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Rotenstein L, Wang H, West CP, Dyrbye LN, Trockel M, Sinsky C, Shanafelt T. Teamwork Climate, Safety Climate, and Physician Burnout: A National, Cross-Sectional Study. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00076-X. [PMID: 38653613 DOI: 10.1016/j.jcjq.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/25/2024]
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Dyrbye LN, West CP. Medical Student Intent to Practice in Underserved Areas-Reply. JAMA 2024; 331:802. [PMID: 38441585 DOI: 10.1001/jama.2023.28306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Liselotte N Dyrbye
- Department of Medicine, University of Colorado School of Medicine, Denver
| | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
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West CP. Embracing Humanness: Integrating Physicians' Personal Experiences With Their Teaching and Patient Care Roles. Acad Med 2024; 99:237-238. [PMID: 38416848 DOI: 10.1097/acm.0000000000005597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
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Collins RA, Herman T, Snyder RA, Haines KL, Stey A, Arora TK, Geevarghese SK, Phillips JD, Vicente D, Griggs CL, McElroy IE, Wall AE, Hughes TM, Sen S, Valinejad J, Alban A, Swan JS, Mercaldo N, Jalali MS, Chhatwal J, Gazelle GS, Rangel E, Yang CFJ, Donelan K, Gold JA, West CP, Cunningham C. Unspoken Truths: Mental Health Among Academic Surgeons. Ann Surg 2024; 279:429-436. [PMID: 37991182 DOI: 10.1097/sla.0000000000006159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To characterize the current state of mental health within the surgical workforce in the United States. BACKGROUND Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown. METHODS Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed. RESULTS Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4%-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. In all, 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P <0.001), anxiety (31.6% vs. 16.2%, P =0.001), PTSD (12.8% vs. 5.6%, P =0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P =0.022). Overall, 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past 2 weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P =0.033) and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P <0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P =0.002) were associated with increased odds of suicidal ideation over the past 12 months. CONCLUSIONS Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the United States.
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Affiliation(s)
- Reagan A Collins
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Tianna Herman
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Rebecca A Snyder
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Anne Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Tania K Arora
- Department of Surgery, Augusta University at the Medical College of Georgia, Augusta, GA
| | | | | | - Diego Vicente
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Cornelia L Griggs
- Department of Pediatric Surgery, Massachusetts General Hospital, Boston, MA
| | - Imani E McElroy
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Anji E Wall
- Department of Surgery, Baylor University Medical Center, Dallas, TX
| | - Tasha M Hughes
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Jaber Valinejad
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Andres Alban
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - J Shannon Swan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Nathaniel Mercaldo
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Mohammad S Jalali
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - G Scott Gazelle
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Erika Rangel
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Karen Donelan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, MO
| | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, MN
| | - Carrie Cunningham
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
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Giri S, West CP, Shanafelt T, Satele D, Dyrbye LN. Distress and well-being in dentists: performance of a screening tool for assessment. BDJ Open 2024; 10:3. [PMID: 38228624 DOI: 10.1038/s41405-024-00185-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVES Dentists' well-being is being challenged today by many factors. However, effective screening tools to assess their distress and well-being are yet to be validated. The present study aims to evaluate the ability of the Well-Being Index (WBI) to identify distress and stratify dentists' well-being and their likelihood for adverse professional consequences. METHOD AND MATERIALS A convenience sample of dentists completed a web-based 9-item WBI survey along with other instruments that measured quality of life (QOL), fatigue, burnout, and questions about suicidal ideation, recent dental error, and intent to leave their current job. RESULTS A total of 597 dentists completed the survey. The overall mean WBI score was 2.3. The mean WBI score was significantly greater in dentists with low QOL than among dentists without low QOL (4.1 vs 1.6, p < 0.001). Dentists with extreme fatigue, burnout, and suicidal ideation had significantly higher mean WBI score than those without distress (all p < 0.001). WBI score stratified the dentists' likelihood of reporting a recent dental error and intent to leave their current job. CONCLUSION The WBI may be a useful screening tool to assess well-being among dentists and identify those in distress and at risk for adverse professional consequences.
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Affiliation(s)
- Subha Giri
- Department of Dental Specialties, Mayo Clinic, Rochester, MN, USA.
| | - Colin P West
- Department of Medicine and Department of Quantitative Health Sciences, Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Tait Shanafelt
- Stanford Medicine, Stanford University, Stanford, CA, USA
| | - Daniel Satele
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Liselotte N Dyrbye
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Sinsky CA, Trockel MT, Dyrbye LN, Wang H, Carlasare LE, West CP, Shanafelt TD. Vacation Days Taken, Work During Vacation, and Burnout Among US Physicians. JAMA Netw Open 2024; 7:e2351635. [PMID: 38214928 PMCID: PMC10787314 DOI: 10.1001/jamanetworkopen.2023.51635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Importance Vacation has been shown to be an important restorative activity in the general population; less is known about physicians' vacation behaviors and their association with burnout and professional fulfillment. Objective To examine the number of vacation days taken per year and the magnitude of physician work while on vacation and their association with physician burnout and professional fulfillment, by individual and organizational characteristics. Design, Setting, and Participants This cross-sectional survey of US physicians was conducted between November 20, 2020, and March 23, 2021. Data analysis was performed from March to July 2023. Main Outcomes and Measures Burnout was measured using the Maslach Burnout Index, and professional fulfillment was measured using the Stanford Professional Fulfillment Index. Number of vacation days taken in the last year, time spent working on patient care and other professional tasks per typical vacation day (ie, work on vacation), electronic health record (EHR) inbox coverage while on vacation, barriers to taking vacation, and standard demographics were collected. Results Among 3024 respondents, 1790 of 3004 (59.6%), took 15 or fewer days of vacation in the last year, with 597 of 3004 (19.9%) taking 5 or fewer days. The majority, 2104 respondents (70.4%), performed patient care-related tasks on vacation, with 988 of 2988 (33.1%) working 30 minutes or more on a typical vacation day. Less than one-half of physicians (1468 of 2991 physicians [49.1%]) reported having full EHR inbox coverage while on vacation. On multivariable analysis adjusting for personal and professional factors, concern about finding someone to cover clinical responsibilities (odds ratio [OR], 0.48 [95% CI, 0.35-0.65] for quite a bit; OR, 0.30 [95% CI, 0.21-0.43] for very much) and financial concerns (OR, 0.49 [95% CI, 0.36-0.66] for quite a bit; OR, 0.38 [95% CI, 0.27-0.54] for very much) were associated with decreased likelihood of taking more than 3 weeks of vacation per year. Taking more than 3 weeks of vacation per year (OR, 0.66 [95% CI, 0.45-0.98] for 16-20 days; OR, 0.59 [95% CI, 0.40-0.86] for >20 days vs none) and having full EHR inbox coverage while on vacation (OR, 0.74; 95% CI, 0.63-0.88) were associated with lower rates of burnout on multivariable analysis, whereas spending 30 minutes or longer per vacation day on patient-related work (OR, 1.58; 95% CI, 1.22-2.04 for 30-60 minutes; OR, 1.97; 95% CI, 1.41-2.77 for 60-90 minutes; OR, 1.92; 95% CI, 1.36-2.73 for >90 minutes) was associated with higher rates of burnout. Conclusions and Relevance In this cross-sectional study of 3024 physicians, the number of vacation days taken and performing patient-related work while on vacation were associated with physician burnout. System-level efforts to ensure physicians take adequate vacation and have coverage for clinical responsibilities, including EHR inbox, may reduce physician burnout.
