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Dodelzon K, Milch HS, Mullen LA, Dialani V, Jacobs S, Parikh JR, Grimm LJ. Factors Contributing to Disproportionate Burnout in Women Breast Imaging Radiologists: A Review. JOURNAL OF BREAST IMAGING 2024; 6:124-132. [PMID: 38330442 DOI: 10.1093/jbi/wbad104] [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: 07/20/2023] [Indexed: 02/10/2024]
Abstract
Physician burnout continues to increase in prevalence and disproportionately affects women physicians. Breast imaging is a woman-dominated subspeciality, and therefore, worsening burnout among women physicians may have significant repercussions on the future of the breast imaging profession. Systemic and organizational factors have been shown to be the greatest contributors to burnout beyond individual factors. Based on the Mayo Model, we review the evidence regarding the 7 major organizational contributors to physician burnout and their potential disproportionate impacts on women breast radiologists. The major organizational factors discussed are work-life integration, control and flexibility, workload and job demands, efficiency and resources, finding meaning in work, social support and community at work, and organizational culture and values. We also propose potential strategies for institutions and practices to mitigate burnout in women breast imaging radiologists. Many of these strategies could also benefit men breast imaging radiologists, who are at risk for burnout as well.
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Affiliation(s)
- Katerina Dodelzon
- Department of Radiology, Weill Cornell Medicine at NewYork-Presbyterian, New York, NY, USA
| | - Hannah S Milch
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lisa A Mullen
- Division of Breast Imaging, The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Vandana Dialani
- Division of Breast Imaging, Department of Radiology, Beth Israel Lahey Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarah Jacobs
- New Ulm Medical Center Radiology, Allina Health, New Ulm, MN, USA
| | - Jay R Parikh
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
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Wilkinson T, Ajjawi R, Mansouri S. Informal peer support for rural doctors. CANADIAN JOURNAL OF RURAL MEDICINE 2024; 29:55-62. [PMID: 38709015 DOI: 10.4103/cjrm.cjrm_16_23] [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: 03/27/2023] [Accepted: 06/13/2023] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Practising medicine exposes physicians to emotionally difficult situations, which can be devastating, and for which they might be unprepared. Informal peer support has been recognised as helpful, although this phenomenon is understudied. Hence, it is important to develop a better understanding of the features of helpful informal peer support from the experiences of physicians who have successfully moved through such difficult events. This could lead to new and potentially more effective ways to support struggling physicians. METHODS Rural Canadian generalist physicians were interviewed. Using a hermeneutic phenomenological approach, data analysis was oriented towards understanding features of helpful informal peer support and the meanings that participants derived from the experience. RESULTS Eleven rural generalist physicians took part. Peer support prompted the processing of difficult emotional experiences, which initially seemed insurmountable and career-ending. Participants overcame feelings of emotional distress after even brief encounters of informal peer support. Most participants described the support they received as vitally important. After the peer support encounter, practitioners no longer thought of leaving medical practice and felt more able to handle such difficulties moving forward. CONCLUSIONS Informal peer support enabled recipients to move through an emotionally difficult experience. Empathy, shared vulnerability and connection were the part of the peer support encounter. In addition, the support offered benefits which are known to help physicians not only process emotionally difficult events but also to acquire 'post-traumatic growth'. Practitioners, healthcare leaders and medical educators all have roles to play in enabling the conditions for informal peer support to flourish. INTRODUCTION La pratique de la médecine expose les médecins à des situations émotionnellement difficiles, qui peuvent être dévastatrices, et auxquelles ils ne sont pas préparés. Le soutien informel par les pairs a été reconnu comme utile, même si ce phénomène est peu étudié. Il est donc important de mieux comprendre les caractéristiques du soutien informel par les pairs à partir des expériences de médecins qui ont réussi à traverser des événements aussi difficiles. Cela pourrait conduire à de nouvelles façons, potentiellement plus efficaces, de soutenir les médecins en difficulté. MTHODES Onze médecins généralistes canadiens ruraux ont été interrogés. En utilisant une approche phénoménologique herméneutique, l'analyse des données a été orientée vers la compréhension des caractéristiques du soutien informel utile par les pairs et des significations que les participants ont tirées de l'expérience. RSULTATS Le soutien des pairs a incité à vivre des expériences émotionnelles difficiles, qui semblaient au départ insurmontables et mettant fin à une carrière. Les participants ont surmonté leurs sentiments de détresse émotionnelle après même de brèves rencontres de soutien informel par leurs pairs. La plupart des participants ont décrit le soutien qu'ils ont reçu comme étant d'une importance vitale. Après la rencontre de soutien par les pairs, les praticiens ne pensaient plus à quitter la pratique médicale et SE sentaient plus capables de faire face à de telles difficultés à l'avenir. CONCLUSION Le soutien informel par les pairs a permis aux bénéficiaires de traverser une expérience émotionnellement difficile. L'empathie, la vulnérabilité partagée et la connexion faisaient partie de la rencontre de soutien par les pairs. En outre, le soutien a offert des avantages connus pour aider les médecins non-seulement à gérer des événements émotionnellement difficiles, mais également à acquérir une 'croissance post-traumatique'. Les praticiens, les dirigeants des soins de santé et les enseignants en médecine ont tous un rôle à jouer pour permettre aux conditions propices au soutien informel par les pairs de s'épanouir.
