Physician Burnout Through the Female Lens: A Silent Crisis

Improving well-being among women in neonatology

OBJECTIVE

To evaluate the factors that improve professional and personal well-being amongst women in neonatology (WiN).

STUDY DESIGN

A 30-question survey of multiple choice, rank order, and open-ended questions focused on professional and personal factors that affect the well-being of WiN members. Quantitative and qualitative methods were used to determine leading factors and themes.

RESULTS

Of 326 respondents, 64% felt "well" professionally over half of the time. Professional well-being was most affected by scheduling flexibility, helping patients, administrative and staffing support, feelings of being valued, and clinical workload/acuity. Time for family and self-care, having domestic help, and scheduling flexibility were factors that most positively impacted personal well-being.

CONCLUSION

In this national survey, WiN members identified the factors that can improve their well-being. Strategic planning and targeted interventions are urgently needed to enhance work-life integration and job satisfaction, leading to improved neonatal workforce retention and improved quality of patient care.

National Comparison of Burnout for a Cohort of Surgical and Nonsurgical Female Trainees

INTRODUCTION

Studies have shown that female physician trainees have an increased risk of burnout. We describe the current state of surgical and nonsurgical female trainee well-being and examine differences between surgical and nonsurgical specialties.

METHODS

Survey responses were received from 1017 female identifying trainees from 26 graduate medical education institutions across the United States. These survey responses included demographic data and well-being measures. Specifically, burnout was assessed using the Maslach Burnout Inventory. Data were analyzed using Wilcoxon rank sum test, Fisher's exact test, and Pearson's Chi-squared test data with significance defined as a P < 0.05. This survey was reported in line with strengthening the reporting of cohort studies in surgery criteria.

RESULTS

Nine-hundred ninety-nine participants completed the demographic and well-being section of the surveys and were included in analysis. Demographic data between the surgical versus nonsurgical group were similar, aside from surgeons being slightly older. Burnout was prevalent among all surveyed trainees with 63% scoring positive. Trainees also scored high in imposter syndrome and moral injury with low levels of self-compassion, although respondents also reported themselves flourishing. Surgical trainees scored higher than nonsurgical trainees in the personal accomplishment domain of burnout (P < 0.048). There was no difference between surgical and nonsurgical trainees in measures of the emotional exhaustion or depersonalization domains of burnout, or in impostor syndrome, self-compassion, moral injury, or flourishing.

CONCLUSIONS

While personal accomplishment was noted to be higher in surgical trainees as compared to nonsurgical trainees, overall rates of burnout are high among both groups. Targeted interventions for well-being, such as coaching, can help decrease the levels of burnout experienced by female physician trainees and do not need to be specialty specific.

Stress and Burnout among Medical Specialists in Romania: A Comparative Study of Clinical and Surgical Physicians

This study, which focuses on 227 participants (196 females and 31 males) comprising 187 clinical specialists and 40 surgical physicians, examines the prevalence of burnout in medical specialists. We investigate the effects of the emotional exhaustion (EE), Depersonalization (D), and personal accomplishment (PA) dimensions on professional satisfaction and plans to change careers using the modified licensed Maslach Burnout Inventory-Human Services Survey (MBI-HSS (MP)). High emotional exhaustion is reported by 52.63% of men and 71.28% of women in the clinical medicine group (n = 188). In the surgical specialties (n = 39), scores are significantly higher, with 75% of men and 77.77% of women reporting EE. In our sample group, 71.36% express high levels of emotional exhaustion, with similar patterns across specialization and gender. Clinical medicine respondents report high degrees of depersonalization in 33.13% of females and 21.05% of males, while surgical specialty respondents report high levels in 33.33% of females and 50% of males. Across genders and specializations, 33.03% of all respondents show high levels of depersonalization. Clinical medicine participants report high levels of personal accomplishment (42.60% of females and 42.10% of males), whereas surgical specialties report 44.44% of females and 66.66% of male on the PA dimension. Of the total number of respondents, 44.05% report having a high level of personal accomplishment; differences exist depending on specialty and gender. In addition, questions regarding professional fulfilment and intention to change careers were presented to the participants. A total of 53.40% (16 male and 105 female) of the clinical medicine respondents said they intended to change careers, while 33 participants (9 male, 34 female) doubted if they would remain in the same specialization. Furthermore, 86 individuals (9 male and 77 female) in the surgical specialties said they would never choose to work in healthcare again. Regression analysis suggests that being male, higher in age, and working in surgical specialties with lower job satisfaction and a higher intention to change profession are associated with higher levels of EE. Age and work satisfaction are significant predictors of depersonalization, and higher career satisfaction is associated with increased levels of PA.

