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McClafferty H. Workforce Concerns: Professional Self Care, Personal Readiness, Impact of the Pandemic, and Other Factors that Impact the Workforce. Pediatr Clin North Am 2024; 71:413-429. [PMID: 38754933 DOI: 10.1016/j.pcl.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Physician burnout is pervasive and takes a heavy toll on individuals and the healthcare system. Post-coronavirus disease 2019 the negative impact of organizational culture on physician burnout has been highlighted. Substantial research has accrued identifying steps organizations can take to pivot and develop leaders committed to physician well-being. Physicians can also proactively explore research in sleep, nutrition, physical activity, stress management, and social connections. Positive mindset has a powerful protective effect in medicine, especially in the emerging areas of self-valuation, self-compassion, and positive psychology. Physician coaching can accelerate positive behavior change. Committed physician leaders are needed for sustained culture change to occur.
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Harrison WN, Mittal VS, O'Toole JK, Quinonez RA, Mink R, Leyenaar JK. Child Health Needs and the Pediatric Hospital Medicine Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678M. [PMID: 38300016 DOI: 10.1542/peds.2023-063678m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Pediatric hospital medicine (PHM) established a new model of care for hospitalized children in the United States nearly 3 decades ago. In that time, the field experienced rapid growth while distinguishing itself through contributions to medical education, quality improvement, clinical and health services research, patient safety, and health system leadership. Hospital systems have also invested in using in-house pediatricians to manage various inpatient care settings as patient acuity has accelerated. National PHM leaders advocated for board certification in 2014, and the first certification examination was administered by the American Board of Pediatrics in 2019. In this article, we describe the development of the subspecialty, including evolving definitions and responsibilities of pediatric hospitalists. Although PHM was not included in the model forecasting future pediatric subspecialties through 2040 in this supplement because of limited historical data, in this article, we consider the current and future states of the workforce in relation to children's health needs. Expected challenges include potential alterations to residency curriculum, changes in the number of fellowship positions, expanding professional roles, concerns related to job sustainability and burnout, and closures of pediatric inpatient units in community hospitals. We simultaneously forecast growing demand in the PHM workforce arising from the increasing prevalence of children with medical complexity and increasing comanagement of hospitalized children between pediatric hospitalists and other subspecialists. As such, our forecast incorporates a degree of uncertainty and points to the need for ongoing investments in future research to monitor and evaluate the size, scope, and needs of pediatric hospitalists and the PHM workforce.
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Affiliation(s)
- Wade N Harrison
- Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vineeta S Mittal
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas
| | - Jennifer K O'Toole
- Division of Hospital Medicine, Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ricardo A Quinonez
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Richard Mink
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center and the David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - JoAnna K Leyenaar
- Department of Pediatrics and the Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Health, Lebanon, New Hampshire
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Webber S, Coller RJ, Schultz R, Rogers EE, Olson ME, Moreno MA, Babal JC. Eight Domains of Pediatrician Wellness: A Stakeholder Informed Model. Acad Pediatr 2024:S1876-2859(23)00480-1. [PMID: 38215902 DOI: 10.1016/j.acap.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Physician wellness is important to health care systems and quality patient care. There has been limited research clarifying the physician wellness construct. We aimed to develop a stakeholder-informed model of pediatrician wellness. METHODS We performed a group concept mapping (GCM) study to create a model of pediatrician wellness. We followed the four main steps of GCM and recruited pediatricians at multiple sites and on social media. During brainstorming, pediatricians individually responded to a prompt to generate ideas describing the concept of pediatrician wellness. Second, pediatricians sorted the list of brainstormed ideas into conceptually similar groups and rated them on importance. Sorted data were analyzed to create maps showing each idea as a point, with lines around groups of points to create clusters of wellness. Mean importance scores for each cluster were calculated and compared using pattern match. RESULTS Pediatricians in this study identified eight clusters of wellness: 1) Experiencing belonging and support at work, 2) Alignment in my purpose, my work, and my legacy, 3) Feelings of confidence and fulfillment at work, 4) Skills and mindset for emotional well-being, 5) Harmony in personal, professional, and community life, 6) Time and resources to support holistic sense of self, 7) Work boundaries and flexibility, and 8) Organizational culture of inclusion and trust. There were no significant differences in mean cluster rating score; the highest rated cluster was Harmony in personal, professional and community life (3.62). CONCLUSION Pediatricians identified eight domains of wellness, spanning professional and personal life, work, and individual factors.