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Affiliation(s)
- Tandi Wilkinson
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Nelson, BC, Canada
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Burwood, Australia
| | - Shireen Mansouri
- Department of Family Practice, Faculty of Medicine, University of Calgary, Yellowknife, NT, Canada
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Miller AN, Strelzow JA, Sakran JV, Ficke JR. AOA Critical Issues Symposium: Gun Violence as a Public Health Crisis. J Bone Joint Surg Am 2024:00004623-990000000-01043. [PMID: 38502726 DOI: 10.2106/jbjs.23.01260] [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: 03/21/2024]
Abstract
ABSTRACT Gun violence is an epidemic throughout the United States and is increasing around the world-it is a public health crisis. The impact of gun violence is not limited to the victims (our patients); it also extends to the physicians and caregivers who are taking care of these patients every day. Even more broadly, gun violence affects those living and going to work in potentially dangerous environments. The "vicarious trauma" that is experienced in these situations can have long-term effects on physicians, nurses, and communities. Importantly, socioeconomic disparities and community deprivation strongly correlate with gun violence. Systemic factors that are deeply ingrained in our society can increase concerns for these underrepresented patient populations and cause increased stressors with substantial health consequences, including delayed fracture-healing and poorer overall health outcomes. It is incumbent on us as physicians to take an active role in speaking up for our patients. The importance of advocacy efforts to change policy (not politics) and continue to push for improvement in the increasingly challenging environments in which patients and physicians find themselves cannot be overstated. Multiple national organizations, including many orthopaedic and general surgery associations, have made statements advocating for change. The American College of Surgeons, in collaboration with many other medical organizations, has supported background checks, registration, licensure, firearm education and training, safe storage practices, red flag laws, addressing mental health issues, and more research to better inform an approach going forward and to address the root causes of violence. We encourage the orthopaedic surgery community to stand together to protect each other and our patients, both physically and mentally, with agreement on these principles.
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Affiliation(s)
- Anna N Miller
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Jason A Strelzow
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
| | - Joseph V Sakran
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - James R Ficke
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Sizemore R, Huecker M, Shreffler J, Zaino M, Thomas A, Kelley J. Physician Path to Wellness. A Qualitative Investigation of Self-Reported Strategies to Shift from Detrimental Health to Optimal Wellness. Am J Lifestyle Med 2024; 18:131-140. [PMID: 39184276 PMCID: PMC11339770 DOI: 10.1177/15598276221114314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
Background: A healthy physician performs better clinically and provides superior care to patients than a physician struggling with burnout. Objective: The purpose of this study is to assess the physician perception of "health" and "burnout," to identify successful wellness-promoting behaviors, and to build a model characterizing the successful transition from poor health to wellness. Methods: Utilizing a qualitative approach, the team conducted one-on-one, in-depth, semi-structured interviews with physicians from different specialties. Questions focused on behaviors, beliefs, and system changes that facilitated their transition from poor health/burnout to wellness. Interviews were recorded and responses qualitatively coded from a set of definitions of wellness and burnout. These coded responses were quantified, and code prevalence was analyzed. Results: Fourteen physicians completed interviews. The codebook consisted of 74 total themes, with nine occurring in more than 10 (71%) of the interviews. Most themes yielded to categories of Wellness, Unwell, and Burnout, with several themes related to individual agency in facilitating wellness. Highly prevalent themes included support systems, nutrition, exercise, and cognitive health. Subjects generally described comprehensive approaches to successfully transitioning to wellness. Conclusion: This study describes strategies for the successful transition to wellness: physician-level factors such as a healthy support system, maintaining a healthy lifestyle, and developing consistent daily routines. These findings support the importance of physician autonomy and individual-level wellness-promoting strategies for a physician's transition to wellness. More research should investigate the overall effect of individual-level strategies versus system-level interventions.
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Affiliation(s)
- Ross Sizemore
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (RS, MH, JS, AT); Internal Medicine, University of Louisville, Louisville, KY, USA (MZ); and Undergraduate Medical Education, Louisville, University of Louisville, KY, USA (JK)
| | - Martin Huecker
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (RS, MH, JS, AT); Internal Medicine, University of Louisville, Louisville, KY, USA (MZ); and Undergraduate Medical Education, Louisville, University of Louisville, KY, USA (JK)
| | - Jacob Shreffler
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (RS, MH, JS, AT); Internal Medicine, University of Louisville, Louisville, KY, USA (MZ); and Undergraduate Medical Education, Louisville, University of Louisville, KY, USA (JK)
| | - Mallory Zaino
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (RS, MH, JS, AT); Internal Medicine, University of Louisville, Louisville, KY, USA (MZ); and Undergraduate Medical Education, Louisville, University of Louisville, KY, USA (JK)
| | - Alyssa Thomas
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (RS, MH, JS, AT); Internal Medicine, University of Louisville, Louisville, KY, USA (MZ); and Undergraduate Medical Education, Louisville, University of Louisville, KY, USA (JK)
| | - Justin Kelley
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (RS, MH, JS, AT); Internal Medicine, University of Louisville, Louisville, KY, USA (MZ); and Undergraduate Medical Education, Louisville, University of Louisville, KY, USA (JK)
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Tolins ML, Rana JS, Lippert S, LeMaster C, Kimura YF, Sax DR. Implementation and effectiveness of a physician-focused peer support program. PLoS One 2023; 18:e0292917. [PMID: 37910457 PMCID: PMC10619771 DOI: 10.1371/journal.pone.0292917] [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: 03/01/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The practice of medicine faces a mounting burnout crisis. Physician burnout leads to worse mental health outcomes, provider turnover, and decreased quality of care. Peer support, a viable strategy to combat burnout, has been shown to be well received by physicians. METHODS This study evaluates the Peer Outreach Support Team (POST) program, a physician-focused peer support initiative established in a 2-hospital system, using descriptive statistical methodologies. We evaluate the POST program using the Practical Robust Implementation and Sustainability Model (PRISM) framework to describe important contextual factors including characteristics of the intervention, recipients, implementation and sustainability infrastructure, and external environment, and to assess RE-AIM outcomes including reach, effectiveness, adoption, implementation, and maintenance. RESULTS This program successfully trained 59 peer supporters across 11 departments in a 2-hospital system over a 3-year period. Trained supporters unanimously felt the training was useful and aided in general departmental culture shift (100% of respondents). After 3 years, 48.5% of physician survey respondents across 5 active departments had had a peer support interaction, with 306 successful interactions recorded. The rate of interactions increased over the 3-year study period, and the program was adopted by 11 departments, representing approximately 60% of all physicians in the 2-hospital system. Important implementation barriers and facilitators were identified. Physician recipients of peer support reported improved well-being, decreased negative emotions and stigma, and perceived positive cultural changes within their departments. CONCLUSIONS We found that POST, a physician-focused peer support program, had widespread reach and a positive effect on perceived physician well-being and departmental culture. This analysis outlines a viable approach to support physicians and suggests future studies considering direct effectiveness measures and programmatic adaptations. Our findings can inform and guide other healthcare systems striving to establish peer support initiatives to improve physician well-being.