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Affiliation(s)
| | | | - Lotte N Dyrbye
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Hanhan Wang
- Stanford University School of Medicine, Palo Alto, California
| | | | - Colin P West
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
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Trockel MT, West CP, Dyrbye LN, Sinsky CA, Tutty M, Wang H, Carlasare LE, Menon NK, Shanafelt TD. Assessment of Adverse Childhood Experiences, Adverse Professional Experiences, Depression, and Burnout in US Physicians. Mayo Clin Proc 2023; 98:1785-1796. [PMID: 38043996 DOI: 10.1016/j.mayocp.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To assess associations of adverse childhood experiences (ACEs) and adverse occupational experiences (AOEs) with depression and burnout in US physicians. PARTICIPANTS AND METHODS We performed a secondary analysis of data from a representative sample survey of US physicians conducted between November 20, 2020, and March 23, 2021, and from a probability-based sample of other US workers. The ACEs, AOEs, burnout, and depression were assessed using previously published measures. RESULTS Analyses included data from 1125 of the 3671 physicians (30.6%) who received a mailed survey and 6235 of 90,000 physicians (6.9%) who received an electronic survey. The proportion of physicians age 29-65 who had lived with a family member with substance misuse during childhood (673 of 5039[13.4%]) was marginally lower (P <.001) than that of workers in other professions (448 of 2505 [17.9%]). The proportion of physicians age 29-65 who experienced childhood emotional abuse (823 of 5038 [16.3%]) was similar to that of workers in other professions (406 of 2508 [16.2%]). The average physician depression T-score was 49.60 (raw score ± SD, 6.48±3.15), similar to the normed US average. The AOEs were associated with mild to severe depression, including making a recent significant medical error (odds ratio [OR], 1.64; 95% CI, 1.33 to 2.02, P<.001), being named in a malpractice suit (OR, 1.30; 95% CI, 1.07 to 1.59, P=.008), and experiencing one or more coronavirus disease 2019-related AOEs (OR, 1.76; 95% CI, 1.56 to 1.99, P<.001). Having one or more ACEs was associated with mild to severe depression (OR, 1.58; 95% CI, 1.38 to 1.79, P<.001). The ACEs, coronavirus disease 2019-related AOEs, and medical errors were also associated with burnout. CONCLUSION Assessing ACEs and AOEs and implementing selective primary prevention interventions may improve population health efforts to mitigate depression and burnout in physicians.
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Affiliation(s)
- Mickey T Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA.
| | - Colin P West
- Department of Medicine and Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Liselotte N Dyrbye
- Department of Medicine, University of Colorado School of Medicine, Aurora, IL
| | - Christine A Sinsky
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, IL
| | - Michael Tutty
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, IL
| | - Hanhan Wang
- WellMD & WellPhD Center, Stanford University School of Medicine, Palo Alto, CA
| | - Lindsey E Carlasare
- Health Care Research and Policy Analysis, American Medical Association, Chicago, IL
| | - Nikitha K Menon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
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Dyrbye LN, Brushaber D, West CP. Association of COVID-19 Intensity With Burnout and Perceptions of Residency Preparedness Among Medical Students. JAMA Netw Open 2023; 6:e2347957. [PMID: 38091043 PMCID: PMC10719746 DOI: 10.1001/jamanetworkopen.2023.47957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/02/2023] [Indexed: 12/17/2023] Open
Abstract
This cross-sectional study of US medical students assesses the association of COVID-19 intensity in the clinical learning environment with student burnout and perceptions regarding residency preparedness.
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Affiliation(s)
- Liselotte N. Dyrbye
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Danielle Brushaber
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Colin P. West
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic Rochester, Minnesota
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Dyrbye LN, Brushaber DE, West CP. US Medical Student Plans to Practice in Underserved Areas. JAMA 2023; 330:1797-1799. [PMID: 37856116 PMCID: PMC10587820 DOI: 10.1001/jama.2023.19521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023]
Abstract
This study explores US medical students’ intent to practice in underserved areas, analyzed by demographic characteristics.
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Affiliation(s)
| | | | - Colin P. West
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Sinsky CA, Trockel M, Carlasare LE, West CP, Wang H, Tutty M, Dyrbye LN, Shanafelt TD. Politicization of Medical Care, Burnout, and Professionally Conflicting Emotions Among Physicians During COVID-19. Mayo Clin Proc 2023; 98:1613-1628. [PMID: 37923520 DOI: 10.1016/j.mayocp.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/19/2023] [Accepted: 07/06/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To evaluate the association of politicization of medical care with burnout, professional fulfillment, and professionally conflicting emotions (eg, less empathy, compassion; more anger, frustration, resentment). PARTICIPANTS AND METHODS Physicians in select specialties were surveyed between December 2021 and January 2022 using methods similar to our prior studies, with additional assessment of politicization of medical care; moral distress; and having had to compromise professional integrity, workload, and professionally conflicting emotions. RESULTS In a sample of 2780 physicians in emergency medicine, critical care, noncritical care hospital medicine, and ambulatory care, stress related to politicization of medical care was reported by 91.8% of physicians. On multivariable analysis, compromised integrity (odds ratio [OR], 3.64; 95% CI, 2.31 to 5.98), moral distress (OR, 2.82; 95% CI, 2.16 to 3.68), and feeling more exhausted taking care of patients with coronavirus disease 2019 (COVID-19) (OR, 3.46; 95% CI, 2.63 to 4.54) were associated with burnout. Compromised integrity, moral distress, and feeling more exhausted taking care of patients with COVID-19 were also statistically significantly associated with lower odds of professional fulfillment and professionally conflicting emotions. Stress related to conversations about non-approved COVID-19 therapies (OR, 1.74; 95% CI, 1.08 to 2.89), patient resistance to mask wearing (OR, 1.84; 95% CI, 1.35 to 2.55), and working more hours due to COVID (OR, 0.66; 95% CI, 0.49 to 0.89) were associated with professionally conflicting emotions. CONCLUSION Most physicians experienced intrusion of politics into medical care during the pandemic. These experiences are associated with professionally conflicting emotions, including less compassion and empathy, greater frustration, and resentment. COVID-19-related moral distress and compromised integrity were also associated with less professional fulfillment and greater occupational burnout.
