
| | - Cassandra Pierre
- Office of Equity, Vitality and Inclusion, Boston University Medical Group, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Hanhan Wang
- Stanford University School of Medicine, Stanford, California
| | - Makaila Manukyan
- Office of Equity, Vitality and Inclusion, Boston University Medical Group, Boston Medical Center, Boston, Massachusetts
| | - Megan Bair-Merritt
- Office of Equity, Vitality and Inclusion, Boston University Medical Group, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Aviva Lee-Parritz
- Office of Equity, Vitality and Inclusion, Boston University Medical Group, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Mary P. Rowe
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge
| | - Tait Shanafelt
- Stanford University School of Medicine, Stanford, California
| | - Mickey Trockel
- Stanford University School of Medicine, Stanford, California
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Hitti E, Hadid D, Khoury SJ, Tamim H, Makki M, Karam CM. Domestic tethers: Gender differences in career paths and domestic responsibilities of top-research medical school graduates. PLoS One 2022; 17:e0267288. [PMID: 35442989 PMCID: PMC9020711 DOI: 10.1371/journal.pone.0267288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Gendered differences in career paths of medical graduates persist globally. We aim to explore the impact of domestic tethers on the career paths of physicians by studying gendered differences in domestic burdens of physicians as well as differences in perceptions around the impact of domestic work on professional advancement. Methods A web-based survey including 38 questions was sent to all 3866 physician alumni of the top academic medical school in Lebanon. Data was collected between November 2018 and January 2019, with up to three invite reminders. Overall, 382 were included in the final analysis, 124 women (32%), 258 men (68%). Results The study had a response rate of 10.4%. Findings show that a greater percentage of men were married and had children (77.5% vs 62.1%, p = 0.004, 77.9% vs 51.6%, <0.001, respectively). Majority of both women and men held full-time positions (82.1% and 87.1%), having children however reduced the odds significantly [OR = 0.2, 95% CI: (0.1–0.6), p = 0.01]for women, while only older age reduced it for men (OR = 0.1,95% CI: (0.04–0.2), p<0.001]. Among full-time physicians, men and women spent similar time on professional activities (60.2hrs/wk vs 58.3hrs/wk, p = 0.32). Women spent more time on parenting and household work (23.5hrs/wk vs 10.4hrs/wk, <0.001; 8.9hrs/wk vs 6.0hrs/wk, p = 0.001, respectively). Women physicians’ spouses contributed to 14.5 hours/week of total time on domestic activities whereas men physicians’ spouses spent two folds more time on domestic activities (35.0 hours/week, P<0.001). Of physicians with children, a higher percentage of women than men reported that children prevented their career advancement or their participation in development opportunities (43.8% vs 15.9%, p<0.001; 50.0% vs 19.4%, p<0.001, respectively). A greater percentage of women than men scaled back their career after first child (31.3% vs 3.5%, <0.001). Of married/partnered physicians, fewer women than men reported their career took priority over their partner’s when conflicts arose, (52.0% vs 86.0%, p<0.001). Conclusion These findings highlight the heavier impact of domestic tethers on the career paths of women physicians than men physicians. Men are more likely than women to hold full-time positions in the early advancement defining phases of their careers. Full-time women shoulder more domestic work than men and experience more professional advancement concessions. Closing persistent gender gaps in medicine requires addressing inequities in domestic burdens through strategies that include mentorship on domestic tethers, support of on-site child-care and advocacy for parental leave policies that encourage shared care-work.
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Affiliation(s)
- Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- * E-mail:
| | - Dima Hadid
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J. Khoury
- Abu Haidar Neuroscience Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Maha Makki
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Charlotte M. Karam
- Telfer School of Management, University of Ottawa and Olayan School of Business, American University of Beirut, Beirut, Lebanon
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Medline A, Grissom H, Guissé NF, Kravets V, Hobson S, Samora JB, Schenker M. From Self-efficacy to Imposter Syndrome: The Intrapersonal Traits of Surgeons. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202204000-00012. [PMID: 35412493 PMCID: PMC10566864 DOI: 10.5435/jaaosglobal-d-22-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Demographic differences among surgical trainees regarding intrapersonal traits, such as imposter syndrome and assertiveness, have become widely acknowledged. However, many of these characteristics have not been examined in tandem, nor among both trainees and surgeons in practice. This study aimed to address these knowledge gaps. METHODS This was an anonymous, voluntary survey study comprised of validated measures of (1) self-efficacy, (2) imposter syndrome, (3) assertiveness, (4) perfectionism, and (5) self-rated likeability. A multimodal recruitment strategy was used and surgeons across all subspecialties were eligible for inclusion. RESULTS A total of 296 participants were included, with 54% identifying as female (n = 161) and 72% between the ages of 25 and 40 years of age (n = 212). Imposter syndrome, assertiveness, and perfectionism scales were normally distributed; self-efficacy and self-rated likeability scales demonstrated slight negative skew. Self-identified male sex was associated with less imposter syndrome (P < 0.001) and perfectionism (P = 0.035) and higher assertiveness (P < 0.001). Imposter syndrome was less common among older age groups (P = 0.001). CONCLUSIONS Surgeons are a self-efficacious group of perfectionists with widespread variability in imposter syndrome and assertiveness. Female sex and younger age were associated with more imposter syndrome and less assertiveness, highlighting an opportunity for early career coaching.