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Affiliation(s)
- Molly L. Tolins
- Department of Emergency Medicine, Kaiser Permanente East Bay, The Permanente Medical Group, Oakland, California, United States of America
| | - Jamal S. Rana
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, The Permanente Medical Group, Oakland, California, United States of America
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Suzanne Lippert
- Department of Emergency Medicine, Kaiser Permanente East Bay, The Permanente Medical Group, Oakland, California, United States of America
| | - Christopher LeMaster
- Department of Emergency Medicine, Kaiser Permanente East Bay, The Permanente Medical Group, Oakland, California, United States of America
| | - Yusuke F. Kimura
- Department of Emergency Medicine, Kaiser Permanente East Bay, The Permanente Medical Group, Oakland, California, United States of America
| | - Dana R. Sax
- Department of Emergency Medicine, Kaiser Permanente East Bay, The Permanente Medical Group, Oakland, California, United States of America
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
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Hilty DM, Groshong LW, Coleman M, Maheu MM, Armstrong CM, Smout SA, Crawford A, Drude KP, Krupinski EA. Best Practices for Technology in Clinical Social Work and Mental Health Professions to Promote Well-being and Prevent Fatigue. CLINICAL SOCIAL WORK JOURNAL 2023; 51:1-35. [PMID: 37360756 PMCID: PMC10233199 DOI: 10.1007/s10615-023-00865-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 06/28/2023]
Abstract
The shift to communication technologies during the pandemic has had positive and negative effects on clinical social worker practice. Best practices are identified for clinical social workers to maintain emotional well-being, prevent fatigue, and avoid burnout when using technology. A scoping review from 2000 to 21 of 15 databases focused on communication technologies for mental health care within four areas: (1) behavioral, cognitive, emotional, and physical impact; (2) individual, clinic, hospital, and system/organizational levels; (3) well-being, burnout, and stress; and (4) clinician technology perceptions. Out of 4795 potential literature references, full text review of 201 papers revealed 37 were related to technology impact on engagement, therapeutic alliance, fatigue and well-being. Studies assessed behavioral (67.5%), emotional (43.2%), cognitive (57.8%), and physical (10.8%) impact at the individual (78.4%), clinic (54.1%), hospital (37.8%) and system/organizational (45.9%) levels. Participants were clinicians, social workers, psychologists, and other providers. Clinicians can build a therapeutic alliance via video, but this requires additional skill, effort, and monitoring. Use of video and electronic health records were associated with clinician physical and emotional problems due to barriers, effort, cognitive demands, and additional workflow steps. Studies also found high user ratings on data quality, accuracy, and processing, but low satisfaction with clerical tasks, effort required and interruptions. Studies have overlooked the impact of justice, equity, diversity and inclusion related to technology, fatigue and well-being, for the populations served and the clinicians providing care. Clinical social workers and health care systems must evaluate the impact of technology in order to support well-being and prevent workload burden, fatigue, and burnout. Multi-level evaluation and clinical, human factor, training/professional development and administrative best practices are suggested.
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Affiliation(s)
- Donald M. Hilty
- Department of Psychiatry & Behavioral Sciences, UC Davis, 2230 Stockton Boulevard, Sacramento, CA 95817 USA
| | | | - Mirean Coleman
- National Association of Social Workers, Washington, DC USA
| | - Marlene M. Maheu
- Coalition for Technology in Behavioral Sciences, Telebehavioral Health Institute, Inc, 5173 Waring Road #124, San Diego, CA 92120 USA
| | - Christina M. Armstrong
- Department of Veterans Affairs, Connected Health Implementation Strategies, Office of Connected Care, Office of Health Informatics, U.S., 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Shelby A. Smout
- Virginia Commonwealth University, 3110 Kensington Ave Apt 3, Richmond, VA 23221 USA
| | - Allison Crawford
- Ontario Mental Health at CAMH, Toronto, Canada
- University of Toronto, Toronto, Canada
- Suicide Prevention Service, 1001 Queen St West, Toronto, ON M6J 1H4 Canada
| | - Kenneth P. Drude
- Coalition Technology in Behavioral Science, 680 E. Dayton Yellow Springs Rd, Fairborn, OH 45324 USA
| | - Elizabeth A. Krupinski
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
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Shanafelt TD, Larson D, Bohman B, Roberts R, Trockel M, Weinlander E, Springer J, Wang H, Stolz S, Murphy D. Organization-Wide Approaches to Foster Effective Unit-Level Efforts to Improve Clinician Well-Being. Mayo Clin Proc 2023; 98:163-180. [PMID: 36603944 DOI: 10.1016/j.mayocp.2022.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/14/2022] [Accepted: 10/12/2022] [Indexed: 01/05/2023]
Abstract
Health care delivery organizations are positioned to have a tremendous impact on addressing the variables in the practice environment that contribute to occupational distress and that, when optimized, can promote clinician well-being. Many organizations are committed to this work and have clarity on how to address general, system-wide issues and provide resources for individual clinicians. While such top of the organization elements are essential for success, many of the specific improvement efforts that are necessary must address local challenges at the work unit level (department, division, hospital ward, clinic). Uncertainty of how to address variability and the unique needs of different work units is a barrier to effective action for many health care delivery systems. Overcoming this challenge requires organizations to recognize that unit-specific improvement efforts require a system-level approach. In this manuscript, we outline 7 steps for organizations to consider as they establish the infrastructure to improve professional well-being and provide a description of application and evidence of efficacy from a large academic medical center. Such unit-level efforts to address the unique needs of each specialty and occupation at the work unit level have the ability to address many of the day-to-day issues that drive clinician well-being. An enterprise approach is necessary to systematically advance such unit-level action.
