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Carlasare LE, Wang H, West CP, Trockel M, Dyrbye LN, Tutty M, Sinsky C, Shanafelt TD. Associations Between Organizational Support, Burnout, and Professional Fulfillment Among US Physicians During the First Year of the COVID-19 Pandemic. J Healthc Manag 2024; 69:368-386. [PMID: 39240266 DOI: 10.1097/jhm-d-23-00124] [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: 09/07/2024]
Abstract
GOAL This research aimed to evaluate variations in perceived organizational support among physicians during the first year of the COVID-19 pandemic and the associations between perceived organizational support, physician burnout, and professional fulfillment. METHODS Between November 20, 2020, and March 23, 2021, 1,162 of 3,671 physicians (31.7%) responded to the study survey by mail, and 6,348 of 90,000 (7.1%) responded to an online version. Burnout was assessed using the Maslach Burnout Inventory, and perceived organizational support was assessed by questions developed and previously tested by the Stanford Medicine WellMD Center. Professional fulfillment was measured using the Stanford Professional Fulfillment Index. PRINCIPAL FINDINGS Responses to organizational support questions were received from 5,933 physicians. The mean organizational support score (OSS) for male physicians was higher than the mean OSS for female physicians (5.99 vs. 5.41, respectively, on a 0-10 scale, higher score favorable; p < .001). On multivariable analysis controlling for demographic and professional factors, female physicians (odds ratio [OR] 0.66; 95% CI: 0.55-0.78) and physicians with children under 18 years of age (OR 0.72; 95% CI: 0.56-0.91) had lower odds of an OSS in the top quartile (i.e., a high OSS score). Specialty was also associated with perceived OSS in mean-variance analysis, with some specialties (e.g., pathology and dermatology) more likely to perceive significant organizational support relative to the reference specialty (i.e., internal medicine subspecialty) and others (e.g., anesthesiology and emergency medicine) less likely to perceive support. Physicians who worked more hours per week (OR for each additional hour/week 0.99; 95% CI: 0.99-1.00) were less likely to have an OSS in the top quartile. On multivariable analysis, adjusting for personal and professional factors, each one-point increase in OSS was associated with 21% lower odds of burnout (OR 0.79; 95% CI: 0.77-0.81) and 32% higher odds of professional fulfillment (OR 1.32; 95% CI: 1.28-1.36). PRACTICAL APPLICATIONS Perceived organizational support of physicians during the COVID-19 pandemic was associated with a lower risk of burnout and a higher likelihood of professional fulfillment. Women physicians, physicians with children under 18 years of age, physicians in certain specialties, and physicians working more hours reported lower perceived organizational support. These gaps must be addressed in conjunction with broad efforts to improve organizational support.
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Affiliation(s)
| | - Hanhan Wang
- Stanford University School of Medicine, Palo Alto, California
| | - Colin P West
- Mayo Clinic, Department of General Internal Medicine, Rochester, Minnesota
| | - Mickey Trockel
- Stanford University School of Medicine, Palo Alto, California
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Tawfik D, Bayati M, Liu J, Nguyen L, Sinha A, Kannampallil T, Shanafelt T, Profit J. Predicting Primary Care Physician Burnout From Electronic Health Record Use Measures. Mayo Clin Proc 2024; 99:1411-1421. [PMID: 38573301 PMCID: PMC11374508 DOI: 10.1016/j.mayocp.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To evaluate the ability of routinely collected electronic health record (EHR) use measures to predict clinical work units at increased risk of burnout and potentially most in need of targeted interventions. METHODS In this observational study of primary care physicians, we compiled clinical workload and EHR efficiency measures, then linked these measures to 2 years of well-being surveys (using the Stanford Professional Fulfillment Index) conducted from April 1, 2019, through October 16, 2020. Physicians were grouped into training and confirmation data sets to develop predictive models for burnout. We used gradient boosting classifier and other prediction modeling algorithms to quantify the predictive performance by the area under the receiver operating characteristics curve (AUC). RESULTS Of 278 invited physicians from across 60 clinics, 233 (84%) completed 396 surveys. Physicians were 67% women with a median age category of 45 to 49 years. Aggregate burnout score was in the high range (≥3.325/10) on 111 of 396 (28%) surveys. Gradient boosting classifier of EHR use measures to predict burnout achieved an AUC of 0.59 (95% CI, 0.48 to 0.77) and an area under the precision-recall curve of 0.29 (95% CI, 0.20 to 0.66). Other models' confirmation set AUCs ranged from 0.56 (random forest) to 0.66 (penalized linear regression followed by dichotomization). Among the most predictive features were physician age, team member contributions to notes, and orders placed with user-defined preferences. Clinic-level aggregate measures identified the top quartile of clinics with 56% sensitivity and 85% specificity. CONCLUSION In a sample of primary care physicians, routinely collected EHR use measures demonstrated limited ability to predict individual burnout and moderate ability to identify high-risk clinics.