Physician Burnout: Evidence-Based Roadmaps to Prioritizing and Supporting Personal Wellbeing

Current literature validates the magnitude of physician burnout as a complex challenge affecting physicians, patients, and healthcare delivery that mandates science-informed intervention. Physician burnout affects both individual practitioners and patient care delivery. Interventions, defined as roadmaps, to prioritizing and supporting personal wellbeing encompass organizational, individual, and moral injury, with virtually no consensus on optimal approaches. The purpose of this conceptual review is to present evidence-based innovative insights on contributing factors, mitigation, and designing adaptive systems to combat and prevent burnout. Science-informed policy initiatives that support long-term organizational changes endorsed by both leadership and institutional stakeholders are keys to sustaining personal wellbeing and ending burnout.

Exploring National Trends and Organizational Predictors of Violence and Mistreatment From Patients and Visitors

GOAL

Rising incidents of violence and mistreatment of healthcare workers by patients and visitors have been reported. U.S. healthcare workers are five times more likely to experience nonfatal workplace violence (WPV) than workers in any other profession. However, less is known about the national trends in the incidence of violence and mistreatment in healthcare. The specific organizational and individual-level factors that relate to stress arising from these occurrences specifically by patients and family members are also not fully understood. The goals of this study were to examine national trends of violence toward healthcare workers, understand which populations are most vulnerable to stress from violence and mistreatment, and explore organizational factors that are related to these occurrences.

METHODS

Data were collected from three sources: (1) The Bureau of Labor Statistics Intentional Injury by Another Person data for the period 2011-2020, (2) data from a large national workers' compensation claim services provider for the period 2018-2022, and (3) results from a survey distributed at a large medical center in June and July 2022. Data were represented graphically and analyzed using multivariate regression and dominance analysis to identify specific predictors of WPV and mistreatment among healthcare workers.

PRINCIPAL FINDINGS

Of the total surveyed sample, 23.7% of participants reported mistreatment from patients or visitors as a major stressor and 14.6% reported WPV from patients or visitors as a major stressor. Stress from mistreatment and WPV was most frequently reported by nurses, employees aged 18 to 24 years other than nurses, those who identified as White, and those who identified as female or a gender minority. The emergency room (ER) showed the highest percentages of stress from mistreatment (61.8%) and violence (55.9%) from patients or visitors. The top predictors of stress from WPV and mistreatment by patients or visitors among healthcare workers ranked high to low were working in the ER, working as a nurse, a lack of necessary supplies or equipment, patient or visitor attitudes or beliefs about COVID-19, and working in a hospital-based unit.

PRACTICAL APPLICATIONS

In addition to protecting employees as a moral imperative, preventing WPV is critical for organizational performance. Employee productivity is estimated to decrease up to 50% in the 6 to 18 weeks following an incident of violence, while turnover can increase 30% to 40%. An effective WPV prevention plan and a proactive approach to supporting the physical and mental health conditions that may result from WPV can mitigate the potential costs and exposures from these incidents. Organizations must also set clear expectations of behavior with patients and visitors by refusing to tolerate violence and mistreatment of caregivers. The impact of WPV can remain present and active for up to 8 years following an incident. Policy-level interventions are also needed. Currently, there are no federal protections for healthcare workers related to violence, though some states have made it a felony to abuse healthcare workers.

Burnout Among Family Physicians in the United States: A Review of the Literature

BACKGROUND AND OBJECTIVES

Burnout among physicians who work in primary care is an important problem that impacts health care quality, local communities, and the public's health. It can degrade the quality of primary care services in an area and exacerbate workforce shortages. This study conducted a review of the published research on burnout among family physicians working in the United States.