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Affiliation(s)
- Tait D Shanafelt
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA.
| | - David Larson
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Bryan Bohman
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Rachel Roberts
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Mickey Trockel
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Eva Weinlander
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jill Springer
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Hanhan Wang
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Sherilyn Stolz
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Daniel Murphy
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
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Knight AP, Rea M, Allgood JA, Sciolla AF, Haywood A, Stephens MB, Rajasekaran S. Bringing Needed Change to Medical Student Well-Being: A Call to Expand Accreditation Requirements. TEACHING AND LEARNING IN MEDICINE 2023; 35:101-107. [PMID: 35085041 DOI: 10.1080/10401334.2021.2020121] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
Issue: Noting high rates of burnout, depression, and suicidality among medical students, academic medical communities are trying to identify preventive and curricular measures that protect and promote student well-being. To date, the effectiveness of these efforts is unclear. In addition, evidence increasingly suggests that the major drivers of distress appear to be factors within the social, learning, and work environments. Specific to medical schools in the United States, neither the Liaison Committee on Medical Education nor the Commission on Osteopathic College Accreditation include accreditation standards regarding well-being curricula and, as such, these curricula are not well-integrated into students' medical school experience. Current accreditation standards also do not specifically require institutions to assess or address systemic factors of the learning environment that negatively affect student well-being. Evidence: This paper proposes expanding current Liaison Committee on Medical Education and Commission on Osteopathic College Accreditation standards on professionalism to incorporate well-being as a core component of professional identity formation by requiring individual and institutional-level actions. Proposed changes to accreditation standards include (1) institutional assessment of the impact of the learning environment on student well-being; (2) continuous quality improvement efforts to address structural factors associated with student well-being and modification of practices that impair student well-being; and (3) integrated curriculum with related assessment to educate students on empirically-supported strategies for well-being. Implications: Refining undergraduate medical education accreditation standards in the United States to include language specific to student well-being will facilitate long overdue changes to the learning environment. In the end, the goal is not just to improve medical student well-being, but to provide a workforce better equipped for a sustainable and meaningful career.
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Affiliation(s)
- Allison P Knight
- Student Affairs, Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Margaret Rea
- Student and Resident Wellness, University of California Davis School of Medicine, Sacramento, California, USA
| | - J Aaron Allgood
- Clinical Science Education and Department of Internal Medicine, A. T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona, USA
| | - Andres F Sciolla
- Department of Psychiatry, University of California Davis School of Medicine, Sacramento, California, USA
| | - Antwione Haywood
- Medical Student Education and Department of Clinical Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mark B Stephens
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Senthil Rajasekaran
- Curricular Affairs and Undergraduate Medical Education, Wayne State University School of Medicine, Detroit, Michigan, USA
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Shanafelt T, Sandborg C. Supporting Peer Supporters. Jt Comm J Qual Patient Saf 2022; 48:427-429. [PMID: 35842285 PMCID: PMC9101698 DOI: 10.1016/j.jcjq.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Hilty DM, Armstrong CM, Smout SA, Crawford A, Maheu MM, Drude KP, Chan S, Yellowlees PM, Krupinski EA. PROVIDER TECHNOLOGY, FATIGUE AND WELL-BEING: A SCOPING REVIEW (Preprint). J Med Internet Res 2021; 24:e34451. [PMID: 35612880 PMCID: PMC9178447 DOI: 10.2196/34451] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/20/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Video and other technologies are reshaping the delivery of health care, yet barriers related to workflow and possible provider fatigue suggest that a thorough evaluation is needed for quality and process improvement. Objective This scoping review explored the relationship among technology, fatigue, and health care to improve the conditions for providers. Methods A 6-stage scoping review of literature (from 10 databases) published from 2000 to 2020 that focused on technology, health care, and fatigue was conducted. Technologies included synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care in 4 concept areas related to provider experience: behavioral, cognitive, emotional, and physical impact; workplace at the individual, clinic, hospital, and system or organizational levels; well-being, burnout, and stress; and perceptions regarding technology. Qualitative content, discourse, and framework analyses were used to thematically analyze data for developing a spectrum of health to risk of fatigue to manifestations of burnout. Results Of the 4221 potential literature references, 202 (4.79%) were duplicates, and our review of the titles and abstracts of 4019 (95.21%) found that 3837 (90.9%) were irrelevant. A full-text review of 182 studies revealed that 12 (6.6%) studies met all the criteria related to technology, health care, and fatigue, and these studied the behavioral, emotional, cognitive, and physical impact of workflow at the individual, hospital, and system or organizational levels. Video and electronic health record use has been associated with physical eye fatigue; neck pain; stress; tiredness; and behavioral impacts related to additional effort owing to barriers, trouble with engagement, emotional wear and tear and exhaustion, cognitive inattention, effort, expecting problems, multitasking and workload, and emotional experiences (eg, anger, irritability, stress, and concern about well-being). An additional 14 studies that evaluated behavioral, emotional, and cognitive impacts without focusing on fatigue found high user ratings on data quality, accuracy, and processing but low satisfaction with clerical tasks, the effort required in work, and interruptions costing time, resulting in more errors, stress, and frustration. Our qualitative analysis suggests a spectrum from health to risk and provides an outline of organizational approaches to human factors and technology in health care. Business, occupational health, human factors, and well-being literature have not studied technology fatigue and burnout; however, their findings help contextualize technology-based fatigue to suggest guidelines. Few studies were found to contextually evaluate differences according to health professions and practice contexts. Conclusions Health care systems need to evaluate the impact of technology in accordance with the Quadruple Aim to support providers’ well-being and prevent workload burden, fatigue, and burnout. Implementation and effectiveness approaches and a multilevel approach with objective measures for clinical, human factors, training, professional development, and administrative workflow are suggested. This requires institutional strategies and competencies to integrate health care quality, technology and well-being outcomes.