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Affiliation(s)
- Daniel Tawfik
- Stanford University School of Medicine, Stanford, CA.
| | | | - Jessica Liu
- Stanford University School of Medicine, Stanford, CA
| | - Liem Nguyen
- Stanford University School of Engineering, Stanford, CA
| | | | | | - Tait Shanafelt
- Stanford University School of Medicine, Stanford, CA; Stanford Medicine WellMD & WellPhD Center, Stanford, CA
| | - Jochen Profit
- Stanford University School of Medicine, Stanford, CA
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Ashmore JA, Waddimba AC, Douglas ME, Coombes SV, Shanafelt TD, DiMaio JM. The Mayo Leadership Impact Index Adapted for Matrix Leadership Structures: Initial Validity Evidence. J Healthc Leadersh 2024; 16:315-327. [PMID: 39161696 PMCID: PMC11330859 DOI: 10.2147/jhl.s465170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/06/2024] [Indexed: 08/21/2024] Open
Abstract
Importance Physician burnout has reached crisis levels. Supportive leadership is one of the strongest drivers of physician well-being, and monitoring supervisor support is key to developing well-being focused leadership skills. Existing measures of leader support were designed within "direct report" supervision structures limiting their applicability to matrixed leadership reporting structures where direct reports are not the predominant norm. Antecedently, no measure of leadership support is validated specifically for implementation in matrixed leadership structures. Objective Adapt and validate the Mayo Leadership Impact Index (MLII) for settings with matrixed leadership structures. Design A psychometric validation study utilizing classical test theory and item response theory. Setting A tripartite hospital system in the southwestern US. Participants Physician-respondents to a 2023 cross-sectional survey. Main Outcomes and Measures After pilot testing, the adapted MLII was examined using a unidimensional graded response model and confirmatory factor analyses. Convergent validity was investigated via correlations with professional fulfillment, perceived autonomy support, self-valuation, and peer connectedness/respect. Divergent validity was tested via correlations with burnout. Results Of the three candidate revisions of the MLII, the 9-item adaptation was selected for its superior validity/reliability indices. Standardized Cronbach's and Ordinal alpha coefficients were 0.958 and 0.973, respectively. CFA loadings exceeded 0.70 (p < 0.001), and coefficients of variation (R2) exceeded 0.60 for all items. GRM slope parameters indicated "high" to "very high" item discrimination. Items 2, 5, and 8 were the most informative. Positive correlations of the adapted MLII with professional fulfillment, perceived autonomy support, and peer connectedness/respect were observed, supporting convergent validity. Negative correlation with overall burnout supports divergent validity. Conclusions and Relevance The findings provide evidence of the adapted MLII's validity, reliability, and appropriateness for implementation within matrixed leadership settings. Prior to this study, no leadership support measure had been validated for use among the growing number of healthcare systems with matrixed leadership reporting structures.
