Association of Compensation and Educational Debt with Burnout and Perceived Impact of Debt on Women Physicians' Career and Lifestyle Choices

The directors of resident support program: a program evaluation of a resident well-being and support innovation

BACKGROUND

Medical training can be a challenging time for residents both professionally and personally. Resident support programs must be able to address a range of potential experiences, be accessible and easy to navigate, and consider the unique context of residency. Rigorous evaluation of resident support programs is needed to determine whether these programs are meeting these goals.

METHODS

The Directors of Resident Support (DRS) program, launched in January 2021 at the Cumming School of Medicine at the University of Calgary, is a near-peer support model consisting of three faculty physicians, trained in peer support, who receive contacts from residents needing support for any issue. DRS physicians provide empathetic listening, referral to existing resources, and peer support for residents. A multisource evaluation of the DRS program, including field notes, data collection forms, and surveys, was guided by the Donabedian framework.

RESULTS

There were 62 total contacts in the 2-year evaluation period which required a median 2 h to address (range 5 min to more than 40 h). The most common topic for contact was to discuss feedback or evaluation (n = 10, 24.4%) and the most common response was listening and support (n = 29, 70.7%). Residents also contacted DRS to discuss experiences of racism, physical assault, sexual harassment, and mental health crises. Residents (n = 13) rated a median score of 74 out of possible 100 for usefulness (interquartile range [IQR] 1-100, with higher scores suggesting greater usefulness). Free text survey responses suggested that residents felt validated by contact with the program though some residents felt that additional follow-up would have been helpful.

CONCLUSION

The DRS program has been well-utilized by residents for a variety of issues. Postgraduate Medical Education offices seeking to create resident support programs may anticipate that about 3% of residents may use a similar program per year and that the typical interaction would last 2 h, with a wide range. Feedback suggested that similar programs should have a formal process for follow-up with residents to ensure their concern was addressed and that resident supporters should have diverse lived experiences.

Exploring Pharmacy Student Experiences with Student Debt and Perspectives on Future Burnout and Loan Relief

OBJECTIVE

Pharmacy students with substantial educational debt are at risk for excessive workloads, burnout, and clinical errors. During the COVID-19 pandemic, policies addressing economic hardships for all student debt borrowers included temporary suspension of monthly payments and 0% interest during the pause. This study aimed to understand student-level factors regarding student debt from the lived experiences of current pharmacy students and aimed to understand how current pharmacy students view temporary loan relief.

METHODS

We used semi-structured interviews of pharmacy students across 4 years of progression in their pharmacy program to better understand student experiences with debt, different factors that may influence the impact of student debt on short-term and long-term outcomes for students, and student perspectives on debt relief policies and potential solutions. Our thematic analysis was grounded in existing evidence and a conceptual framework, while also allowing codes to emerge directly from the data.

RESULTS

A total of 20 pharmacy students were interviewed with a median student debt of $77,000, with debt amounts ranging from $0 to $209,000. Students described what mediating factors influenced their experiences, the influence of student debt on clinician burnout, and other outcomes impacted by student debt. Six overarching themes emerged relevant to current students: student debt influences education and career decisions, debt is risky given the saturated pharmacy market, debt is an accepted burden, debt will inhibit starting a life, the COVID-19 loan relief is revealing, and early financial education is needed.

CONCLUSION

Pharmacy students burdened with debt described a variety of different experiences and attitudes toward that debt and provided their perspectives on how student debt influences short-term education and career decisions. While students accept the trade-off of debt for their education as an inevitable burden, reported coping mechanisms and strategies shared suggest some solutions may be available to ameliorate this burden.