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Affiliation(s)
- Donald M Hilty
- Department of Psychiatry & Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
- Northern California Veterans Affairs Health Care System, Mather, CA, United States
| | - Christina M Armstrong
- Office of Connected Care, Department of Veterans Affairs, Washington, DC, United States
| | - Shelby A Smout
- Virginia Commonwealth University, Richmond, VA, United States
| | - Allison Crawford
- Extension for Community Healthcare Outcomes, Ontario Mental Health at Centre for Addiction and Mental Health, University of Toronto Virtual Mental Health, and Canada Suicide Prevention Service, Toronto, ON, Canada
| | - Marlene M Maheu
- Telebehavioral Health Institute, LLC and Coalition for Technology in Behavioral Science, San Diego, CA, United States
| | - Kenneth P Drude
- Coalition for Technology in Behavioral Science & Ohio Board of Psychology, Dayton, OH, United States
| | - Steven Chan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine & Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Peter M Yellowlees
- Department of Psychiatry & Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Elizabeth A Krupinski
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
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McDiarmid M, Condon M, Gaitens J. The Healthcare Sector Employer's Duty of Care: Implications for Worker Well-Being. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6015. [PMID: 34205069 PMCID: PMC8199909 DOI: 10.3390/ijerph18116015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/20/2022]
Abstract
Pandemic diseases of this century have differentially targeted healthcare workers globally. These infections include Severe Acute Respiratory Syndrome SARS, the Middle East respiratory syndrome coronavirus Middle East respiratory syndrome coronavirus (MERS-CoV) and Ebola. The COVID-19 pandemic has continued this pattern, putting healthcare workers at extreme risk. Just as healthcare workers have historically been committed to the service of their patients, providing needed care, termed their "duty of care", so too do healthcare employers have a similar ethical duty to provide care toward their employees arising from historical common law requirements. This paper reports on results of a narrative review performed to assess COVID-19 exposure and disease development in healthcare workers as a function of employer duty of care program elements adopted in the workplace. Significant duty of care deficiencies reported early in the pandemic most commonly involved lack of personal protective equipment (PPE) availability. Beyond worker safety, we also provide evidence that an additional benefit of employer duty of care actions is a greater sense of employee well-being, thus aiding in the prevention of healthcare worker burnout.
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Affiliation(s)
| | - Marian Condon
- School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (M.M.); (J.G.)
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12
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Hlubocky FJ, Symington BE, McFarland DC, Gallagher CM, Dragnev KH, Burke JM, Lee RT, El-Jawahri A, Popp B, Rosenberg AR, Thompson MA, Dizon DS, Srivastava P, Patel MI, Kamal AH, Daugherty CK, Back AL, Dokucu ME, Shanafelt TD. Impact of the COVID-19 Pandemic on Oncologist Burnout, Emotional Well-Being, and Moral Distress: Considerations for the Cancer Organization's Response for Readiness, Mitigation, and Resilience. JCO Oncol Pract 2021; 17:365-374. [PMID: 33555934 DOI: 10.1200/op.20.00937] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fay J Hlubocky
- University of Chicago Medicine, Maclean Center for Clinical Medical Ethics, Chicago, IL
| | | | - Daniel C McFarland
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry, New York, NY
| | - Colleen M Gallagher
- MD Anderson Cancer Center, Section of Integrated Ethics in Cancer Care, Houston, TX
| | | | | | - Richard T Lee
- Case Comprehensive Cancer Center, Department of Medicine, Division of Hematology/Oncology, School of Medicine, Cleveland OH
| | - Areej El-Jawahri
- Massachusetts General Hospital, Cancer Center, Harvard Medical School, Boston MA
| | - Beth Popp
- Ichan School of Medicine, Geriatrics and Palliative Medicine, Mount Sinai, New York, NY
| | - Abby R Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine; Seattle WA; Seattle Children's Research Institute, Seattle, WA
| | | | - Don S Dizon
- Lifespan Cancer Institute, Rhode Island Hospital, Brown University Providence, RI
| | | | - Manali I Patel
- Stanford University, VA Palo Alto Health Care System, Palo Alto, CA
| | - Arif H Kamal
- Duke University, Duke Cancer Institute, Population Health Sciences, Durham, NC
| | - Christopher K Daugherty
- University of Chicago Medicine, Department of Medicine, Section Hematology/Oncology, Maclean Center for Clinical Medical Ethics, Chicago, IL Chicago, IL
| | - Anthony L Back
- University of Washington, Department of Medicine/Oncology, Seattle, WA
| | - Mehmet E Dokucu
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL
| | - Tait D Shanafelt
- Stanford University, Department of Medicine, Med/Hematology, Chief Wellness Officer, Palo Alto, CA
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13
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Maternal and neonatal health care worker well-being and patient safety climate amid the COVID-19 pandemic. J Perinatol 2021; 41:961-969. [PMID: 33727700 PMCID: PMC7962434 DOI: 10.1038/s41372-021-01014-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess maternal and neonatal healthcare workers (HCWs) perspectives on well-being and patient safety amid the COVID-19 pandemic. STUDY DESIGN Anonymous survey of HCW well-being, burnout, and patient safety over the prior conducted in June 2020. Results were analyzed by job position and burnout status. RESULT We analyzed 288 fully completed surveys. In total, 66% of respondents reported symptoms of burnout and 73% felt burnout among their co-workers had significantly increased. Workplace strategies to address HCW well-being were judged by 34% as sufficient. HCWs who were "burned out" reported significantly worse well-being and patient safety attributes. Compared to physicians, nurses reported higher rates of unprofessional behavior (37% vs. 14%, p = 0.027) and difficulty focusing on work (59% vs. 36%, p = 0.013). CONCLUSION Three months into the COVID-19 pandemic, HCW well-being was substantially compromised, with negative ramifications for patient safety.