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Affiliation(s)
| | | | | | | | - Hanhan Wang
- American Medical Association, Chicago, IL, USA
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West CP, Dyrbye LN, Shanafelt TD. Regarding Racial and Gender Differences in Medical Student Burnout: A 2021 National Survey. Mayo Clin Proc 2023; 98:1731. [PMID: 37923533 DOI: 10.1016/j.mayocp.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/15/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Colin P West
- Department of Medicine, Mayo Clinic, Rochester, MN
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Shanafelt TD, West CP, Sinsky CA, Trockel MT, Tutty MA, Wang H, Carlasare LE, Dyrbye LN. At-Risk Work Hours Among U.S. Physicians and Other U.S. Workers. Am J Prev Med 2023; 65:568-578. [PMID: 37178097 DOI: 10.1016/j.amepre.2023.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Systematic reviews by the WHO have shown an increased risk of morbidity and mortality related to ischemic heart disease and stroke among individuals working an average of ≥55 hours/week. METHODS A cross-sectional survey of U.S. physicians and a probability-based sample of the general U.S. working population (n=2,508) was conducted between November 20, 2020, and February 16, 2021 (data analyzed in 2022). Among 3,617 physicians who received a mailed survey, 1,162 (31.7%) responded; among 90,000 physicians who received an electronic survey, 6,348 (7.1%) responded. Mean weekly work hours were assessed. RESULTS The mean reported weekly work hours for physicians and U.S. workers in other fields were 50.8 hours and 40.7 hours, respectively (p<0.001). Less than 10% of U.S. workers in other fields (9.2%) reported working ≥55 hours/week compared with 40.7% of physicians. Although work hours decreased among physicians working less than full time, the decrease in work hours was smaller than the reported reduction in professional work effort. Specifically, for physicians who worked between half-time and full-time (i.e., full-time equivalent=50%-99%), work hours decreased by approximately 14% for each 20% reduction in full-time equivalent. On multivariable analysis of physicians and workers in other fields adjusting for age, gender, relationship status, and level of education, individuals with a professional/doctorate degree other than an MD/DO (OR=3.74; 95% CI=2.28, 6.09) and physicians (OR=8.62; 95% CI=6.44, 11.80) were more likely to work ≥55 hours/week. CONCLUSIONS A substantial proportion of physicians have work hours previously shown to be associated with adverse personal health outcomes.
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Affiliation(s)
- Tait D Shanafelt
- Stanford Department of Medicine, Stanford University, Palo Alto, California.
| | - Colin P West
- Mayo Clinic Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mickey T Trockel
- Stanford Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | | | - Hanhan Wang
- Stanford WellMD & WellPhD Center, Mayo Clinic, Rochester, Minnesota
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Dyrbye LN, Gill PR, Satele DV, West CP. Professional Coaching and Surgeon Well-being: A Randomized Controlled Trial. Ann Surg 2023; 277:565-571. [PMID: 36000783 DOI: 10.1097/sla.0000000000005678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if individualized professional coaching reduces burnout, improves quality of life, and increases resilience among surgeons. BACKGROUND Burnout is common among surgeons and associated with suboptimal patient care and personal consequences. METHODS A randomized controlled trial of 80 surgeons evaluating the impact of 6 monthly professional coaching sessions on burnout (Maslach Burnout Inventory), quality of life (single-item linear analog scale), and resilience (Connor-Davidson Resilience Scale) immediately postintervention and 6 months later. Participants randomized to the control group subsequently received 6 professional coaching sessions during months 6 to 12 (delayed intervention). RESULTS At the conclusion of professional coaching in the immediate intervention group, the rate of overall burnout decreased by 2.5% in the intervention arm compared with an increase of 2.5% in the control arm [delta: -5.0%, 95% confidence interval (CI): -8.6%, -1.4%; P =0.007]. Resilience scores improved by 1.9 points in the intervention arm compared with a decrease of 0.2 points in the control arm (delta: 2.2 points; 95% CI: 0.07, 4.30; P =0.04). Six months after completion of the coaching period, burnout had returned to near baseline levels while resilience continued to improve among the immediate intervention group. The delayed intervention group experienced improvements in burnout during their coaching experience relative to the immediate intervention group during their postintervention period (18.2% decrease vs 2.9% increase, delta: -21.1%, 95% CI: -24.9%, -17.3%; P <0.001). CONCLUSIONS Professional coaching over 6 months improved burnout and resilience among surgeons, with reductions in improvement over the ensuing 6 months.
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Affiliation(s)
- Liselotte N Dyrbye
- Senior Associate Dean and Chief Well-being Officer, University of Colorado, Denver
| | | | - Daniel V Satele
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Colin P West
- Director, Program on Physician Well-Being and Medical Director of Employee Well-being, Mayo Clinic, Rochester, MN
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15
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Hunt TL, West CP, Leighton JA, Mueller PS. Is it Time to Intentionally Improve the Satisfaction of Health Care Employees? Mayo Clin Proc Innov Qual Outcomes 2023; 7:140-142. [PMID: 36970064 PMCID: PMC10033901 DOI: 10.1016/j.mayocpiqo.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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16
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West CP. The value of values alignment in healthcare. J Intern Med 2023; 293:666-667. [PMID: 36861315 DOI: 10.1111/joim.13626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Colin P West
- Departments of Medicine and Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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17
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Dyrbye LN, Gordon J, O'Horo J, Belford SM, Wright M, Satele DV, West CP. Relationships Between EHR-Based Audit Log Data and Physician Burnout and Clinical Practice Process Measures. Mayo Clin Proc 2023; 98:398-409. [PMID: 36868747 DOI: 10.1016/j.mayocp.2022.10.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To explore the relationship of electronic health record (EHR)-based audit log data with physician burnout and clinical practice process measures. METHODS From September 4 to October 7, 2019, we surveyed physicians in a larger academic medical department and matched responses to August 1 through October 31, 2019, EHR-based audit log data. Multivariable regression analysis evaluated the relationship between log data and burnout and the interrelationship between log data and turnaround time for In Basket messages and percentage of encounters closed within 24 hours. RESULTS Of the 537 physicians surveyed, 413 (77%) responded. On multivariable analysis, number of In Basket messages received per day (each additional message: odds ratio, 1.04 [95% CI, 1.02 to 1.07]; P<.001) and time spent in the EHR outside scheduled patient care (each additional hour: odds ratio, 1.01 [95% CI, 1.00 to 1.02]; P=.04) were associated with burnout. Time spent doing In Basket work (each additional minute: parameter estimate, -0.11 [95% CI, -0.19 to -0.03]; P=.01) and in the EHR outside scheduled patient care (each additional hour: parameter estimate, 0.04 [95% CI, 0.01 to 0.06]; P=.002) were associated with turnaround time (days per message) for In Basket messages. None of the variables explored were independently associated with percentage of encounters closed within 24 hours. CONCLUSION Electronic health record-based audit log data of workload relate to odds of burnout and responsiveness to patient-related inquiries and results. Further study is needed to determine whether interventions that reduce the number of and time spent doing In Basket messages or time spent in the EHR outside scheduled patient care reduce physician burnout and improve clinical practice process measures.
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Affiliation(s)
- Liselotte N Dyrbye
- Department of Medicine. University of Colorado School of Medicine, Denver, CO.