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Affiliation(s)
- Alexandra Medline
- From the Emory University School of Medicine, Atlanta, GA (Medline, Dr. Grissom, Kravets, Dr. Hobson, and Dr. Schenker); the Emory University Department of Orthopaedic Surgery, Atlanta, GA; the Washington University Department of Orthopaedic Surgery, St. Louis, MO (Dr. Guissé); and the Nationwide Children's Hospital, Columbus, OH (Dr. Samora)
| | - Helyn Grissom
- From the Emory University School of Medicine, Atlanta, GA (Medline, Dr. Grissom, Kravets, Dr. Hobson, and Dr. Schenker); the Emory University Department of Orthopaedic Surgery, Atlanta, GA; the Washington University Department of Orthopaedic Surgery, St. Louis, MO (Dr. Guissé); and the Nationwide Children's Hospital, Columbus, OH (Dr. Samora)
| | - Ndéye F. Guissé
- From the Emory University School of Medicine, Atlanta, GA (Medline, Dr. Grissom, Kravets, Dr. Hobson, and Dr. Schenker); the Emory University Department of Orthopaedic Surgery, Atlanta, GA; the Washington University Department of Orthopaedic Surgery, St. Louis, MO (Dr. Guissé); and the Nationwide Children's Hospital, Columbus, OH (Dr. Samora)
| | - Victoria Kravets
- From the Emory University School of Medicine, Atlanta, GA (Medline, Dr. Grissom, Kravets, Dr. Hobson, and Dr. Schenker); the Emory University Department of Orthopaedic Surgery, Atlanta, GA; the Washington University Department of Orthopaedic Surgery, St. Louis, MO (Dr. Guissé); and the Nationwide Children's Hospital, Columbus, OH (Dr. Samora)
| | - Sandra Hobson
- From the Emory University School of Medicine, Atlanta, GA (Medline, Dr. Grissom, Kravets, Dr. Hobson, and Dr. Schenker); the Emory University Department of Orthopaedic Surgery, Atlanta, GA; the Washington University Department of Orthopaedic Surgery, St. Louis, MO (Dr. Guissé); and the Nationwide Children's Hospital, Columbus, OH (Dr. Samora)
| | - Julie Balch Samora
- From the Emory University School of Medicine, Atlanta, GA (Medline, Dr. Grissom, Kravets, Dr. Hobson, and Dr. Schenker); the Emory University Department of Orthopaedic Surgery, Atlanta, GA; the Washington University Department of Orthopaedic Surgery, St. Louis, MO (Dr. Guissé); and the Nationwide Children's Hospital, Columbus, OH (Dr. Samora)
| | - Mara Schenker
- From the Emory University School of Medicine, Atlanta, GA (Medline, Dr. Grissom, Kravets, Dr. Hobson, and Dr. Schenker); the Emory University Department of Orthopaedic Surgery, Atlanta, GA; the Washington University Department of Orthopaedic Surgery, St. Louis, MO (Dr. Guissé); and the Nationwide Children's Hospital, Columbus, OH (Dr. Samora)
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Cha E, Mathis NJ, Joshi H, Sharma S, Zinovoy M, Ru M, Cahlon O, Gillespie EF, Marshall DC. Bias in Patient Experience Scores in Radiation Oncology: A Multicenter Retrospective Analysis. J Am Coll Radiol 2022; 19:542-551. [PMID: 35247326 PMCID: PMC9017791 DOI: 10.1016/j.jacr.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient experience scores are increasingly important in measuring quality of care and determining reimbursement from payers, including the Hospital Value-Based Purchasing Program and the Radiation Oncology Model. However, the role of bias in patient experience scores in oncology is unknown, raising the possibility that such payment structures may inadvertently perpetuate bias in reimbursement. Therefore, the authors characterized patient-, physician-, and practice-level predictors of patient experience scores in patients undergoing radiation therapy. METHODS The authors retrospectively reviewed patient experience surveys for radiation oncology patients treated at two large multisite academic cancer centers. The outcome was responses on four survey questions. Covariates included self-reported patient demographics, physician characteristics, practice setting characteristics, and wait-time rating linked to each survey. Multivariable ordinal regression models were fitted to identify predictors of receiving a higher score on each of the survey questions. RESULTS In total, 2,868 patients completed surveys and were included in the analysis. Patient experience scores were generally high, with >90% of respondents answering 5 of 5 on the four survey items. Physician gender was not associated with any measured patient experience outcomes (P > 0.40 for all). Independent predictors of higher score included a wait-time experience classified as "good" as compared with "not good" (q < .001 for all). CONCLUSIONS Oncology practices aiming to improve patient experience scores may wish to focus their attention on improving wait times for patients. Although a difference in patient experience scores on the basis of physician gender was not observed, such bias is likely to be complex, and further research is needed to characterize its effects.