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Affiliation(s)
- Jamile A Ashmore
- Office of Professionalism and Well-Being, Baylor Scott & White-The Heart Hospital, Plano, TX, USA
- College of Medicine, Texas A&M University, Dallas, TX, USA
| | - Anthony C Waddimba
- College of Medicine, Texas A&M University, Dallas, TX, USA
- Division of Surgical Research, Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
- Research Development & Analytics Core, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Megan E Douglas
- Trauma Research Consortium, Baylor Scott and White Research Institute, Dallas, TX, USA
| | | | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - J Michael DiMaio
- College of Medicine, Texas A&M University, Dallas, TX, USA
- Research Development & Analytics Core, Baylor Scott and White Research Institute, Dallas, TX, USA
- Division of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, TX, USA
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Dyrbye LN, Satele D, West CP. A Pragmatic Approach to Assessing Supervisor Leadership Capability to Support Healthcare Worker Well-Being. J Healthc Manag 2024; 69:280-295. [PMID: 38976788 DOI: 10.1097/jhm-d-23-00137] [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: 07/10/2024]
Abstract
GOAL We sought to build upon previous studies that have demonstrated how healthcare workers' ratings of their immediate supervisor's leadership capabilities relate to their well-being and job satisfaction. METHODS In 2022, we analyzed cross-sectional data from 1,780 physicians and 39,896 allied health professionals (collected in 2017) and 729 residents (collected in 2019), as well as longitudinal data from 1,632 physicians (collected from 2015 to 2017), to identify a psychometrically strong, broadly applicable, actionable, and low-burden approach to assessing supervisor leadership capability to support healthcare worker well-being. PRINCIPAL FINDINGS The magnitude of association between our 1-, 2-, 3-, and 9-item leadership indexes and burnout, and between our 1-, 2-, 3-, and 9-item leadership indexes and satisfaction with the organization were similar to each other in the cross-sectional and longitudinal cohorts and across diverse groups of healthcare workers, including physicians, residents, and allied health professionals. The likelihood ratio for a high leadership score increased with an increasing score for each leadership measure. The area under the receiver operating characteristic curve for the 1-, 2-, and 3-item measures for a high leadership score was 0.9349, 0.9672, and 0.9819, respectively. PRACTICAL APPLICATIONS A single item assessing perceptions of leadership capability efficiently provides useful information about leadership qualities of healthcare workers' immediate supervisors. The inclusion of this item in healthcare worker surveys may be useful for evaluating interventions and galvanizing organizational action to support healthcare worker well-being.
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Affiliation(s)
| | - Daniel Satele
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Schwatka NV, Burden M, Dyrbye LN. An Organizational Leadership Development Approach to Support Health Worker Mental Health. Am J Public Health 2024; 114:142-147. [PMID: 38354347 PMCID: PMC10916722 DOI: 10.2105/ajph.2023.307407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Natalie V Schwatka
- Natalie V. Schwatka is with the Center for Health, Work & Environment, Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Marisha Burden is with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora. Liselotte N. Dyrbye is the senior associate dean of faculty and chief well-being officer, professor of medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Marisha Burden
- Natalie V. Schwatka is with the Center for Health, Work & Environment, Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Marisha Burden is with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora. Liselotte N. Dyrbye is the senior associate dean of faculty and chief well-being officer, professor of medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Liselotte N Dyrbye
- Natalie V. Schwatka is with the Center for Health, Work & Environment, Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Marisha Burden is with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora. Liselotte N. Dyrbye is the senior associate dean of faculty and chief well-being officer, professor of medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
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Shanafelt TD, Dyrbye LN, West CP, Trockel M, Tutty M, Wang H, Carlasare LE, Sinsky CA. Career Plans of US Physicians After the First 2 Years of the COVID-19 Pandemic. Mayo Clin Proc 2023; 98:1629-1640. [PMID: 37923521 DOI: 10.1016/j.mayocp.2023.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To assess the career plans of US physicians at the end of 2021 relative to 2011 and 2014. METHODS Physicians in the United States were surveyed from December 9, 2021, to January 24, 2022, using methods similar to prior studies in 2011 and 2014. Responding physicians in active practice (n=1884) were included in the analysis. At all time-points, physicians indicated the likelihood they would (1) reduce clinical work hours in the next 12 months and (2) leave their current practice within 24 months. RESULTS In 2021, 542 of 1344 (40.3%) indicated that it was "likely" or "definite" they would reduce clinical work hours in the next 12 months compared with 1120 of 6950 (16.1%) and 1275 of 6452 (19.8%) in 2011 and 2014. In 2021, 466 of 1817 (25.6%) indicated it was "likely" or "definite" they would leave their current practice in the next 24 months compared with 1284 of 6975 (18.4%) and 1726 of 6496 (26.6%) in 2011 and 2014. On multivariable analysis pooling responders from 2011, 2014, and 2021, physicians who responded in 2021 had higher odds of reporting intent to reduce clinical work hours compared with those who responded in 2014 (OR, 3.12; 95% CI, 2.73 to 3.57), whereas those responding in 2011 had lower odds relative to 2014 (OR, 0.81; 95% CI, 0.74 to 0.89). CONCLUSION Roughly two of every five US physicians intend to reduce their clinical work hours in the next year, more than double previous rates. These findings have potentially profound implications for the adequacy of a US physician workforce already facing substantial shortages.