| | - Joel Gordon
- Department of Family Medicine, Mayo Clinic Health System, Mankato, MN; Deparment of Medicine, Division of Public Health, Infectious Disease, and Occupational Medicine
| | - John O'Horo
- Division of Public Health, Infectious Diseases and Occupational Medicine, Rochester, MN
| | | | | | - Daniel V Satele
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Colin P West
- Department of Medicine, Division of General Internal Medicine
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18
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Kelsey EA, West CP, Fischer KM, Croghan IT. Response to Enhancing Well-being in the University Workplace: The Context of Higher Educational Institution (JPC-23-0187). J Prim Care Community Health 2023; 14:21501319231183444. [PMID: 37449441 PMCID: PMC10350778 DOI: 10.1177/21501319231183444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Affiliation(s)
- Elizabeth A. Kelsey
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA
| | - Colin P. West
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Program on Physician Well-Being, Mayo Clinic, Rochester, MN, USA
| | - Karen M. Fischer
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Ivana T. Croghan
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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19
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Ghosh K, Nanda S, Hurt RT, Schroeder DR, West CP, Fischer KM, Bauer BA, Fokken SC, Ganesh R, Hanson JL, Lindeen SA, Pruthi S, Croghan IT. Mindfulness Using a Wearable Brain Sensing Device for Health Care Professionals During a Pandemic: A Pilot Program. J Prim Care Community Health 2023; 14:21501319231162308. [PMID: 36960553 PMCID: PMC10041582 DOI: 10.1177/21501319231162308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVE The purpose of this feasibility pilot study was to evaluate safety and adherence of a wearable brain sensing wellness device designed to reduce stress among healthcare professionals (HCP). METHODS A total of 40 HCP were invited to participate in an open-label pilot study. Participants were asked to use a brain sensing wearable device (MUSE-S™) on a daily basis to reduce their stress, for a total of 90 days. Total study participation duration was 180 days. Study enrollment began in August 2021 and ended December 2021. The exploratory outcomes included stress, depression, sleep, burn-out, resilience, quality of life, and cognition. RESULTS Among the 40 HCP in study, the majority were female (85%), white (87.5%) and with an average age of 41.3 ± 11.0 years (SD). Participants used the wearable device an average of 23.8 times over a 30-day period with a mean duration of 5.8 min with each use. Study results demonstrate the positive impact of guided mindfulness using the wearable device MUSE-S™ and its accompanying application (APP). A statistically significant improvement was found for a reduction in stress (P < .001) and improvement in resilience (P = .02), quality of life (P = .003), and cognition (P < .001). The majority (91.9%) of the participants indicated they felt more relaxed after using the device, and 73% indicated they would continue to use this device at end-of-study. No adverse effects were reported. CONCLUSION Study results show that 3 to 10 min of guided meditation during work hours through the use of a brain sensing wearable device is safe and acceptable, with associated health benefits for HCP.
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20
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Kelsey EA, West CP, Fischer KM, Croghan IT. Well-being in the Workplace: A Book Club Among Health Care Workers During the COVID-19 Pandemic. J Prim Care Community Health 2023; 14:21501319231161441. [PMID: 36941768 PMCID: PMC10031587 DOI: 10.1177/21501319231161441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION/OBJECTIVES A culture of joy in the workplace supports well-being, but less is known about the effect of a shared experience on well-being and burnout in a health care setting. This pilot study investigated personal well-being and occupational burnout among primary care staff who participated in a 3-month virtual book club. METHODS In December 2021, health care workers from a primary care practice were invited to participate in a 3-month virtual book club. Participants were emailed a preintervention survey with questions regarding well-being and burnout, the pandemic's influence on emotional health, and demographic information. The book club met virtually every month from January 2022 through March 2022. After the March 2022 book club meeting, a paired postintervention survey was sent to participants with additional questions regarding their participation in the book club. Well-being and burnout were measured with the 11-point Well-Being Index, and the pandemic's influence on emotional health was assessed with the 64-point Pandemic Emotional Impact Scale. RESULTS Of 12 book club participants, 9 participants (6 physicians and 3 nurses) completed surveys before and after the intervention. Postintervention improvement in the median score of the Pandemic Emotional Impact Scale was significant (7 points, P = .04). Although Well-Being Index results uniformly favored improved well-being after book club participation, the median improvement of 1 point was not significant (P = .69). CONCLUSIONS Social connection through a virtual workplace activity such as a book club may contribute to well-being and may decrease occupational burnout.
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21
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Kelsey EA, West CP, Fischer KM, Croghan IT. Response to Strategies and Interventions to Improve Health Care Professionals' Well-Being and Reduce Burnout (JPC-23-0161.R1). J Prim Care Community Health 2023; 14:21501319231181736. [PMID: 37750496 PMCID: PMC10524066 DOI: 10.1177/21501319231181736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Affiliation(s)
- Elizabeth A. Kelsey
- Mayo Clinic, Department of Internal Medicine, Division of Community Internal Medicine, Rochester, MN, USA
- Mayo Clinic, Division of Quantitive Health Sciences, Rochester, MN, USA
| | - Colin P. West
- Mayo Clinic, Department of Internal Medicine, Division of General Internal Medicine, Rochester, MN, USA
| | - Karen M. Fischer
- Mayo Clinic, Division of Quantitive Health Sciences, Rochester, MN, USA
| | - Ivana T. Croghan
- Mayo Clinic, Department of Internal Medicine, Division of Community Internal Medicine, Rochester, MN, USA
- Mayo Clinic, Department of Internal Medicine, Division of General Internal Medicine, Rochester, MN, USA
- Mayo Clinic, Division of Quantitive Health Sciences, Rochester, MN, USA
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22
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Shanafelt TD, West CP, Dyrbye LN, Trockel M, Tutty M, Wang H, Carlasare LE, Sinsky C. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic. Mayo Clin Proc 2022; 97:2248-2258. [PMID: 36229269 PMCID: PMC9472795 DOI: 10.1016/j.mayocp.2022.09.002] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the prevalence of burnout and satisfaction with work-life integration (WLI) in US physicians at the end of 2021, roughly 21 months into the COVID-19 pandemic, with comparison to 2020, 2017, 2014, and 2011. METHODS Between December 9, 2021, and January 24, 2022, we surveyed US physicians using methods similar to those of our prior studies. Burnout, WLI, depression, and professional fulfillment were assessed with standard instruments. RESULTS There were 2440 physicians who participated in the 2021 survey. Mean emotional exhaustion and depersonalization scores were higher in 2021 than those observed in 2020, 2017, 2014, and 2011 (all P<.001). Mean emotional exhaustion scores increased 38.6% (2020 mean, 21.0; 2021 mean, 29.1; P<.001), whereas mean depersonalization scores increased 60.7% (2020 mean, 6.1; 2021 mean, 9.8; P<.001). Overall, 62.8% of physicians had at least 1 manifestation of burnout in 2021 compared with 38.2% in 2020, 43.9% in 2017, 54.4% in 2014, and 45.5% in 2011 (all P<.001). Although these trends were consistent across nearly all specialties, substantial variability by specialty was observed. Satisfaction with WLI declined from 46.1% in 2020 to 30.2% in 2021 (P<.001). Mean scores for depression increased 6.1% (2020 mean, 49.54; 2021 mean, 52.59; P<.001). CONCLUSION A dramatic increase in burnout and decrease in satisfaction with WLI occurred in US physicians between 2020 and 2021. Differences in mean depression scores were modest, suggesting that the increase in physician distress was overwhelmingly work related. Given the association of physician burnout with quality of care, turnover, and reductions in work effort, these findings have profound implications for the US health care system.