METHODS

We used a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided approach and several article databases to identify, filter, and analyze published research on US family physician burnout that uses data collected from 2015 onward.

RESULTS

Thirty-three empirical studies were identified with findings that included US family physician burnout prevalence and/or associations between burnout and specific personal and contextual drivers. Mean family physician burnout prevalence across studies that measured it was 35%. Almost half of the studies classified one-third or more of their family physician samples as burned out. Physician gender (being female), age (being younger), and job/work-related factors (workload, time pressures) were the most commonly identified correlates of family physician burnout. The vast majority of studies were cross-sectional and used secondary data.

CONCLUSIONS

The extant research literature on family physician burnout in the United States shows that burnout is currently a meaningful problem. Several important correlates of the problem can be identified, some of which managers and health care organizations can proactively address. Other correlates require managers and health care organizations also viewing family physicians in differentiated ways. The collective literature can be improved through a more consistent focus on similar burnout correlates across studies; inclusion of interventions aimed at lessening the effects of key burnout correlates; employment of more robust longitudinal and quasi-experimental research designs; and additional pandemic-era data collection on burnout.

The role of social support as a moderator between resilience and levels of burden of multimorbidity management among general practitioners: a cross-sectional study in Portugal

BACKGROUND

Multimorbidity management poses significant challenges for general practitioners (GPs). The aim of this study is to analyse the role of resilience and social support on the burden experienced by GPs in managing patients with multiple health conditions in Portugal.

METHODS

Cross-sectional quantitative study conducted among GPs in Portugal using an online questionnaire that included validated measurement tools: Questionnaire of Evaluation of Burden of Management of Multimorbidity in General and Family Medicine (SoGeMM-MGF), European Portuguese Version of the Resilience Scale (ER14), and the Oslo Social Support Scale-3 (OSSS-3) in Portuguese. A multiple linear regression analysis was conducted to examine the factors influencing the burden of managing multimorbidity.

RESULTS

Two hundred and thirty-nine GPs were included, with 76.6% being female and a median age of 35 years. Most participants were specialists (66.9%) and had less than a decade of experience managing multimorbidity. Over 70% had not received specific training in multimorbidity. Female GPs and those with a higher proportion of multimorbid patients in the registries experienced higher burden levels. A multivariate regression model with moderation revealed that the effect of resilience on burden varied depending on the level of social support. Higher resilience was associated with higher burden in the "Poor Social Support" category, while it was associated with lower burden in the "Moderate Social Support" and "Strong Social Support" categories, although not statistically significant.

CONCLUSIONS

The study highlights the importance of GPs' social support and resilience in managing the burden of multimorbidity, with poor social support potentially worsening the effects of high resilience.

Burnout and Intention to Change Profession among Romanian Dentists during COVID-19: A Cross Sectional Study Using the Maslach Burnout Inventory

This study aims to examine the relationship between burnout and dentists' intentions to change careers during the COVID-19 pandemic. The MBI-Human Services Survey for Medical Personnel-MBI-HSS (MP) was used to measure burnout levels and investigate how they relate to dentists' intentions to change their profession. The sample included 69 Romanian dentists, 56 of whom were women and 13 of whom were men. Self-reported questionnaires provided to the participants were used to collect the data. Female participants reported higher levels of emotional Exhaustion and Depersonalisation than males. However, there were no substantial differences in Personal Accomplishment levels between genders. As for the intentions to change careers, 41 expressed a clear intention to change their profession, 15 were still determining if they would choose the same speciality, and 28 indicated they would not choose the medical field. The study's findings provide insight into how dentists' thoughts about perceived burnout during the COVID-19 pandemic significantly influenced their attitudes regarding their career paths. The results suggest concerns regarding burnout in the dental field and emphasise the necessity for burnout interventions and support services, particularly during healthcare crises. Further research and interventions to mitigate burnout and promote well-being among dentists are needed to ensure the sustainability and quality of dental healthcare services in Romania.

