Sources of conflict in the medical marriage

Physician Well-being 2.0: Where Are We and Where Are We Going?

Although awareness of the importance of physician well-being has increased in recent years, the research that defined this issue, identified the contributing factors, and provided evidence on effective individual and system-level solutions has been maturing for several decades. During this interval, the field has evolved through several phases, each influenced not only by an expanding research base but also by changes in the demographic characteristics of the physician workforce and the evolution of the health care delivery system. This perspective summarizes the historical phase of this journey (the "era of distress"), the current state (Well-being 1.0), and the early contours of the next phase based on recent research and the experience of vanguard institutions (Well-being 2.0). The key characteristics and mindset of each phase are summarized to provide context for the current state, to illustrate how the field has evolved, and to help organizations and leaders advance from Well-being 1.0 to Well-being 2.0 thinking. Now that many of the lessons of the Well-being 1.0 phase have been internalized, the profession, organizations, leaders, and individual physicians should act to accelerate the transition to Well-being 2.0.

Beyond Burnout: Responding to the COVID-19 Pandemic Challenges to Self-care

PURPOSE OF REVIEW

This paper is a review of the self-care challenges of the COVID-19 pandemic on the physical and emotional health and well-being of healthcare providers. New self-care practices are presented.

RECENT FINDINGS

Globally, thousands of health care practitioners and staff have been infected; many have died. Research studies reveal that this pandemic has threatened the health of healthcare staff, their families, and communities in many unique ways, such as fear of infecting family (lack of safety at home), moral injury, witnessing the suffering of the "innocent," coping with a problem too big to solve (the enormity problem), and racial trauma. The COVID-19 pandemic has impacted the global population in ways not seen in a century. The unique self-care challenges of COVID-19 while enhancing the symptoms of burnout, i.e., physical, and mental exhaustion, despair, helplessness, and suicidal thinking, need to be addressed directly. This paper offers a new COVID-19 self-care model and approach.

Prevalence of and Associations With Distress and Professional Burnout Among Otolaryngologists: Part I, Trainees

OBJECTIVE

To assess the prevalence of distress and burnout in otolaryngology trainees, including associations with relevant sociodemographic and professional factors, and to compare these results with those of attending otolaryngologists.

STUDY DESIGN

A cross-sectional survey of trainees and attending physicians.

SETTING

Twelve academic otolaryngology programs.

METHODS

Distress and burnout were measured with the Expanded Physician Well-being Index and the 2-item Maslach Burnout Inventory. The Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2 were used to screen for depressive disorders and anxiety disorders, respectively. Associations with sociodemographic and professional characteristics were assessed.

RESULTS

Of the 613 surveys administered to trainees and attending physicians, 340 were completed (56%). Among 154 trainees, distress was present in 49%, professional burnout in 35%, positive depressive disorder screening in 5%, and positive anxiety disorder screening in 16%. In univariable analysis, female gender, hours worked in a typical week (HW), and nights on call in a typical week (NOC) were significantly associated with distress. In multivariable analysis, female gender (odds ratio, 3.91; P = .001) and HW (odds ratio for each 10 HW, 1.89; P = .003) remained significantly associated with distress. Female gender, HW, and NOC were significantly associated with burnout univariably, although only HW (odds ratio for each 10 HW, 1.92; P = .003) remained significantly associated with burnout in a multivariable setting. Attending physicians had less distress than trainees (P = .02) and felt less callous and less emotionally hardened than trainees (P < .001).

CONCLUSION

Otolaryngology trainees experience significant work-place distress (49%) and burnout (35%). Gender, HW, and NOC had the strongest associations with distress and burnout.

Intimate Partner Relationships, Work-Life Factors, and Their Associations With Burnout Among Partnered Pediatric Residents

BACKGROUND

Burnout is prevalent among pediatric residents, and reducing burnout is a priority for pediatric residency programs. Understanding residents' personal circumstances, including relationship satisfaction and perceived work-life conflict, may identify novel determinants of burnout.

OBJECTIVES

To describe intimate partner relationships among pediatric residents and examine associations among relationship satisfaction, work-life factors, and burnout.