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23
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Centor RM, West CP. Web Exclusive. Annals On Call - Benefits of Sigmoidoscopy for Colon Cancer Screening. Ann Intern Med 2022; 175:OC1. [PMID: 36534997 DOI: 10.7326/a21-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Robert M Centor
- Huntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)
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24
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Shanafelt TD, Dyrbye LN, Sinsky C, Trockel M, Makowski MS, Tutty M, Wang H, Carlasare LE, West CP. Imposter Phenomenon in US Physicians Relative to the US Working Population. Mayo Clin Proc 2022; 97:1981-1993. [PMID: 36116974 DOI: 10.1016/j.mayocp.2022.06.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/12/2022] [Accepted: 06/20/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the prevalence of imposter phenomenon (IP) experiences among physicians and evaluate their relationship to personal and professional characteristics, professional fulfillment, burnout, and suicidal ideation. PARTICIPANTS AND METHODS Between November 20, 2020, and February 16, 2021, we surveyed US physicians and a probability-based sample of the US working population. Imposter phenomenon was measured using a 4-item version of the Clance Imposter Phenomenon Scale. Burnout and professional fulfillment were measured using standardized instruments. RESULTS Among the 3237 physician responders invited to complete the subsurvey including the IP scale, 3116 completed the IP questions. Between 4% (133) and 10% (308) of the 3116 physicians endorsed each of the 4 IP items as a "very true" characterization of their experience. Relative to those with a low IP score, the odds ratio for burnout among those with moderate, frequent, and intense IP was 1.28 (95% CI, 1.04 to 1.58), 1.79 (95% CI, 1.38 to 2.32), and 2.13 (95% CI, 1.43 to 3.19), respectively. A similar association between IP and suicidal ideation was observed. On multivariable analysis, physicians endorsed greater intensity of IP than workers in other fields in response to the item, "I am disappointed at times in my present accomplishments and think I should have accomplished more." CONCLUSION Imposter phenomenon experiences are common among US physicians, and physicians have more frequent experiences of disappointment in accomplishments than workers in other fields. Imposter phenomenon experiences are associated with increased burnout and suicidal ideation and lower professional fulfillment. Systematic efforts to address the professional norms and perfectionistic attitudes that contribute to this phenomenon are necessary.
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25
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Vaa Stelling BE, West CP. In Reply to Baird et al. Acad Med 2022; 97:1094. [PMID: 35917535 DOI: 10.1097/acm.0000000000004739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Brianna E Vaa Stelling
- Assistant professor of medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota;
| | - Colin P West
- Professor of medicine, medical education, and biostatistics, Divisions of General Internal Medicine and Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
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26
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Leep Hunderfund AN, West CP, Rackley SJ, Dozois EJ, Moeschler SM, Vaa Stelling BE, Winters RC, Satele DV, Dyrbye LN. Social Support, Social Isolation, and Burnout: Cross-Sectional Study of U.S. Residents Exploring Associations With Individual, Interpersonal, Program, and Work-Related Factors. Acad Med 2022; 97:1184-1194. [PMID: 35442910 DOI: 10.1097/acm.0000000000004709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To examine associations of social support and social isolation with burnout, program satisfaction, and organization satisfaction among a large population of U.S. residents and fellows and to identify correlates of social support and social isolation. METHOD All residents and fellows enrolled in graduate medical education programs at Mayo Clinic sites were surveyed in February 2019. Survey items measured social support (emotional and tangible), social isolation, burnout, program satisfaction, and organization satisfaction. Factors of potential relevance to social support were collected (via the survey, institutional administrative records, and interviews with program coordinators and/or program directors) and categorized as individual, interpersonal, program, or work-related factors (duty hours, call burden, elective time, vacation days used before survey administration, required away rotations, etc.). Multivariable regression analyses were conducted to examine relationships between variables. RESULTS Of 1,146 residents surveyed, 762 (66%) from 58 programs responded. In adjusted models, higher emotional and tangible support were associated with lower odds of burnout and higher odds of program and organization satisfaction, while higher social isolation scores were associated with higher odds of burnout and lower odds of program satisfaction and organization satisfaction. Independent predictors of social support and/or social isolation included age, gender, relationship status, parental status, postgraduate year, site, ratings of the program leadership team, ratings of faculty relationships and faculty professional behaviors, satisfaction with autonomy, and vacation days used before survey administration. CONCLUSIONS This study demonstrates that social support and social isolation are strongly related to burnout and satisfaction among residents and fellows. Personal and professional relationships, satisfaction with autonomy, and vacation days are independently associated with social support and/or social isolation, whereas most program and work-related factors are not. Additional studies are needed to determine if social support interventions targeting these factors can improve well-being and enhance satisfaction with training.
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Affiliation(s)
- Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is associate professor of neurology, Mayo Clinic, and associate director of clinical learning environment optimization, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | - Colin P West
- C.P. West is professor of medicine, medical education, and biostatistics, Divisions of General Internal Medicine and Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1628-5023
| | - Sandra J Rackley
- S.J. Rackley is assistant professor of psychiatry, Mayo Clinic, and assistant dean for trainee well-being, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | - Eric J Dozois
- E.J. Dozois is professor of surgery, Mayo Clinic, Rochester, Minnesota
| | - Susan M Moeschler
- S.M. Moeschler is associate professor of anesthesiology, Mayo Clinic, Rochester, Minnesota
| | | | - Richard C Winters
- R.C. Winters is assistant professor of emergency medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel V Satele
- D.V. Satele is statistician, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Liselotte N Dyrbye
- L.N. Dyrbye is professor of medicine and medical education and co-director of the physician well-being program, Mayo Clinic, Rochester, Minnesota
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27
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Byun K, Aristizabal S, Wu Y, Mullan AF, Carlin JD, West CP, Mazurek KA. Investigating How Auditory and Visual Stimuli Promote Recovery After Stress With Potential Applications for Workplace Stress and Burnout: Protocol for a Randomized Trial. Front Psychol 2022; 13:897241. [PMID: 35719506 PMCID: PMC9201821 DOI: 10.3389/fpsyg.2022.897241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Work-related stress is one of the top sources of stress amongst working adults. Relaxation rooms are one organizational strategy being used to reduce workplace stress. Amongst healthcare workers, relaxation rooms have been shown to improve perceived stress levels after 15 min of use. However, few studies have examined physiological and cognitive changes after stress, which may inform why relaxation rooms reduce perceived stress. Understanding the biological mechanisms governing why perceived stress improves when using a relaxation room could lead to more effective strategies to address workplace stress. Objective The purpose of this research study is to understand how physiological measures, cognitive performance, and perceived stress change after acute stress and whether certain sensory features of a relaxation room are more effective at promoting recovery from stress. Methods 80 healthy adults will perform a stress induction task (Trier Social Stress Test, TSST) to evaluate how physiological and cognitive responses after stress are affected by sensory features of a relaxation room. After the stress induction task, participants will recover for 40 min in a MindBreaks™ relaxation room containing auditory and visual stimuli designed to promote relaxation. Participants will be randomized into four cohorts to experience auditory and visual stimuli; auditory stimuli; visual stimuli; or no stimuli in the room. Measures of heart rate and neural activity will be continuously monitored using wearable devices. Participants will perform working memory assessments and rate their perceived stress levels throughout the experiment. These measures will be compared before and after the stress induction task to determine how different sensory stimuli affect the rate at which individuals recover. Results Recruitment started in December 2021 and will continue until December 2022 or until enrollment is completed. Final data collection and subsequent analysis are anticipated by December 2022. We expect all trial results will be available by early 2023. Discussion Findings will provide data and information about which sensory features of a relaxation room are most effective at promoting recovery after acute stress. This information will be useful in determining how these features might be effective at creating individualized and organizational strategies for mitigating the effects of workplace stress.