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Affiliation(s)
- Elaine Cha
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Noah J Mathis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Himanshu Joshi
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sonam Sharma
- Assistant Program Director, Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Zinovoy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meng Ru
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Oren Cahlon
- Deputy Physician-in-Chief for Strategic Partnerships and Vice Chair, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
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McKayMadeleine, Lavergne MR, Prince LeaAmanda, Le M, Grudniewicz A, Blackie D, Goldsmith LJ, Marshall EG, Mathews M, McCracken R, McGrail K, Wong S, Rudoler D. Government policies targeting primary care physician practice from 1998-2018 in three Canadian provinces: A jurisdictional scan. Health Policy 2022; 126:565-575. [DOI: 10.1016/j.healthpol.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 02/22/2022] [Accepted: 03/11/2022] [Indexed: 11/28/2022]
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Creating work environments where people of all genders in gynecologic oncology can thrive: An SGO evidence-based review. Gynecol Oncol 2022; 164:473-480. [PMID: 35000796 PMCID: PMC9465952 DOI: 10.1016/j.ygyno.2021.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/14/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023]
Abstract
Equality, equity, and parity in the workplace are necessary to optimize patient care across all aspects of medicine. Gender-based inequities remain an obstacle to quality of care, including within the now majority women subspecialty of gynecologic oncology. The results of the 2020 SGO State of the Society Survey prompted this evidence-based review. Evidence related to relevant aspects of the clinical care model by which women with malignancies are cared for is summarized. Recommendations are made that include ways to create work environments where all members of a gynecologic oncology clinical care team, regardless of gender, can thrive. These recommendations aim to improve equality and equity within the specialty and, in doing so, elevate the care that our patients receive.
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Kumaresan A, Suganthirababu P, Srinivasan V, Vijay Chandhini Y, Divyalaxmi P, Alagesan J, Vishnuram S, Ramana K, Prathap L. Prevalence of burnout syndrome among Work-From-Home IT professionals during the COVID-19 pandemic. Work 2022; 71:379-384. [PMID: 35095012 DOI: 10.3233/wor-211040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many countries adopted a complete or partial lockdown to prevent the spread of COVID-19, and various professions started to work-from-home. People who work-from-home experience constant stress which leads to burnout syndrome. Burnout can be defined as a chronic stress-induced occupational syndrome resulting in fatigue, decreased job productivity, and poor motivation towards the job. OBJECTIVE This research work primarily focuses on exploring the prevalence of burnout syndrome among IT professionals who work-from-home and to determine the impact of burnout in different gender and age-groups during the COVID-19 pandemic. METHODS Using snowball sampling method 934 IT professionals were selected based on selection criteria, explained about the study processes, and instructed to submit an online survey consist of Maslach Burnout Inventory scale (MBI) through mail, social media, or through a researcher by direct interview. RESULTS Descriptive statistics were used to interpret the data. In 25-30 years age-group, men were affected (93%) less than women (94%) and also in 31-35 years age-group, men were affected (96%) less than women (98%). Overall burnout scores of men were 94% and women were 96%. Results indicate female IT professionals were more prone experience burnout syndrome than Male population. CONCLUSIONS From the results, it is concluded that 95% of the IT professionals are suffering from burnout, where women are more prevalent to burnout when compared to male. It is also suggested that an early, routine and frequent assessment of physical status, mental status and burnout syndrome is essential to maintain mental health.