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Affiliation(s)
| | | | | | | | | | - Hanhan Wang
- University of Colorado School of Medicine, Denver, CO, USA
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7
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Dyrbye LN. Taking Action Against Burnout: Organizations Moving Forward with Impact. Jt Comm J Qual Patient Saf 2023; 49:507-510. [PMID: 37596169 DOI: 10.1016/j.jcjq.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
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Peccoralo LA, Pietrzak RH, Tong M, Kaplan S, Feingold JH, Feder A, Chan C, Verity J, Charney D, Ripp J. A Longitudinal Cohort Study of Factors Impacting Healthcare Worker Burnout in New York City During the COVID-19 Pandemic. J Occup Environ Med 2023; 65:362-369. [PMID: 36727906 PMCID: PMC10171104 DOI: 10.1097/jom.0000000000002790] [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] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to longitudinally examine the prevalence and correlates of burnout in frontline healthcare workers (FHCWs) during COVID-19 in New York City. METHODS A prospective cohort study of 786 FHCWs at Mount Sinai Hospital was conducted during the initial COVID surge in April to May 2020 (T1) and November 2020 to January 2021 (T2) to assess factors impacting burnout. RESULTS Burnout increased from 38.9% to 44.8% ( P = 0.002); 222 FHCWs (28.3%) had persistent burnout, 82 (10.5%) had early burnout, and 129 (16.5%) had delayed burnout. Relative to FHCWs with no burnout ( n = 350; 44.7%), those with persistent burnout reported more prepandemic burnout (relative risk [RR], 6.67), less value by supervisors (RR, 1.79), and lower optimism (RR, 0.82), whereas FHCWs with delayed burnout reported more prepandemic burnout (RR, 1.75) and caring for patients who died (RR, 3.12). CONCLUSION FHCW burnout may be mitigated through increasing their sense of value, support, and optimism; treating mental health symptoms; and counseling regarding workplace distress.
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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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Shanafelt T, Trockel M, Wang H, Mayer T, Athey L. Assessing Professional Fulfillment and Burnout Among CEOs and Other Healthcare Administrative Leaders in the United States. J Healthc Manag 2022; 67:317-338. [PMID: 35984407 PMCID: PMC9447437 DOI: 10.1097/jhm-d-22-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GOAL The objective of this study was to evaluate the prevalence of burnout and professional fulfillment among healthcare administrative leaders and examine the association between burnout and professional fulfillment and personal and professional characteristics. METHODS Between June 7 and June 30, 2021, we performed a national survey of CEOs and other senior operational leaders to evaluate their personal work experience. Burnout and professional fulfillment-as well as a sleep-related impairment and self-valuation-were assessed using standardized instruments. PRINCIPLE FINDINGS Of the 5,994 members of the American College of Healthcare Executives who were sent an invitation to participate, 1,269 (21.2%), including 279 CEOs, submitted usable responses. The mean overall burnout score was 2.71 (range: 0-10), and 33% of participants had burnout scores that fell in the high range (unfavorable). Mean professional fulfillment score was 7.29 (range: 0-10), with 56.6% scoring in the high range (favorable). Burnout and professional fulfillment scores varied by role. On multivariable analysis, sleep-related impairment (OR for each 1-point increase = 1.29, 95% CI [1.19-1.41]; p < .001) and self-valuation (OR for each 1-point increase = 0.63, 95% CI [0.57-0.68]; p < .001) were independently associated with burnout after adjusting for all other variables. APPLICATIONS TO PRACTICE Results of this study suggest that healthcare leaders had lower burnout and professional fulfillment scores than clinicians. Nonetheless, one third of healthcare leaders had burnout scores that fell in the high range. At the individual level, improved sleep health and self-valuation appear to reduce risk of burnout and promote professional fulfillment.