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14
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Shanafelt T, Stolz S, Springer J, Murphy D, Bohman B, Trockel M. A Blueprint for Organizational Strategies To Promote the Well-being of Health Care Professionals. ACTA ACUST UNITED AC 2020. [DOI: 10.1056/cat.20.0266] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Tait Shanafelt
- Professor of Medicine, Chief Wellness Officer, and Associate Dean, Stanford University School of Medicine, Stanford, California, USA
| | - Sherilyn Stolz
- Executive Administrative Director, Stanford Medicine WellMD Center, Stanford University School of Medicine, Stanford, California, USA
| | - Jill Springer
- Administrative Director, Stanford Medicine WellMD Center, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Murphy
- Professor of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Bryan Bohman
- Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford Medicine, Stanford, California, USA
| | - Mickey Trockel
- Associate Professor, Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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15
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Abstract
Burnout afflicts a significant number of academic faculty and clinicians. There are many efforts the individual can undertake to prevent or lessen burnout. However, it not likely these will be successful without the institutional environment that promotes and atmosphere that assures self-efficacy, a sense of value and meaning and clear communication between leaders and members of the organization. This review discusses the factors that organizations and their leaders can leverage to create such an environment. Such measures are critically important not only for the health of the individual but to the organization as well.
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Abstract
Work-life balance, burnout, and physician wellness have become an important focus over the last 20 years in the field of medicine. Significant work design and cultural changes are to blame for these newly recognized aspects of a physician's career and life as a whole. Unique aspects of the work environment in the United States not only contribute to these issues in the field of medicine, but also affect the US workforce at large. Stagnant responses from governmental bodies and private organizations have allowed the issue to worsen over time. Now with added attention from some leaders, both inside and outside the health care industry, along with the increasing body of research to guide these changes, there is hope for the necessary cultural change to address work-life balance, burnout, and physician wellness. Studies are available to identify the negative contributing factors, establish evidence-based prevention strategies, and help physicians to find their ideal work-life balance, avoid burnout, and achieve overall wellness. This article seeks to provide a brief background in the area of work-life balance, burnout, and physician wellness. It will also review key points of the current literature and provide a combination of solutions suggested by experts in the field.
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17
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Quality and Safety in Healthcare, Part LVIII: Promoting Physician Happiness and Wellness. Clin Nucl Med 2019; 45:365-367. [PMID: 31876803 DOI: 10.1097/rlu.0000000000002826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the past, many articles focused on one or several interventions to prevent physician burnout, but increasingly, articles now focus on comprehensive programs to not only decrease burnout, but also to promote physician happiness and wellness. These programs include measuring burnout and joy in the workplace, promoting workplace safety and wellness activities, career assistance, optimizing compensation, increasing the respect shown to individuals and their teams, and coordination of the goals between the individual, the teams, and the organization.
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18
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Swetz KM, Frazier SL, Richardson JW, Shanafelt TD. Personal-Professional Boundaries and Ethical Issues in Palliative Care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:60-62. [PMID: 31971083 DOI: 10.1080/15265161.2019.1675800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Keith M Swetz
- University of Alabama School of Medicine at Birmingham
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19
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Olson K, Marchalik D, Farley H, Dean SM, Lawrence EC, Hamidi MS, Rowe S, McCool JM, O'Donovan CA, Micek MA, Stewart MT. Organizational strategies to reduce physician burnout and improve professional fulfillment. Curr Probl Pediatr Adolesc Health Care 2019; 49:100664. [PMID: 31588019 DOI: 10.1016/j.cppeds.2019.100664] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Burnout is highly prevalent among physicians and has been associated with negative outcomes for physicians, patients, staff, and health-care organizations. Reducing physician burnout and increasing physician well-being is a priority. Systematic reviews suggest that organization-based interventions are more effective in reducing physician burnout than interventions targeted at individual physicians. This consensus review by leaders in the field across multiple institutions presents emerging trends and exemplary evidence-based strategies to improve professional fulfillment and reduce physician burnout using Stanford's tripartite model of physician professional fulfillment as an organizing framework: practice efficiency, culture, and personal resilience to support physician well-being. These strategies include leadership traits, latitude of control and autonomy, collegiality, diversity, teamwork, top-of-license workflows, electronic health record (EHR) usability, peer support, confidential mental health services, work-life integration and reducing barriers to practicing a healthy lifestyle. The review concludes with evidence-based recommendations on establishing an effective physician wellness program.
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Affiliation(s)
- Kristine Olson
- Yale School of Medicine, Yale New Haven Health, 20 York Street, New Haven, CT 06510, United States.
| | - Daniel Marchalik
- Medstar Health, Georgetown University School of Medicine, Washington, DC, United States
| | - Heather Farley
- Christiana Care Health System, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, United States
| | - Shannon M Dean
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | | | - Maryam S Hamidi
- Department of Psychiatry and Behavioral Sciences, Stanford Medicine WellMD Center, Stanford University, Stanford, CA, United States
| | - Susannah Rowe
- Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Joanne M McCool
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Mark A Micek
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Miriam T Stewart
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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20
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Stewart MT, Reed S, Reese J, Galligan MM, Mahan JD. Conceptual models for understanding physician burnout, professional fulfillment, and well-being. Curr Probl Pediatr Adolesc Health Care 2019; 49:100658. [PMID: 31629639 DOI: 10.1016/j.cppeds.2019.100658] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Physician burnout is a highly complex phenomenon whose origins are multifactorial. As the medical profession works to better understand and reduce physician burnout, conceptual models can offer a framework to guide research and practice in the field of physician well-being. Conceptual models represent complex systems in a simplified fashion that facilitates understanding of and communication about those systems. This paper reviews seven conceptual models of physician well-being and discusses their strengths and limitations.