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Affiliation(s)
- A Kumaresan
- Saveetha College of Physiotherapy, SIMATS, Chennai, India
| | | | | | | | - P Divyalaxmi
- Saveetha College of Physiotherapy, SIMATS, Chennai, India
| | | | | | - K Ramana
- Saveetha College of Physiotherapy, SIMATS, Chennai, India
| | - Lavanya Prathap
- Department of Anatomy, Saveetha Dental college, SIMATS, Chennai, India
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Ukeje C, Elmasri A, Kielb S. Improving Gender Diversity in Urologic Residency Training. Curr Urol Rep 2021; 22:60. [PMID: 34913093 DOI: 10.1007/s11934-021-01074-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Women remain underrepresented in urology despite being well-represented in medicine overall. A more diverse urological workforce has the potential to lead to better health outcomes for patients. This paper presents an overview of barriers faced by women in urology at the student, resident, and attending level and potential solutions to mitigate these issues. RECENT FINDINGS Although the number of women entering urology has increased since the first woman became a board-certified urologist in 1962, women still are underrepresented, advance more slowly, and hold only a small percentage of leadership positions. Women in urology and surgical fields in general face numerous challenges and obstacles which can be improved to bring and keep more women in the field of urology. Recent efforts by both academic urologists and trainees themselves offer hope for change. Women in urology face challenges in the field which include more limited mentorship opportunities, harassment and bias, and 'pigeonholing'. Recent efforts by both academic urologists and trainees themselves offer hope for change to attract and keep more women in the field. These efforts include the American Urological Association's public commitment to advocating for and fostering a diverse and inclusive environment within urology. A more diverse urological workforce has the potential to lead to better health outcomes for patients, particularly in those populations where access to urological care may be limited.
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Affiliation(s)
- Chideraa Ukeje
- Department of Urology, Feinberg School of Medicine, Northwestern University, 676 N St. Clair, Suite 2300, Chicago, IL, 60611, USA
| | - Ayman Elmasri
- Department of Urology, Feinberg School of Medicine, Northwestern University, 676 N St. Clair, Suite 2300, Chicago, IL, 60611, USA
| | - Stephanie Kielb
- Department of Urology, Feinberg School of Medicine, Northwestern University, 676 N St. Clair, Suite 2300, Chicago, IL, 60611, USA.
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Poplau S, Linzer M, Allwood D, Montori V, Armbruster R, Koka S. Designing the careful and kind clinic: an evidence-based approach. BMJ LEADER 2021; 6:87-91. [DOI: 10.1136/leader-2021-000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/28/2021] [Indexed: 11/04/2022]
Abstract
BackgroundThere is evidence that creating a ‘healthy workplace’ can be of profound importance for clinicians, team members and patients. Yet there have been few papers that have proposed mechanisms to take decades of research and translate this into a practical list of options for leaders and managers to take into account when structuring a clinic based on care and kindness to achieve optimal health.EvidenceWe bring together 20 years of scholarship linking care of the caregivers with outcomes for caregivers and patients. The data are used to support both structures and cultures that will result in satisfied and thriving healthcare team members, as well as satisfied and healthy patients.ResultsThe clinic based on care of the caregivers will be structured to address key aspects of worklife that are known to cause either satisfaction or burnout. Aspects of care, such as time pressure, chaotic environments and worker control of their workplace, will be taken into account in clinical design; organisational culture will be supportive and cohesive, emphasising quality, values and communication. Experiences based on gender and race will be measured and continuously improved; and performance will be evaluated in a new, human-centred manner.OutcomesThe careful and kind clinic will be a remarkable place to work; in contrast to industrialised healthcare, this will be an environment where health can indeed be optimised, for both workers and patients.