Economics of a Dermatology Practice

Understanding the economics behind any medical practice comes down to one basic concept: Profit = Revenue - Expenses. This article aims to demystify the details that underlie this simple formula and to provide the budding dermatologist the information and the tools needed to determine their own profitability in the "real world."

Burnout and motivation to study medicine among students during the COVID-19 pandemic

Aim

To investigate medical students' burnout and motivation levels in each of the six years of their studies during the COVID-19 pandemic and identify independent predictors of burnout and motivation.

Methods

An anonymous cross-sectional survey was sent to the students of all six years within our school. Burnout was measured with the adapted Oldenburg Burnout Inventory questionnaire (OLBI-S) and motivation with the updated Strength of Motivation for Medical School (SMMS-R) questionnaire. Univariate analysis was performed with the Kruskal-Wallis test and Spearman's correlation, while multivariable analysis with linear regression models.

Results

A total of 333 medical students (52% of student body) responded. Higher burnout levels correlated with lower motivation to study medicine (rho = -0.30, p < 0.001). Burnout levels differed between the six years of medical studies, peaking in years two and four whereas being the lowest in year one (p = 0.01). Motivation levels differed significantly as well, peaking in years one and four whereas being the lowest in years five and six (p = 0.012). In the multivariable linear regression models, being a female (b = 2.22, p = 0.016), studying in the fourth year vs. first year (b = 2.54, p = 0.049), having a perceived beginner/intermediate vs. advanced/expert technology level (b = 2.05, p = 0.032) and a perceived poor school support system (b = 6.35, p < 0.001) were independently associated with higher burnout levels. Furthermore, studying in the fifth year vs. first year (b = -5.17, p = 0.019) and a perceived poor school support system (b = -3.09, p = 0.01) were independently associated with a reduced motivation to study medicine.

Conclusion

Our study highlighted potential areas for intervention to decrease the rate of burnout and low motivation among medical students. However, further research is needed to unravel the full effect of the pandemic on medical students.

Veterinarian burnout demographics and organizational impacts: a narrative review

Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.

Relationships between job satisfaction, organizational commitment, burnout and job performance of healthcare professionals in a district-level health care system of Shenzhen, China

BACKGROUND

Existing research indicates that job satisfaction has effects on job performance, but little evidence exists about the mechanism through which the satisfaction-performance association operates. This study aims to examine the effect of job satisfaction on job performance in a district-level health care system of China and to explore the effect mechanism mediated by organizational commitment and burnout.

METHODS

Cluster sampling was used in this study. All healthcare professionals in the Nanshan Medical Group, who were at work in the last 3 months and able to complete online questionnaire independently were invited to participate the anonymous online survey. Job satisfaction, organizational commitment, burnout and job performance were measured by tools, which have been validated in China. Descriptive statistics were used for the socio-demographic variables and the four job psychological variables. Pearson correlation coefficients was used to determine associations among each of the psychological variables. Linear regression was used to examine association between job performance and other three psychological variables. PROCESS macro was used to examine the mediation effects of organizational commitment and burnout on the association between job satisfaction and performance.

RESULTS

In total, 1,200 healthcare professionals completed the anonymous online survey. Job satisfaction, organizational commitment, and job performance were positively correlated with one another, with burnout negatively correlated with them. Linear regression revealed that demographic characteristics, job satisfaction, organizational commitment, and burnout explained 5, 6, 2, and 9% of the variance in job performance. Path analysis showed that the coefficient of the direct effect of job satisfaction on job performance was 0.18, the coefficients of the indirect effects of job satisfaction on job performance through organizational commitment and burnout were 0.17 and 0.37, respectively. The coefficients of the indirect effects of organizational commitment on job performance through burnout was -0.04, but it was not significant.

CONCLUSION

It is promising to improve job performance of providers in Chinese healthcare systems by improving job satisfaction and reducing burnout. Tailored support policies for female healthcare professionals, appropriate incentive mechanisms and improving multidisciplinary healthcare delivery are potential to improve job performance of healthcare professionals in integrated healthcare systems.