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Affiliation(s)
| | | | | | | | - Leslie Athey
- American College of Healthcare Executives, Chicago, Illinois
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Abstract
OBJECTIVE One potential barrier to optimal healthcare may be provider burnout or occupational-related stress in the workplace. The objective of this study is to conduct a systematic review to identify the predictors of burnout among US. healthcare providers. DESIGN Systematic review using in-depth critical appraisal to assess risk of bias and present the quality of evidence in synthesised results from the prognostic studies. DATA SOURCES We searched 11 databases, registries, existing reviews and contacted experts through 4 October 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included all studies evaluating potential predictors and documenting the presence and absence of associations with burnout assessed as a multidimensional construct. We excluded studies that relied solely on a single continuous subscale of burnout. Data were abstracted from eligible studies and checked for accuracy by a content expert and a methodologist. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened citations and full-text publications using predetermined eligibility criteria. RESULTS The 141 identified studies evaluated a range of burnout predictors. Findings for demographic characteristics were conflicting or show no association. Workplace factors, such as workload, work/life balance, job autonomy and perceived support from leadership, had stronger associations with risk for burnout. Mental health factors, such as anxiety, and physical health risks may increase the risk, although the direction of these associations is unclear as few prospective studies exist to address this question. Factors such as social support appear to have a protective effect. CONCLUSION We found the most evidence for workplace, mental health and psychosocial factors in predicting burnout but limited evidence for other potential predictors. However, more prospective studies are needed to improve our understanding about how to prevent provider burnout. PROSPERO REGISTRATION NUMBER CRD4202014836.
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Affiliation(s)
| | | | - Joan Chang
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, USA
| | - Jody Larkin
- RAND Corporation, Santa Monica, California, USA
| | - Aneesa Motala
- RAND Corporation, Santa Monica, California, USA
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Susanne Hempel
- RAND Corporation, Santa Monica, California, USA
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
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Lerman C, Hughes-Halbert C, Falcone M, Gosky DM, Jensen RA, Lee KP, Mitchell E, Odunsi K, Pegher JW, Rodriguez E, Sanchez Y, Shaw R, Weiner G, Willman CL. Leadership Diversity and Development in the Nation's Cancer Centers. J Natl Cancer Inst 2022; 114:1214-1221. [PMID: 35897143 PMCID: PMC9468284 DOI: 10.1093/jnci/djac121] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 12/12/2022] Open
Abstract
The capacity and diversity of the oncology leadership workforce has not kept pace with the emerging needs of our increasingly complex cancer centers and the spectrum of challenges our institutions face in reducing the cancer burden in diverse catchment areas. Recognizing the importance of a diverse workforce to reduce cancer inequities, the Association of American Cancer Institutes conducted a survey of its 103 cancer centers to examine diversity in leadership roles from research program leaders to cancer center directors. A total of 82 (80%) centers responded, including 64 National Cancer Institute-designated and 18 emerging centers. Among these 82 respondents, non-Hispanic White individuals comprised 79% of center directors, 82% of deputy directors, 72% of associate directors, and 72% of program leaders. Women are underrepresented in all leadership roles (ranging from 16% for center directors to 45% for associate directors). Although the limited gender, ethnic, and racial diversity of center directors and perhaps deputy directors is less surprising, the demographics of current research program leaders and associate directors exposes a substantial lack of diversity in the traditional cancer center senior leadership pipeline. Sole reliance on the cohort of current center leaders and leadership pipeline is unlikely to produce the diversity in cancer center leadership needed to facilitate the ability of those centers to address the needs of the diverse populations they serve. Informed by these data, this commentary describes some best practices to build a pipeline of emerging leaders who are representative of the diverse populations served by these institutions and who are well positioned to succeed.