Investigation of Health Behavior on Burnout Scores in Women Physicians who Self-Identify as Runners: A Cross-Sectional Survey Study

As the proportion of women in the physician workforce increases, burnout in this population warrants further investigation. Exercise is an often-proposed strategy to combat burnout. Evaluating physical activity across a cohort of women physicians can assess associations of health behaviors with burnout. Cross-sectional study of women attending physicians in the United States who are actively engaged in a social media group for runners. An electronic survey comprised of 60 questions covering demographics, health behaviors, and burnout was administered. A healthy lifestyle subgroup (HLS) was defined based on American Heart Association physical activity and nutrition recommendations. We determine the prevalence of burnout and investigate associations between health behavior factors and burnout. Of the 369 included surveys, most respondents were at least six years out from medical training (85.9%) and White (74.5%). Forty-two percent experienced burnout symptoms. Time exercising was significantly associated with fruit/vegetable consumption (P=.00002). There was no significant difference in burnout between the HLS compared to others (P = .37). This group of self-reported physically active women physicians was found to have a lower prevalence of burnout when compared to other women physicians. Exercise and nutrition may be protective against burnout in women physicians but deserve further investigation.

Factors Associated With Burnout in Physical Medicine and Rehabilitation Residents in the United States

OBJECTIVES

The aims of the study were to determine the prevalence of burnout in physical medicine and rehabilitation residents in the United States and to identify the personal- and program-specific characteristics most strongly associated with residents reporting burnout.

DESIGN

This was a cross-sectional survey of US physical medicine and rehabilitation residents. Emotional exhaustion, depersonalization, and burnout were assessed using two validated items from the Maslach Burnout Inventory. Associations of burnout with demographics and personal factors, residency program characteristics, perceived program support, and work/life balance were evaluated.

RESULTS

The survey was completed by 296 residents (22.8%), with 35.8% of residents meeting the criteria for burnout. Residents' perception of not having adequate time for personal/family life was the factor most strongly associated with burnout (χ2 = 93.769, P < 0.001). Residents who reported inappropriate clerical burden and working more than 50 hrs/wk on inpatient rotations were most likely to report that they did not have adequate time for personal/family life. Faculty support (χ2 = 41.599, P < 0.001) and performing activities that led residents to choose physical medicine and rehabilitation as a specialty (χ2 = 93.082, P < 0.001) were protective against burnout.

CONCLUSIONS

Residents reporting having inadequate time for their personal/family life was most strongly associated with physical medicine and rehabilitation resident burnout, although many personal and program characteristics were associated with burnout.

Fertility Benefits at Top U.S. Medical Schools

Background: Female physicians have a higher prevalence of infertility compared with the general population. Physician well-being can be significantly impacted by the physical and emotional challenges associated with this, including the high cost of fertility treatments, which are often not covered by health insurance. There are limited data on the current state of fertility coverage available for physicians. This study examines fertility insurance benefits offered for faculty at top U.S. medical schools. Methods: Between March and April 2021, we reviewed fertility benefits at medical schools ranked in the top 14 for research as identified by the US News & World Report 2021. The summary plan descriptions of benefits were collected from each institution's human resources (HR) website and direct phone call to HR representatives. We examined descriptions of coverage for fertility services including evaluation, treatments, medications, maximum lifetime coverage, and whether a formal diagnosis of infertility was required for benefit eligibility. Results: Fourteen institutions offer benefits for fertility evaluation and 13 offer benefits for treatment. Of the 13 institutions that offer treatment coverage, 11 cover in vitro fertilization, with 6 having limits on the number of cycles. Twelve offer medication coverage. Ten institutions specified maximum lifetime coverage for treatments and medications, ranging from $10,000 to $100,000. Only 1 school provided coverage for elective fertility preservation, and none covered surrogacy expenses. Half of the schools are in states where fertility benefits are mandated. Conclusion: There is wide variation in fertility benefits offered at top medical schools across the country. Many schools offered coverage for fertility evaluation and treatments; however, majority had restrictions and limitations to the benefits, suggesting that there is still inadequate coverage provided. This study's selected sample also does not reflect other medical schools across the country, which may not be as well-resourced in their provision of fertility benefits.