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Affiliation(s)
- Sarah Webber
- Department of Pediatrics (S Webber, RJ Coller, R Schultz, MA Moreno, and JC Babal), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Ryan J Coller
- Department of Pediatrics (S Webber, RJ Coller, R Schultz, MA Moreno, and JC Babal), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Roger Schultz
- Department of Pediatrics (S Webber, RJ Coller, R Schultz, MA Moreno, and JC Babal), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Elizabeth E Rogers
- Department of Pediatrics (EE Rogers), University of California San Francisco
| | - Maren E Olson
- Department of Pediatrics (ME Olson), University of Minnesota, Minneapolis, Minn
| | - Megan A Moreno
- Department of Pediatrics (S Webber, RJ Coller, R Schultz, MA Moreno, and JC Babal), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Jessica C Babal
- Department of Pediatrics (S Webber, RJ Coller, R Schultz, MA Moreno, and JC Babal), University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Nigri L, Carrasco-Sanz A, Pop TL, Giardino I, Vural M, Ferrara P, Indrio F, Pettoello-Mantovani M. Burnout in Primary Care Pediatrics and the Additional Burden from the COVID-19 Pandemic. J Pediatr 2023; 260:113447. [PMID: 37120131 PMCID: PMC10139743 DOI: 10.1016/j.jpeds.2023.113447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Luigi Nigri
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; Italian Federation of Primary Care Pediatricians, Rome, Italy; European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany
| | - Angel Carrasco-Sanz
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany; European Confederation of Primary Care Pediatricians, Lyon, France; Spanish Primary Care Pediatric Association, Madrid, Spain
| | - Tudor Lucian Pop
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany; Romania Society of Social Pediatrics, Cluj, Romania
| | - Ida Giardino
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Mehmet Vural
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany; Turkish Pediatric Association, Istanbul, Turkey
| | - Pietro Ferrara
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany; Italian Academy of Pediatrics, Milan, Italy
| | - Flavia Indrio
- European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany; Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Pettoello-Mantovani
- Association pour l'Activité et la Recherche Scìentifiques, Neuchatel, Switzerland; European Pediatric Association/Union of National European Pediatric Societies and Associations, Berlin, Germany; Italian Academy of Pediatrics, Milan, Italy.
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Haxel CS, Belser AH, DeSarno M, Glickstein J, Flyer JN. Pediatric Cardiology Condolence Letter Writing: Does a Fellowship Curriculum Impact Practice? J Pain Symptom Manage 2023; 66:e343-e352. [PMID: 37327916 DOI: 10.1016/j.jpainsymman.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT Condolence letter (CL) writing after the death of a child is an important opportunity for humanism. Pediatric cardiology fellowship training now recognizes the importance of palliative care, but rarely includes CL education, despite its fragile patient population. OBJECTIVES To address this professionalism gap, a formal CL writing curriculum was created and implemented in a pediatric cardiology fellowship. This study investigated the impact of the curriculum on pediatric cardiology CL writing, and broader CL practices and beliefs. METHODS Pediatric cardiology fellows at a high volume urban academic program from 2000 to 2022 were divided into two cohorts (exposure to CL curriculum [2014-2022] vs. no exposure [2000-2013]) and responded by anonymous electronic multiple choice and open ended survey to assess the CL curriculum and describe current CL practices and beliefs. Impact of curriculum elements was determined by ordinal ranking. A 5-point Likert scale was used to report physician behaviors. Chi-square tests of independence were utilized for group comparisons. RESULTS The overall survey response rate was 59% (63/107). Cardiologists who participated in the curriculum (64%, 35/55) were more likely to report writing CLs (80% vs. 40%; P < 0.01). Impactful curriculum elements included the opportunity for all fellows to contribute to a CL (78%) and identifying a primary fellow to write the CL (66%). A majority (>75%) of curriculum participants agreed that formal teaching increased their frequency, ability, and comfort in writing CLs. CONCLUSION Development of condolence expression educational programs in pediatric cardiology training should be expanded.
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Affiliation(s)
- Caitlin S Haxel
- Department of Pediatric (C.S.H, J.N.F.), The Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT; Division of Pediatric Cardiology (C.S.H.), University of Vermont Children's Hospital, Burlington, VT, USA.
| | - Abigail H Belser
- Boston Combined Residency Program (A.H.B.), Boston Children's Hospital, Boston, MA, USA
| | - Michael DeSarno
- Department of Medical Biostatistics (M.D.), The Robert Larner M.D. College of Medicine at the University of Vermont, Colchester, VT, USA
| | - Julie Glickstein
- Department of Pediatrics, Division of Pediatric Cardiology (J.G.), Morgan Stanley Children's Hospital of New York Presbyterian, New York, NY, USA
| | - Jonathan N Flyer
- Department of Pediatric (C.S.H, J.N.F.), The Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT; Division of Pediatric Cardiology (C.S.H.), University of Vermont Children's Hospital, Burlington, VT, USA
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Khan S, Wilson PM. One Size Does Not Fit All: The Current State of Wellness in Pediatrics. Hosp Pediatr 2023; 13:e14-e16. [PMID: 36274195 DOI: 10.1542/hpeds.2022-006997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Sarah Khan
- Department of Pediatrics, Division of Hospital Medicine
| | - Paria M Wilson
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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