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Affiliation(s)
- Miriam T Stewart
- Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Suzanne Reed
- Nationwide Children's, Columbus, OH, United States
| | - Jennifer Reese
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Meghan M Galligan
- Children's Hospital of Philadelphia, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
| | - John D Mahan
- Nationwide Children's, Columbus, OH, United States
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21
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Brindley PG, Olusanya S, Wong A, Crowe L, Hawryluck L. Psychological 'burnout' in healthcare professionals: Updating our understanding, and not making it worse. J Intensive Care Soc 2019; 20:358-362. [PMID: 31695741 PMCID: PMC6820226 DOI: 10.1177/1751143719842794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Many healthcare professionals and professional societies are demanding action to counter 'burnout', especially in the acute care medical specialties. This review is intended to empower this laudable 'call to arms', while also validating concerns that have been raised about how we typically define, measure and counter this important issue. This review aims to advance the discussion, dispel common misconceptions, add important nuance, and identify common ground. We also encourage the ideas contained within the military term 'occupational stress injury', which include a cultural shift away from blame and stigmatization, and towards shared responsibility and empathy. We also outline why mandatory testing can be troublesome and why interventions should be tailored to individuals. While the need for immediate action may seem self-evident, we wish to mitigate the real possibility that good intentions could make a perilous situation worse. 'Burnout' matters, but how individuals and organizations go forward matters even more.
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Affiliation(s)
- Peter G Brindley
- Division of Critical Care Medicine,
University
of Alberta, Edmonton, AB, Canada
| | | | - Adrian Wong
- Royal Surrey County Hospital NHS
Foundation Trust, Guildford, UK
| | - Liz Crowe
- School of Medicine, Queensland
University, Brisbane, QLD, Australia
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22
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Ganeshan D, Wei W, Yang W. Burnout in Chairs of Academic Radiology Departments in the United States. Acad Radiol 2019; 26:1378-1384. [PMID: 30638976 DOI: 10.1016/j.acra.2018.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We aimed to estimate the self-reported prevalence of burnout in chairs of academic radiology departments in the United States and identify factors associated with high burnout in chairs. MATERIALS AND METHODS An anonymous cross-sectional online survey was conducted of members of the Society of Chairs of Academic Radiology Departments. Burnout was measured using the abbreviated Maslach Burnout Inventory Human Services Survey. Associations between survey participants' characteristics and burnout were tested using Fisher's exact test and Wilcoxon rank sum test. RESULTS Of the 123 chairs invited to complete the survey, 87 responded (response rate, 71%). The mean age of the participants was 58 years. The survey respondents had an average of 9 years of experience as department chair. The average number of work hours per week was 62 hours. Four participants (5%) of the academic chairs met all three criteria for high burnout including high emotional exhaustion, high depersonalization, and low personal accomplishment. Thirty-three participants (38%) had high emotional exhaustion and/or high depersonalization score. Low professional satisfaction score, low work-life balance satisfaction score, and low chair effectiveness score were significantly associated with high burnout. High emotional exhaustion and/or high depersonalization were significantly associated with numerous professional stressors. Lack of an institutional support group for chairs and lower number of faculty members in the department were significantly associated with burnout. CONCLUSION A significant proportion of chairs of academic radiology departments are experiencing 1 or more symptoms of burnout. Efforts to address burnout in radiology chairs should be initiated promptly at the national, institutional, and departmental levels.
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23
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Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians: A Pilot Randomized Clinical Trial. JAMA Intern Med 2019; 179:1406-1414. [PMID: 31380892 PMCID: PMC6686971 DOI: 10.1001/jamainternmed.2019.2425] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Burnout symptoms among physicians are common and have potentially serious ramifications for physicians and their patients. Randomized studies testing interventions to address burnout have been uncommon. OBJECTIVE To explore the effect of individualized coaching on the well-being of physicians. DESIGN, SETTING, AND PARTICIPANTS A pilot randomized clinical trial involving 88 practicing physicians in the departments of medicine, family medicine, and pediatrics who volunteered for coaching was conducted between October 9, 2017, and March 27, 2018, at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin. Statistical analysis was conducted from August 24, 2018, to March 25, 2019. INTERVENTIONS A total of 6 coaching sessions facilitated by a professional coach. MAIN OUTCOMES AND MEASURES Burnout, quality of life, resilience, job satisfaction, engagement, and meaning at work using established metrics. Analysis was performed on an intent-to-treat basis. RESULTS Among the 88 physicians in the study (48 women and 40 men), after 6 months of professional coaching, emotional exhaustion decreased by a mean (SD) of 5.2 (8.7) points in the intervention group compared with an increase of 1.5 (7.7) points in the control group by the end of the study (P < .001). Absolute rates of high emotional exhaustion at 5 months decreased by 19.5% in the intervention group and increased by 9.8% in the control group (-29.3% [95% CI, -34.0% to -24.6%]) (P < .001). Absolute rates of overall burnout at 5 months also decreased by 17.1% in the intervention group and increased by 4.9% in the control group (-22.0% [95% CI, -25.2% to -18.7%]) (P < .001). Quality of life improved by a mean (SD) of 1.2 (2.5) points in the intervention group compared with 0.1 (1.7) points in the control group (1.1 points [95% CI, 0.04-2.1 points]) (P = .005), and resilience scores improved by a mean (SD) of 1.3 (5.2) points in the intervention group compared with 0.6 (4.0) points in the control group (0.7 points [95% CI, 0.0-3.0 points]) (P = .04). No statistically significant differences in depersonalization, job satisfaction, engagement, or meaning in work were observed. CONCLUSIONS AND RELEVANCE Professional coaching may be an effective way to reduce emotional exhaustion and overall burnout as well as improve quality of life and resilience for some physicians. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03207581.
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Affiliation(s)
- Liselotte N Dyrbye
- Department of Medicine, Program on Physician Well-Being, Mayo Clinic, Rochester, Minnesota
| | - Tait D Shanafelt
- Department of Medicine, WellMD Center, Stanford School of Medicine, Stanford University, Palo Alto, California
| | | | - Daniel V Satele
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Colin P West
- Department of Medicine, Program on Physician Well-Being, Mayo Clinic, Rochester, Minnesota.,Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
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25
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Chetlen AL, Chan TL, Ballard DH, Frigini LA, Hildebrand A, Kim S, Brian JM, Krupinski EA, Ganeshan D. Addressing Burnout in Radiologists. Acad Radiol 2019; 26:526-533. [PMID: 30711406 DOI: 10.1016/j.acra.2018.07.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 01/01/2023]
Abstract
Burnout is a global health problem affecting physicians across all medical specialties. Radiologists, in particular, experience high rates of burn out, and this trend has only continued to worsen. The "Promoting Health and Wellness for Radiologists Task Force of the Association of University Radiologists-Radiology Research Alliance" presents a review of the prevalence, causes, and impact of burnout among radiology faculty and trainees, and a discussion on strategies for overcoming burnout and promoting overall health and well-being among radiologists.