METHODS

We identified 203 partnered residents (married or in a self-identified committed, ongoing relationship) from a cross-sectional survey of 258 residents in 11 New England pediatric programs (response rate 54% of 486 surveys distributed), conducted from April through June of 2013. We analyzed associations among relationship satisfaction, work-life factors, and burnout using multivariable regression. Burnout was measured with the brief Maslach Burnout Inventory, and relationship satisfaction with the validated Relationship Assessment Scale.

RESULTS

Burnout was reported by 40.9% of partnered respondents. The vast majority of partnered residents (n = 167; 85.2%) reported high relationship satisfaction. Lower relationship satisfaction was not associated with burnout. Approximately half of the respondents (n = 102; 51.5%) reported being satisfied with life as a resident. When controlling for common stressors, such as sleep deprivation, work-life measures associated with burnout included frequent perceived conflicts between personal and professional life (adjusted odds ratio, 4.35; 95% confidence interval, 1.91-9.88) and dissatisfaction with life as a resident (adjusted odds ratio, 11.74; 95% confidence interval, 4.23-32.57).

CONCLUSION

Low relationship satisfaction and common work-life stressors were not associated with burnout among partnered pediatric residents. However, perceived work-life conflict and dissatisfaction with resident life were strongly associated with burnout and are targets for residency programs seeking to ameliorate burnout.

Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout

These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives face this challenge with a disillusioned physician workforce. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness. Physician burnout has been shown to influence quality of care, patient safety, physician turnover, and patient satisfaction. Although burnout is a system issue, most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work. There is a strong business case for organizations to invest in efforts to reduce physician burnout and promote engagement. Herein, we summarize 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic. Our experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Leadership and sustained attention from the highest level of the organization are the keys to making progress.

Divorce among physicians and other healthcare professionals in the United States: analysis of census survey data

OBJECTIVES

To estimate the prevalence and incidence of divorce among US physicians compared with other healthcare professionals, lawyers, and non-healthcare professionals, and to analyze factors associated with divorce among physicians.

DESIGN

Retrospective analysis of nationally representative surveys conducted by the US census, 2008-13.

SETTING

United States.

PARTICIPANTS

48,881 physicians, 10,086 dentists, 13,883 pharmacists, 159,044 nurses, 18,920 healthcare executives, 59,284 lawyers, and 6,339,310 other non-healthcare professionals.

MAIN OUTCOME MEASURES

Logistic models of divorce adjusted for age, sex, race, annual income, weekly hours worked, number of years since marriage, calendar year, and state of residence. Divorce outcomes included whether an individual had ever been divorced (divorce prevalence) or became divorced in the past year (divorce incidence).

RESULTS

After adjustment for covariates, the probability of being ever divorced (or divorce prevalence) among physicians evaluated at the mean value of other covariates was 24.3% (95% confidence interval 23.8% to 24.8%); dentists, 25.2% (24.1% to 26.3%); pharmacists, 22.9% (22.0% to 23.8%); nurses, 33.0% (32.6% to 33.3%); healthcare executives, 30.9% (30.1% to 31.8%); lawyers, 26.9% (26.4% to 27.4%); and other non-healthcare professionals, 35.0% (34.9% to 35.1%). Similarly, physicians were less likely than those in most other occupations to divorce in the past year. In multivariable analysis among physicians, divorce prevalence was greater among women (odds ratio 1.51, 95% confidence interval 1.40 to 1.63). In analyses stratified by physician sex, greater weekly work hours were associated with increased divorce prevalence only for female physicians.

CONCLUSIONS

Divorce among physicians is less common than among non-healthcare workers and several health professions. Female physicians have a substantially higher prevalence of divorce than male physicians, which may be partly attributable to a differential effect of hours worked on divorce.

A survey of U.S. physicians and their partners regarding the impact of work-home conflict

BACKGROUND

Work-home conflicts (WHC) threaten work-life balance among physicians, especially those in dual career relationships. In this study, we analyzed factors associated with WHC for physicians and their employed partners.