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Affiliation(s)
- Kunjoon Byun
- Well Living Lab, Rochester, MN, United States.,Delos Living LLC., New York, NY, United States
| | - Sara Aristizabal
- Well Living Lab, Rochester, MN, United States.,Delos Living LLC., New York, NY, United States
| | - Yihan Wu
- Graduate Program in Cognitive Science, University of Minnesota-Twin Cities, Minneapolis, MN, United States
| | - Aidan F Mullan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Jeremiah D Carlin
- Well Living Lab, Rochester, MN, United States.,Delos Living LLC., New York, NY, United States
| | - Colin P West
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States.,Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Kevin A Mazurek
- Well Living Lab, Rochester, MN, United States.,Delos Living LLC., New York, NY, United States.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States.,Department of Neuroscience, The Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
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28
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Ratelle JT, Gallagher CN, Sawatsky AP, Kashiwagi DT, Schouten WM, Gonzalo JD, Beckman TJ, West CP. The Effect of Bedside Rounds on Learning Outcomes in Medical Education: A Systematic Review. Acad Med 2022; 97:923-930. [PMID: 35020612 PMCID: PMC9126262 DOI: 10.1097/acm.0000000000004586] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE To determine if bedside rounds, compared with other forms of hospital ward rounds, improve learning outcomes in medical education. METHOD For this systematic review, the authors searched Ovid MEDLINE, Embase, and Scopus from inception through February 20, 2020. Experimental studies were included if they (1) compared bedside rounds to any other form of rounds in a hospital-based setting, and (2) reported a quantitative comparison of a learning outcome (e.g., learner reaction, knowledge, skills, behavior, health care delivery) among physicians-in-training (medical students, residents, fellows). Extraction elements were summarized using descriptive statistics and a narrative synthesis of design, implementation, and outcomes. RESULTS Twenty studies met inclusion criteria, including 7 randomized trials. All studies involved resident physicians, and 11 also involved medical students. The design and implementation of bedside rounds varied widely, with most studies (n = 13) involving cointerventions (e.g., staff education, real-time order entry).Of the 15 studies that reported learner satisfaction, 7 favored bedside rounds, 4 favored the control, and 4 were equivocal. Of the 4 studies reporting an outcome of learners' knowledge and skills, 2 favored bedside rounds and 2 were equivocal. Of the 8 studies that reported on learner behavior (e.g., bedside communication with patients), 5 favored bedside rounds, 1 favored the control, and 2 were equivocal. Finally, of the 14 studies that reported a health care delivery outcome (e.g., teamwork, rounding time), 8 favored bedside rounds and 6 were equivocal. Due to the high risk of bias and unexplained heterogeneity across studies, the overall strength of evidence was low. CONCLUSIONS In hospital-based settings, learners' satisfaction with bedside rounds is mixed. However, bedside rounds appear to have a positive effect on learner behavior and health care delivery. Given their potential value, additional research is needed to identify barriers to and facilitators of educationally successful bedside rounds.
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Affiliation(s)
- John T. Ratelle
- J.T. Ratelle is assistant professor of medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0001-8061-283X
| | - Caitlyn N. Gallagher
- C.N. Gallagher is a second-year resident, Department of Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-4906-4019
| | - Adam P. Sawatsky
- A.P. Sawatsky is associate professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-4050-7984
| | - Deanne T. Kashiwagi
- D.T. Kashiwagi is associate professor of medicine, Division of Hospital Internal Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Will M. Schouten
- W.M. Schouten is assistant professor of medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-0448-3615
| | - Jed D. Gonzalo
- J.D. Gonzalo is professor of medicine, Division of General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0001-8061-283X
| | - Thomas J. Beckman
- T.J. Beckman is professor of medicine and medical education, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-4343-3936
| | - Colin P. West
- C.P. West is professor of medicine, medical education, and biostatistics, Divisions of General Internal Medicine, and Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1628-5023
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Patlolla SH, Kandlakunta H, Kuchkuntla AR, West CP, Murad MH, Wang Z, Kochar A, Rab ST, Gersh BJ, Holmes DR, Zhao DX, Vallabhajosyula S. Newer P2Y 12 Inhibitors vs Clopidogrel in Acute Myocardial Infarction With Cardiac Arrest or Cardiogenic Shock: A Systematic Review and Meta-analysis. Mayo Clin Proc 2022; 97:1074-1085. [PMID: 35662424 DOI: 10.1016/j.mayocp.2022.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/18/2022] [Accepted: 02/15/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the outcomes, safety, and efficacy of dual antiplatelet therapy (DAPT) with newer P2Y12 inhibitors compared with clopidogrel in patients with acute myocardial infarction (AMI) complicated by cardiac arrest (CA) or cardiogenic shock (CS). PATIENTS AND METHODS MEDLINE, EMBASE, and the Cochrane Library were queried systematically from inception to January 2021 for comparative studies of adults (≥18 years) with AMI-CA/CS receiving DAPT with newer P2Y12 inhibitors as opposed to clopidogrel. We compared outcomes (30-day or in-hospital and 1-year all-cause mortality, major bleeding, and definite stent thrombosis) of newer P2Y12 inhibitors and clopidogrel in patients with AMI-CA/CS. RESULTS Eight studies (1 randomized trial and 7 cohort studies) comprising 1100 patients (695 [63.2%] receiving clopidogrel and 405 [36.8%] receiving ticagrelor or prasugrel) were included. The population was mostly male (68.5%-86.7%). Risk of bias was low for these studies, with between-study heterogeneity and subgroup differences not statistically significant. Compared with the clopidogrel cohort, the newer P2Y12 cohort had lower rates of early mortality (odds ratio [OR], 0.60; 95% CI, 0.45 to 0.81; P=.001) (7 studies) and 1-year mortality (OR, 0.51; 95% CI, 0.36 to 0.71; P<.001) (3 studies). We did not find a significant difference in major bleeding (OR, 1.21; 95% CI, 0.71 to 2.06; P=.48) (6 studies) or definite stent thrombosis (OR, 2.01; 95% CI, 0.63 to 6.45; P=.24) (7 studies). CONCLUSION In patients with AMI-CA/CS receiving DAPT, compared with clopidogrel, newer P2Y12 inhibitors were associated with lower rates of early and 1-year mortality. Data on major bleeding and stent thrombosis were inconclusive.
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Affiliation(s)
- Sri Harsha Patlolla
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
| | - Harika Kandlakunta
- Department of Medicine, Staten Island University Hospital, Staten Island, NY
| | | | - Colin P West
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Department of Medicine, Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - M Hassan Murad
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ajar Kochar
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - S Tanveer Rab
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
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Dyrbye LN, West CP, Sinsky CA, Trockel M, Tutty M, Satele D, Carlasare L, Shanafelt T. Physicians' Experiences With Mistreatment and Discrimination by Patients, Families, and Visitors and Association With Burnout. JAMA Netw Open 2022; 5:e2213080. [PMID: 35587344 PMCID: PMC9121189 DOI: 10.1001/jamanetworkopen.2022.13080] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/01/2022] [Indexed: 11/30/2022] Open
Abstract
Importance Burnout is common among physicians and is associated with suboptimal patient outcomes. Little is known about how experiences with patients, families, and visitors differ by physician characteristics or contribute to the risk of burnout. Objective To examine the occurrence of mistreatment and discrimination by patients, families, and visitors by physician characteristics and the association between such interactions and experiencing burnout. Design, Setting, and Participants This cross-sectional survey was conducted from November 20, 2020, to March 23, 2021, among US physicians. Exposures Mistreatment and discrimination were measured using items adapted from the Association of American Medical College's Graduation Questionnaire with an additional item querying respondents about refusal of care because of the physicians' personal attributes; higher score indicated greater exposure to mistreatment and discrimination. Main Outcomes and Measures Burnout as measured by the Maslach Burnout Inventory. Results Of 6512 responding physicians, 2450 (39.4%) were female, and 369 (7.2%) were Hispanic; 681 (13.3%) were non-Hispanic Asian, Native Hawaiian, or Pacific Islander; and 3633 (70.5%) were non-Hispanic White individuals. Being subjected to racially or ethnically offensive remarks (1849 [29.4%]), offensive sexist remarks (1810 [28.7%]), or unwanted sexual advances (1291 [20.5%]) by patients, families, or visitors at least once in the previous year were common experiences. Approximately 1 in 5 physicians (1359 [21.6%]) had experienced a patient or their family refusing to allow them to provide care because of the physician's personal attributes at least once in the previous year. On multivariable analyses, female physicians (OR, 2.33; 95% CI, 2.02-2.69) and ethnic and racial minority physicians (eg, Black or African American: OR, 1.59; 95% CI, 1.13-2.23) were more likely to report mistreatment or discrimination in the previous year. Experience of mistreatment or discrimination was independently associated with higher odds of burnout (vs score of 0 [no mistreatment], score of 1: OR, 1.27; 95% CI, 1.04-1.55; score of 2: OR, 1.70; 95% CI, 1.38-2.08; score of 3: OR, 2.20; 95% CI, 1.89-2.57). There was no difference in the odds of burnout by gender after controlling for experiencing mistreatment and discrimination score and other demographic factors, specialty, practice setting, work hours, and frequency of overnight call. Conclusions and Relevance In this study, mistreatment and discrimination by patients, families, and visitors were common, especially for female and racial and ethnic minority physicians, and associated with burnout. Efforts to mitigate physician burnout should include attention to patient and visitor conduct.