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Rotenstein L, Harry E, Wickner P, Gupte A, Neville BA, Lipsitz S, Cullen E, Rozenblum R, Sequist TD, Dudley J. Contributors to Gender Differences in Burnout and Professional Fulfillment: A Survey of Physician Faculty. Jt Comm J Qual Patient Saf 2021; 47:723-730. [PMID: 34507905 DOI: 10.1016/j.jcjq.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study was conducted to describe gender differences in physician burnout and professional fulfillment and to explore their potential contributors. METHODS This was a single-center, cross-sectional survey study of physician faculty at Brigham and Women's Hospital, an academic medical center in Boston. The population included all physician faculty who practiced clinical medicine in 2017 (n = 2,388). The study was conducted using the Stanford Physician Wellness Survey. Burnout and professional fulfillment were the main outcome measures assessed. Other variables assessed included ratings of culture of wellness, personal resilience, and efficiency of practice factors associated with physician experience. RESULTS The study population consisted of 1,066 faculty, of whom 46.4% were female and 59.8% were younger than 50. Female physicians reported significantly higher rates of burnout (42.4% vs. 34.4%, p = 0.01) and lower rates of professional fulfillment (35.1% vs. 50.4%, p < 0.01) than male physicians. Female physicians reported lower ratings for self-compassion and multiple culture of wellness factors. After adjusting for demographic factors and academic rank, the study team identified multiple culture of wellness factors (perceived appreciation, schedule control, work environment diversity and inclusion) and self-compassion as attenuating the significant relationship between gender and burnout. Only perceived appreciation attenuated the significant relationship between gender and professional fulfillment. CONCLUSION This study demonstrated higher rates of burnout and lower rates of professional fulfillment among female vs. male physician faculty. Culture of wellness factors and self-compassion may contribute to gender differences in burnout and professional fulfillment and potentially represent modifiable targets for efforts seeking to eliminate gender disparities in physicians' workplace experiences.
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Ramas ME, Webber S, Braden AL, Goelz E, Linzer M, Farley H. Innovative Wellness Models to Support Advancement and Retention Among Women Physicians. Pediatrics 2021; 148:e2021051440H. [PMID: 34873620 DOI: 10.1542/peds.2021-051440h] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/24/2022] Open
Abstract
Despite improvements in representation of women in academic medicine, the rate of promotion and career advancement remains unequal. Compared with their male colleagues, women report lower rates of personal-organizational value alignment and higher rates of burnout. Particular challenges further exist for Black women, Indigenous women, women of color, and third gender or gender nonbinary faculty. Promoting the well-being of women physicians requires innovative approaches beyond the traditional scope of physician well-being efforts and careful attention to the unique barriers women face. Three wellness-oriented models are presented to promote the professional fulfillment and well-being of women physicians: (1) redefine productivity and create innovative work models, (2) promote equity through workplace redesign and burnout reduction, and (3) promote, measure, and improve diversity, equity, and inclusion. By engaging in innovative models for equitable advancement and retention, it is anticipated that diverse groups of women faculty will be better represented at higher levels of leadership and thus contribute to the creation of more equitable work climates, fostering well-being for women physicians.
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Affiliation(s)
- Marie-Elizabeth Ramas
- GateHouse Treatment Center, Southern New Hampshire Medical Center, Nashua, New Hampshire
| | - Sarah Webber
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Andrea L Braden
- Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Elizabeth Goelz
- Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota
| | - Heather Farley
- Center for WorkLife Wellbeing, ChristianaCare, Wilmington, Delaware
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Alli A, Lin T, Thorndyke LE, Parekh R, Nunez A. Advancing Women to Leadership Positions Through Individual Actions and Institutional Reform. Pediatrics 2021; 148:e2021051440D. [PMID: 34470879 DOI: 10.1542/peds.2021-051440d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 01/13/2023] Open
Abstract
Women in medicine experience disparities in the workplace and in achieving leadership roles. They face challenges related to climate and culture, equitable compensation, work-life integration, opportunities for professional development and advancement, and occupational and systemic factors that can lead to burnout. Without specific resources to support women's development and advancement and promote conducive workplace climates, efforts to recruit, retain, and promote women physicians into leadership roles may be futile. This article is designed for 2 audiences: women physicians of all career stages, who are exploring factors that may adversely impact their advancement opportunities, and leaders in academic medicine and health care, who seek to achieve inclusive excellence by fully engaging talent. The need for greater representation of women leaders in medicine is both a moral and a business imperative that requires systemic changes. Individuals and institutional leaders can apply the practical strategies and solutions presented to catalyze successful recruitment, retention, and promotion of women leaders and widespread institutional reform.
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Affiliation(s)
| | - Tammy Lin
- Health Sciences, University of California, San Diego, San Diego, California
| | - Luanne E Thorndyke
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ranna Parekh
- American College of Cardiology, Washington, District of Columbia
| | - Ana Nunez
- Medical School, University of Minnesota, Minneapolis, Minnesota
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