METHODS

We surveyed 89,831 physicians from all specialty disciplines listed in the Physician Masterfile. Of the 7,288 (27.7 %) physicians who completed the survey, 1,644 provided the e-mail contact information of their partner. We surveyed these partners and 891 (54 %) responded. Burnout, quality of life (QOL), and depression were measured using validated instruments in both surveys. Satisfaction with career, work-life balance, and personal relationships, as well as experience of WHC were also evaluated.

RESULTS

WHC within the previous 3 weeks were commonly experienced by physicians and their employed partners (44.3 % and 55.7 %, respectively). On multivariate analysis, greater work hours for physicians and their employed partners were independently associated with WHC (OR 1.31 and 1.23 for each additional 10 h, respectively, both p < 0.0001). Physicians and partners who had experienced a recent WHC were more likely to have symptoms of burnout (47.1 % vs. 26.6 % for physicians with and without WHC; 42.4 % vs. 23.8 % for partners with and without WHC, both p < 0.0001).

CONCLUSIONS

WHC are commonly experienced by physicians and their employed partners. These conflicts may be a major contributor to personal distress for physicians and their partners.

The medical marriage: a national survey of the spouses/partners of US physicians

OBJECTIVE

To evaluate physician relationships from the perspective of their spouses/partners.

METHODS

Nearly all data on satisfaction with physician relationships come from the perspective of the physician rather than their spouse/partner. We conducted a national study of the spouses/partners of US physicians from August 17, 2011, through September 12, 2011. Responding spouses/partners provided information on demographic characteristics, their own work life, and the work life of their physician partners. Spouses/partners also rated relationship satisfaction and the effect of the work life of their physician partner on the relationship.

RESULTS

Of the 1644 spouses/partners of physicians surveyed, 891 (54.2%) responded. Most spouses/partners (86.8%) reported that they were satisfied with their relationship with their physician partner. Satisfaction strongly related to the amount of time spent awake with their physician partners each day. Despite their overall satisfaction, spouses/partners reported their physician partners frequently came home irritable, too tired to engage in home activities, or preoccupied with work. On multivariate analysis, minutes spent awake with their physician partners each day was the strongest predictor of relationship satisfaction, exhibiting a dose-response effect. No professional characteristic of the physician partners (eg, hours worked per week, specialty area, and practice setting) other than the number of nights on call per week correlated with relationship satisfaction on adjusted analysis.

CONCLUSION

The spouses/partners of US physicians report generally high satisfaction with their relationships. The mean time spent with their physician partners each day appears to be a dominant factor associated with relationship satisfaction and overshadows any specific professional characteristic of the physicians' practice, including specialty area, practice setting, and work hours.

Quality of life during orthopaedic training and academic practice: part 2: spouses and significant others

BACKGROUND

Orthopaedic residents and attending physicians who report having a supportive spouse show lower levels of burnout and psychological distress than those without supportive spouses. However, little is known about the experiences of the spouses. This nationwide study examines burnout, psychological distress, and marital satisfaction of the spouses and significant others (collectively referred to hereafter as spouses) of orthopaedists in training and in orthopaedic practice in an academic setting.

METHODS

Employing previously reported methodology, 259 spouses of orthopaedic residents and 169 spouses of full-time orthopaedic faculty completed a voluntary, anonymous survey. The survey included three validated instruments (the Maslach Burnout Inventory, the General Psychological Health Questionnaire-12, and the Revised Dyadic Adjustment Scale) and three novel question sets addressing demographic information, relationship issues, stress, and work/life balance.

RESULTS

Psychological distress was noted in 18% of resident spouses compared with only 10% of faculty spouses (p = 0.014). Resident spouses reported greater loneliness (p &lt; 0.0009) and stress (p = 0.03) than faculty spouses. Among working spouses, 30% of resident spouses and 13% of faculty spouses showed high levels of emotional exhaustion (p &lt; 0.003). Twenty-eight percent of employed resident spouses and 5% of employed faculty spouses showed problematic levels of depersonalization (p &lt; 0.0001). Twenty-six percent of employed resident spouses and 12% of employed faculty spouses showed a diminished sense of personal accomplishment (p = 0.012). Marital satisfaction was high for both resident and faculty spouses. Decreased satisfaction correlated with excessive mate irritability and fatigue that precluded their mate's involvement in family activities. A gratifying sex life, full-time work outside the home, and spending more than ninety minutes a day with their mate correlated significantly with marital satisfaction.