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Affiliation(s)
- Liselotte N. Dyrbye
- Mayo Clinic, Rochester, Minnesota
- now with University of Colorado School of Medicine, Denver
| | | | | | - Mickey Trockel
- Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California
| | | | - Daniel Satele
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Affiliation(s)
- Colin P West
- Division of General Internal Medicine, Department of Medicine, Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
| | - Julia A Files
- Division of Women's Health, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Patricia Friedrich
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ
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Sinsky CA, Shanafelt TD, Dyrbye LN, Sabety AH, Carlasare LE, West CP. Health Care Expenditures Attributable to Primary Care Physician Overall and Burnout-Related Turnover: A Cross-sectional Analysis. Mayo Clin Proc 2022; 97:693-702. [PMID: 35227508 DOI: 10.1016/j.mayocp.2021.09.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/04/2021] [Accepted: 09/09/2021] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To estimate the excess health care expenditures due to US primary care physician (PCP) turnover, both overall and specific to burnout. METHODS We estimated the excess health care expenditures attributable to PCP turnover using published data for Medicare patients, calculated estimates for non-Medicare patients, and the American Medical Association Masterfile. We used published data from a cross-sectional survey of US physicians conducted between October 12, 2017, and March 15, 2018, of burnout and intention to leave one's current practice within 2 years by primary care specialty to estimate excess expenditures attributable to PCP turnover due to burnout. A conservative estimate from the literature was used for actual turnover based on intention to leave. Additional publicly available data were used to estimate the average PCP panel size and the composition of Medicare and non-Medicare patients within a PCP's panel. RESULTS Turnover of PCPs results in approximately $979 million in excess health care expenditures for public and private payers annually, with $260 million attributable to PCP burnout-related turnover. CONCLUSION Turnover of PCPs, including that due to burnout, is costly to public and private payers. Efforts to reduce physician burnout may be considered as one approach to decrease US health care expenditures.
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O'Brien BC, Lypson ML, Chan TM, Coverdale J, DeVilbiss MB, West CP, Roberts LW. Academic Olympism and Authorship: Honoring Contributions to Collaborative Scholarship. Acad Med 2022; 97:315-318. [PMID: 35212673 DOI: 10.1097/acm.0000000000004560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Shanafelt TD, West CP, Sinsky C, Trockel M, Tutty M, Wang H, Carlasare LE, Dyrbye LN. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2020. Mayo Clin Proc 2022; 97:491-506. [PMID: 35246286 DOI: 10.1016/j.mayocp.2021.11.021] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/20/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the prevalence of burnout and satisfaction with work-life integration (WLI) among physicians and US workers in 2020 relative to 2011, 2014, and 2017. METHODS Between November 20, 2020, and March 23, 2021, we surveyed US physicians and a probability-based sample of the US working population using methods similar to our prior studies. Burnout and WLI were measured using standard tools. Information about specific work-related COVID-19 experiences was collected. RESULTS There were 7510 physicians who participated in the survey. Nonresponder analysis suggested that participants were representative of US physicians. Mean emotional exhaustion and depersonalization scores were lower in 2020 than in 2017, 2014, and 2011 (all P<.001). However, emotional exhaustion and depersonalization scores did not improve in specialties most heavily affected by COVID-19. Overall, 38.2% of physicians reported 1 or more symptoms of burnout in 2020 compared with 43.9% in 2017, 54.4% in 2014, and 45.5% in 2011 (all P<.001). Providing care without adequate personal protective equipment (odds ratio [OR], 1.53; 95% CI, 1.35 to 1.72) and having suffered disruptive economic consequences due to COVID-19 (OR, 1.49; 95% CI, 1.32 to 1.69) were independently associated with risk of burnout. On multivariable analysis, physicians were at increased risk for burnout (OR, 1.41; 95% CI, 1.25 to 1.58) and were less likely to be satisfied with WLI (OR, 0.71; 95% CI, 0.64 to 0.79) than other working US adults. CONCLUSION Burnout and satisfaction with WLI among US physicians improved between 2017 and 2020. The impact of the COVID-19 pandemic on physicians varies on the basis of professional characteristics and experiences. Physicians remain at increased risk for burnout relative to workers in other fields.
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Affiliation(s)
| | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, MN
| | - Christine Sinsky
- Professional Satisfaction and Practice, American Medical Association, Chicago, IL
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Michael Tutty
- Professional Satisfaction and Practice, American Medical Association, Chicago, IL
| | - Hanhan Wang
- WellMD & WellPhD Center, Stanford Univeristy School of Medicine
| | - Lindsey E Carlasare
- Health Care Research and Policy Analysis, American Medical Association, Chicago, IL
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Dyrbye L, Satele D, West CP. A Longitudinal National Study Exploring Impact of the Learning Environment on Medical Student Burnout, Empathy, and Career Regret. Acad Med 2021; 96:S204-S205. [PMID: 34705705 DOI: 10.1097/acm.0000000000004285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Liselotte Dyrbye
- Author affiliations: L. Dyrbye, D. Satele, C.P. West, Mayo Clinic College of Medicine
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Kelsey EA, West CP, Cipriano PF, Peterson C, Satele D, Shanafelt T, Dyrbye LN. Original Research: Suicidal Ideation and Attitudes Toward Help Seeking in U.S. Nurses Relative to the General Working Population. Am J Nurs 2021; 121:24-36. [PMID: 34629376 DOI: 10.1097/01.naj.0000798056.73563.fa] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Although previous studies have revealed professional consequences of burnout among nurses, less is known about the potential personal consequences. This study investigated the prevalence of suicidal ideation and attitudes toward help seeking among U.S. nurses relative to other workers, and the extent to which personal and professional factors, including burnout, were related to suicidal ideation. METHODS In November 2017, a cross-sectional survey was sent to 86,858 nurses who were members of the American Nurses Association and to a probability-based sample of 5,198 U.S. workers. The survey included questions regarding suicidal ideation, burnout, symptoms of depression, individual and professional characteristics, and willingness to seek professional help if a serious emotional problem arose. Multivariable logistic regression analyses were conducted to identify factors associated with suicidal ideation after controlling for other factors. RESULTS Among the 7,378 nurse respondents, 403 (5.5%) reported having suicidal ideation within the past year. Most nurses (84.2%) indicated willingness to seek professional help for a serious emotional problem. Yet nurses with suicidal ideation were less likely to report that they'd seek such help (72.6%) than nurses without suicidal ideation (85%). In a multivariable analysis of nurses' data, after controlling for other personal and professional characteristics, we found that burnout was strongly associated with suicidal ideation. Adjusted combined multivariable analyses showed that nurses were more likely than other workers to have suicidal ideation. Both nurses and other workers who reported suicidal ideation were less likely to seek help than were those who did not report such ideation. CONCLUSIONS Compared with other U.S. workers, nurses are at higher risk for suicidal ideation, and nurses with such ideation are more reluctant to seek help than those without it. Burnout contributes to the risk of suicidal ideation. These issues warrant greater attention. Systems- and practice-level interventions must be identified and implemented, both to address the higher prevalences of burnout and suicidal ideation in nurses and to mitigate the stigma about mental health problems and other barriers to seeking help.