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Affiliation(s)
- Alison L Chetlen
- Penn State Health, Milton S. Hershey Medical Center, Department of Radiology, Division of Breast Imaging, 30 Hope Drive, Suite 1800 EC 008, Hershey, PA 17033.
| | - Tiffany L Chan
- Penn State Health, Milton S. Hershey Medical Center, Department of Radiology, Hershey, PA 17033
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Shannon Kim
- Eastern Virginia Medical School, Department of Radiology, Norfolk, VA 23501
| | - James M Brian
- Penn State Health, Milton S. Hershey Medical Center, Department of Radiology, Division of Pediatric Radiology, Hershey, PA 17033
| | | | - Dhakshinamoorthy Ganeshan
- University of Texas, Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, TX 77030-4009
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26
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Tawfik DS, Profit J, Webber S, Shanafelt TD. Organizational factors affecting physician well-being. ACTA ACUST UNITED AC 2019; 5:11-25. [PMID: 31632895 DOI: 10.1007/s40746-019-00147-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose of review Symptoms of burnout affect approximately half of pediatricians and pediatric subspecialists at any given time, with similarly concerning prevalence of other aspects of physician distress, including fatigue, depressive symptoms, and suicidal ideation. Physician well-being affects quality of care, patient satisfaction, and physician turnover. Organizational factors influence well-being, stressing the need for organizations to address this epidemic. Recent findings Organizational characteristics, policies, and culture influence physician well-being, and specific strategies may support an environment where physicians thrive. We highlight four organizational opportunities to improve physician well-being: developing leaders, cultivating community and organizational culture, improving practice efficiency, and optimizing administrative policies. Leaders play a key role in aligning organizational and individual values, promoting professional fulfillment, and fostering a culture of collegiality and social support among physicians. Reducing documentation burden and improving practice efficiency may help balance job demands and resources. Finally, reforming administrative policies may reduce work-home conflict, support physician's efforts to attend to their own well-being, and normalize use of supportive resources. Summary Physician well-being is critical to organizational success, sustainment of an adequate workforce, and optimal patient outcomes. Because burnout is primarily influenced by organizational factors, organizational interventions are key to promoting well-being. Developing supportive leadership, fostering a culture of wellness, optimizing practice efficiency, and improving administrative policies are worthy of organizational action and further research.
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Affiliation(s)
- Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.,California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Sarah Webber
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
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27
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Tawfik DS, Profit J, Morgenthaler TI, Satele DV, Sinsky CA, Dyrbye LN, Tutty MA, West CP, Shanafelt TD. Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. Mayo Clin Proc 2018; 93:1571-1580. [PMID: 30001832 PMCID: PMC6258067 DOI: 10.1016/j.mayocp.2018.05.014] [Citation(s) in RCA: 350] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/04/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate physician burnout, well-being, and work unit safety grades in relationship to perceived major medical errors. PARTICIPANTS AND METHODS From August 28, 2014, to October 6, 2014, we conducted a population-based survey of US physicians in active practice regarding burnout, fatigue, suicidal ideation, work unit safety grade, and recent medical errors. Multivariate logistic regression and mixed-effects hierarchical models evaluated the associations among burnout, well-being measures, work unit safety grades, and medical errors. RESULTS Of 6695 responding physicians in active practice, 6586 provided information on the areas of interest: 3574 (54.3%) reported symptoms of burnout, 2163 (32.8%) reported excessive fatigue, and 427 (6.5%) reported recent suicidal ideation, with 255 of 6563 (3.9%) reporting a poor or failing patient safety grade in their primary work area and 691 of 6586 (10.5%) reporting a major medical error in the prior 3 months. Physicians reporting errors were more likely to have symptoms of burnout (77.6% vs 51.5%; P<.001), fatigue (46.6% vs 31.2%; P<.001), and recent suicidal ideation (12.7% vs 5.8%; P<.001). In multivariate modeling, perceived errors were independently more likely to be reported by physicians with burnout (odds ratio [OR], 2.22; 95% CI, 1.79-2.76) or fatigue (OR, 1.38; 95% CI, 1.15-1.65) and those with incrementally worse work unit safety grades (OR, 1.70; 95% CI, 1.36-2.12; OR, 1.92; 95% CI, 1.48-2.49; OR, 3.12; 95% CI, 2.13-4.58; and OR, 4.37; 95% CI, 2.06-9.28 for grades of B, C, D, and F, respectively), adjusted for demographic and clinical characteristics. CONCLUSION In this large national study, physician burnout, fatigue, and work unit safety grades were independently associated with major medical errors. Interventions to reduce rates of medical errors must address both physician well-being and work unit safety.
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Affiliation(s)
- Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Timothy I Morgenthaler
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Daniel V Satele
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | - Colin P West
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
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28
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Peck J, Viswanath O. Physician Burnout: A Leading Indicator of Health Performance and "Head-Down" Mentality in Medical Education-II. Mayo Clin Proc 2018; 93:544-545. [PMID: 29622104 DOI: 10.1016/j.mayocp.2018.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/05/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Jacquelin Peck
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL
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Olson KD. Physician Burnout-A Leading Indicator of Health System Performance? Mayo Clin Proc 2017; 92:1608-1611. [PMID: 29101929 DOI: 10.1016/j.mayocp.2017.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/25/2017] [Indexed: 11/23/2022]
Affiliation(s)
- Kristine D Olson
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
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