CONCLUSIONS

Many orthopaedic resident spouses showed elevated levels of burnout, and a substantial number showed psychological distress. Spouses of orthopaedic faculty surgeons showed low rates of burnout and psychological distress. While both resident and faculty spouses reported high levels of marital satisfaction, the engagement of their surgeon mates had a considerable impact on the well-being of the relationship.

[Social support and physicians' health]

OBJECTIVES

Over the last decades, social support (SU) has proved to be an important psychological health resource in the prevention of mental and physical illness as well as for the promotion and restoration of general health. This study evaluates the relevance of social support for the health and well-being of physicians.

METHOD

This is a systematic literature review using PubMed from 1970 to 2007 with the keywords "social support", "physicians", "physician's role", and respectively "medical staff, hospital" from medical subheadings (MeSH). From the retrieved articles the additionally relevant keywords "marriage", "spouse", "friends", and "self-help groups" (MeSH) were identified and researched.

RESULTS

Social support with distinct effects on physician's health could be shown in the areas of colleagues and professional network (30 sources), marriage/spouse (47), friends (3), and support groups (13). Female physicians appeared to seek and profit more from SU than did male physicians. Informal friendships have yet to be evaluated thoroughly.

CONCLUSION

In the light of a physician's daily stress, SU appears to be a jeopardized resource that could significantly contribute to the prevention of burnout or other profession-related symptoms or illnesses.

Perceptions and Predictors of Surgeon Satisfaction: A Survey of Spouses of Academic Surgeons

BACKGROUND

Although several studies have addressed the role of spouses in physicians' career choices, there is limited data about spousal perception of surgeons' careers after training. This study examined satisfaction with surgeons' careers and potential contributing factors from a spousal standpoint.

STUDY DESIGN

A survey of spouses of academic surgeons in 38 participating departments was conducted. Questions included demographic information and perceptions of career satisfaction and contributing factors. Data were analyzed using descriptive statistics, Student's t-test or Mann-Whitney U test, and chi-square or Fisher's exact test.

RESULTS

Three hundred seventy-nine surveys (27%) were returned, with the majority (81%) perceiving their surgeon spouses to be satisfied. Contributing factors to surgeon dissatisfaction included: work hours/call (42%); practice limitations (18%); reimbursement/income (12%); and malpractice/insurance (7%). Dissatisfied surgeons, as perceived by their spouses, did not differ from satisfied surgeons in terms of work hours, income expectations, geographic desirability, or home involvement. On the other hand, predictors of dissatisfied spouses included lack of input into career decisions, less satisfaction with location, and lack of their surgeon spouses' participation in household and child-care activities.

CONCLUSIONS

There are many positive and negative aspects to being an academic surgeon. Yet, despite the time commitment, work hours per se do not appear to contribute to either surgeon or spousal satisfaction. Spousal satisfaction is dependent on surgeon contribution to household and childcare activities. Despite the multiple potential detractors from an academic surgical career, most surgeons, as perceived by their spouses, would not have chosen differently and are satisfied with their career choices.

Physicians' wives evaluate their marriages, their husbands, and life in medicine: Results of the AMA-Alliance Medical Marriage Survey

This largest-ever investigation of the attitudes, lifestyles, and marital adjustment of physicians' wives disputes many stereotypes of medical marriage. Responses of 603 members of the American Medical Association Alliance to standardized and subjective measures indicated high levels of marital adjustment and overall satisfaction with work/life balance. Wives' marital adjustment was affected by age of oldest child, husbands' work hours, and wives' work outside the home. It is proposed that, more than hours worked, it is how a couple treats each other when they are not working that most powerfully determines the quality of a contemporary medical marriage. Wives' advice on marital and work/life issues is summarized.

Are anaesthetists prone to suicide? A review of rates and risk factors

Suicide represents a major source of mortality in Western countries. There is an emerging literature about suicide and the medical profession. The suicide of an anaesthetist represents a catastrophic event, with painful consequences for family, colleagues and the community at large. This review will examine the literature regarding suicide amongst anaesthetists and trainees in the field. It is presented in three sections. First, it provides an overview of existing epidemiological data, comparing rates in the general population, the medical profession, in general, and in anaesthesia, in particular. Second, risk factors that may account for differences in rates will be discussed. Finally, a series of recommendations has been formulated.