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Affiliation(s)
- Caryn Lerman
- University of Southern California Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Chanita Hughes-Halbert
- University of Southern California Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mary Falcone
- University of Southern California Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David M Gosky
- The Ohio State University Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
| | - Roy A Jensen
- University of Kansas Cancer Center, University of Kansas, Kansas City, KS, USA
| | - Kelvin P Lee
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Edith Mitchell
- Thomas Jefferson University Kimmel Cancer Center, Philadelphia, PA, USA
| | - Kunle Odunsi
- University of Chicago Medicine Comprehensive Cancer Center, University of Chicago Medicine, Chicago, IL, USA
| | | | | | - Yolanda Sanchez
- Norris Cotton Cancer Center, Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Reuben Shaw
- Salk Institute for Biological Studies, La Jolla, CA, USA
| | - George Weiner
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Cheryl L Willman
- Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, MN, USA
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Halbach SM, Pillutla K, Seo-Mayer P, Schwartz A, Weidemann D, Mahan JD. Burnout in Pediatric Nephrology Fellows and Faculty: Lessons From the Sustainable Pediatric Nephrology Workforce Project (SUPERPOWER). Front Pediatr 2022; 10:849370. [PMID: 35601419 PMCID: PMC9114807 DOI: 10.3389/fped.2022.849370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Physician well-being is an important contributor to both job satisfaction and patient outcomes. Rates of burnout among physicians vary by specialty, ranging from 35 to 70%. Among pediatric residents, longitudinal data demonstrates consistent rates of burnout around 50-60%, although little is known about burnout among pediatric subspecialty fellows. Specifically, the degree of burnout among pediatric nephrologists remains unknown, as does the impact faculty burnout may have on trainee burnout. We sought to evaluate prevalence and predictors of burnout among US pediatric nephrology fellows and faculty, and assess for interactions between groups. In this multi-center pilot survey of all United States pediatric nephrology training programs from February to April 2020, burnout was assessed through abbreviated Maslach Burnout Inventory and predictors were explored through survey items devoted to demographic, personal characteristics, and job and career satisfaction questions. A total of 30/34 available fellows and 86/102 faculty from 11 institutions completed the survey (overall response rate 85%). The prevalence of burnout was 13% among fellows and 16% among faculty. Demographic (age, gender, year of training, faculty rank, marital status) and program factors (fellowship size, faculty size, current block/rotation, vacation or weekend off timing) were not significantly associated with burnout. Faculty and fellows with burnout reported significantly lower quality of life (5.3 vs. 7.9, p < 0.05), higher perceived stress (2.4 vs. 1.4, p < 0.05) and lower satisfaction with career choice (66 vs. 22%) and work life balance (28 vs. 0%), compared to those without burnout (p < 0.05 for all). Other important factors positively associated with burnout included lower institutional support for wellness programs and lower satisfaction with both colleague and faculty support. Larger studies are needed to explore if burnout is truly less prevalent among pediatric nephrology fellows and faculty compared to pediatric residents and graduate physicians. A larger sample size is also necessary to determine whether any interactions exist between the faculty and trainee roles in the developments of burnout. Future studies should also explore how to promote well-being through addressing key factors such as overall learning/working environment, stress reduction, and building personal resilience.
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Affiliation(s)
- Susan M Halbach
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Kartik Pillutla
- Department of Pediatrics, University of Texas Dell Medical School, Austin, TX, United States
| | - Patricia Seo-Mayer
- Division of Nephrology, Inova Children's Hospital, Falls Church, VA, United States
| | - Alan Schwartz
- Department of Medical Education and Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, United States.,Association of Pediatric Program Directors, McLean, VA, United States
| | - Darcy Weidemann
- Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, United States.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - John D Mahan
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
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