A qualitative study of physicians' own wellness-promotion practices

OBJECTIVE

To delineate the specific practices that physicians use to promote their own well-being.

DESIGN, SETTING, AND PARTICIPANTS

304 members of a primary care practice-based research group responded by mail to a survey on physician well-being. From the original survey, 130 subjects responded to an open-ended survey item regarding their own wellness-promotion practices.

METHODS

Qualitative content analysis was used to identify the common themes in the physicians' responses to the open-ended question. A validated 18-item instrument, the Scales of Psychological Well-Being (SPWB), was used for measurement.

MAIN OUTCOME MEASURES

Similarities and differences between the various wellness-promotion practices that respondents reported using and associations between the use of these practices and SPWB scores.

RESULTS

The 5 primary wellness-promotion practices that evolved from thematic analysis of the survey responses included "relationships," "religion or spirituality," "self-care," "work," and "approaches to life." The use of the last type of practice was significantly associated with increased psychological well-being (SPWB) scores compared with the use of any of the other wellness-promotion practice categories (P<0.01), and there was a trend toward increased well-being among users of any category of wellness-promotion practices. Comments by our respondents provide specific descriptions of how physicians attend to their emotional, spiritual, and psychological well-being.

CONCLUSION

Physicians use a variety of approaches to promote their own well-being, which sort themselves into 5 main categories and appear to correlate with improved levels of psychological well-being among users.

Marital and parental satisfaction of married physicians with children

OBJECTIVE

To evaluate personal and professional factors associated with marital and parental satisfaction of physicians.

STUDY DESIGN

Cross-sectional study.

PARTICIPANTS

A survey was sent to equal numbers of licensed male and female physicians in a Southern California county. Of 964 delivered questionnaires, 656 (68%) were returned completed. Our sample includes 415 currently married physicians with children, 64% male and 36% female.

MEASUREMENTS AND MAIN RESULTS

Ratings of marital and parental satisfaction were measured on a 5-point Likert scale, 5 being extremely satisfied. Prevalence of work and home life factors was also evaluated. The mean score for marital satisfaction was 3.92 (range 1.75-5.0). Approximately half of the physicians reported high levels of marital satisfaction (63% of male physicians and 45% of female physicians). The gender difference disappeared after adjusting for age differences. Two factors were associated with high marital satisfaction: a supportive spouse (odds ratio [OR] 10.37; 95% confidence interval [CI] 2.66, 40.08) and role conflict (OR 0.61; 95% CI 0.42, 0.88). The mean score for parental satisfaction was 3. 43 (range 1.0-5.0), and approximately two thirds of both male and female physicians reported at least moderate levels of parental satisfaction. The major factors associated with parental satisfaction were a supportive spouse (OR 2.24; 95% CI 1.32, 3.80), role conflict (OR 0.35; 95% CI 0.23, 0.53), salaried practice setting (OR 2.14; 95% CI 1.21, 3.81), marriage to a spouse working in a profession (OR 2.14; 95% CI 1.21, 3.81), and marriage to a spouse working as a homemaker (OR 2.33; 95% CI 1.20, 4.56). Number of hours worked was not found to be related to either satisfaction score, but rather to an intervening variable, role conflict.

CONCLUSIONS

For physicians with children, our study indicates that minimizing the level of role conflict and having a supportive spouse are associated with higher levels of marital and parental satisfaction. Working in salaried positions and marriage to a spouse who is either working in a profession or who is a stay-at-home parent are also related to high parental satisfaction.

Maternal parenting stress in physicians' families

The families of 16 male staff physicians and 26 male residents were studied. All spouses completed the Abidin Parenting Stress Index (PSI) prior to a well-child visit. Home interviews were conducted to identify factors contributing to stress. PSI scores were similar in both groups. The interviews suggested that physician fathers had limited time and energy for parenting. Resident fathers were twice as likely as staff fathers to participate in child care when home. Parenting stress tended to stay the same in 25% of families or increased in 50% of families after residency training.