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Affiliation(s)
- Elizabeth A Kelsey
- Elizabeth A. Kelsey is an NP and assistant professor at Mayo Clinic Minnesota in Rochester, where Colin P. West and Liselotte N. Dyrbye are professors and codirectors of the Mayo Clinic Program on Physician Well-Being and Daniel Satele is a statistician. Pamela F. Cipriano is first vice president of the International Council of Nurses and dean of the University of Virginia School of Nursing, Charlottesville; she is also a former president of the American Nurses Association (ANA). Cheryl Peterson is vice president-nursing programs at the ANA in Silver Springs, MD. Tait Shanafelt is chief wellness officer and associate dean at the Stanford University School of Medicine, Stanford, CA. Funding for this study was provided by the Mayo Clinic Program on Physician Well-Being and the ANA and was based on work partially supported by a National Science Foundation (NSF) grant (No. 2041339). Any opinions, findings, and conclusions or recommendations expressed in this article are those of the authors and do not necessarily reflect the views of the NSF. Funding sources had no role in study design; in the collection, analysis, and interpretation of data; or in the writing and publication of this article. Contact author: Elizabeth A. Kelsey, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Dyrbye LN, Major-Elechi B, Hays JT, Fraser CH, Buskirk SJ, West CP. Physicians' Ratings of their Supervisor's Leadership Behaviors and Their Subsequent Burnout and Satisfaction: A Longitudinal Study. Mayo Clin Proc 2021; 96:2598-2605. [PMID: 34538425 DOI: 10.1016/j.mayocp.2021.01.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the relationships between immediate supervisors' leadership qualities and the subsequent levels and changes in burnout and satisfaction of supervised physicians 2 years later. PARTICIPANTS AND METHODS In 2015 and 2017 physicians were asked to complete surveys that included the 9-item Mayo Clinic Leadership Score (range, 9 to 45) assessing their supervisor, an item about satisfaction with the organization, and two items from the Maslach Burnout Inventory. Individual participants' responses to the surveys were linked. RESULTS Among the 3698 physicians invited to complete both the 2015 and 2017 survey, 1795 (48.5%) responded. The mean composite baseline leadership score was 38.1 (SD, 8.4). Lower mean baseline leadership scores were reported by physicians who had burnout (mean [SD], 36.0 [9.7] vs 39.1 [7.3]; P<.001) 2 years later in comparison to those who did not have burnout 2 years later. In multivariable analysis, higher baseline leadership score of supervisors was independently associated with lower odds of physicians having burnout 2 years later (for each 1-point increase, odds ratio, 0.98; 95% CI, 0.96 to 0.99; P=.002) after adjusting for burnout at baseline, age, gender, length of service, and specialty. Baseline composite leadership score of supervisors was also independently associated with physicians' satisfaction with the organization 2 years later (odds ratio, 1.05; 95% CI, 1.03 to 1.07; P<.0001). CONCLUSION Physicians' ratings of their immediate supervisors' leadership qualities were associated with their subsequent levels and changes in burnout and satisfaction 2 years later. Additional studies are needed to determine the effect of sharing such scores with immediate supervisors and providing additional leadership training to those with low scores, and if doing so ultimately reduces burnout and improves satisfaction of the supervised physicians.
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Affiliation(s)
| | | | - J Taylor Hays
- Department of Mayo Clinic Leadership and Workforce Development, Rochester, MN
| | | | | | - Colin P West
- Mayo Clinic Program on Physician Well-Being, Rochester, MN
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West CP, Dyrbye LN, Satele DV, Shanafelt TD. Colleagues Meeting to Promote and Sustain Satisfaction (COMPASS) Groups for Physician Well-Being: A Randomized Clinical Trial. Mayo Clin Proc 2021; 96:2606-2614. [PMID: 34366134 DOI: 10.1016/j.mayocp.2021.02.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/26/2021] [Accepted: 02/24/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate physician small groups to promote physician well-being in a scenario with provided discussion topics but without trained facilitators, and for which protected time was not provided but meal expenses were compensated. PARTICIPANTS AND METHODS We conducted a randomized controlled trial of 125 practicing physicians in the Department of Medicine, Mayo Clinic, Rochester, Minnesota, between October 2013 and October 2014 with subsequent assessment of organizational program implementation. Twelve biweekly self-facilitated discussion groups involving reflection, shared experience, and small-group learning took place over 6 months. Main outcome measures included meaning in work, burnout, symptoms of depression, quality of life, social support, and job satisfaction assessed using validated metrics. RESULTS At 6 months after completion of the intervention (12 months from baseline), the rate of overall burnout had decreased by 12.7% (31/62 to 19/51) in the intervention arm versus a 1.9% increase (25/61 to 24/56) in the control arm (P<.001). The rate of depressive symptoms had decreased by 12.8% (29/62 to 17/50) in the intervention arm versus a 1.1% increase (20/61 to 19/56) in the control arm (P<.001). The proportion of physicians endorsing at least moderate self-reported likelihood of leaving their current practice in the subsequent 2 years had decreased by 1.9% (17/62 to 13/51) in the intervention arm and increased by 6.1% (14/61 to 16/55) in the control arm (P<.001). No statistically significant differences were seen in mean changes in burnout scale scores, meaning, or social support, although numeric differences generally favored the intervention. CONCLUSION Self-facilitated physician small-group meetings improved burnout, depressive symptoms, and job satisfaction. This intervention represents a low-cost strategy to promote important dimensions of physician well-being. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT04466423.
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Affiliation(s)
- Colin P West
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN; Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
| | - Liselotte N Dyrbye
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Daniel V Satele
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Tait D Shanafelt
- Division of Hematology, Department of Medicine, Stanford University, Palo Alto, CA
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Dyrbye LN, Major-Elechi B, Thapa P, Hays JT, Fraser CH, Buskirk SJ, West CP. Characterization of Nonphysician Health Care Workers' Burnout and Subsequent Changes in Work Effort. JAMA Netw Open 2021; 4:e2121435. [PMID: 34415312 PMCID: PMC8379653 DOI: 10.1001/jamanetworkopen.2021.21435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Burnout is a pervasive, unrelenting problem among health care workers (HCWs), with detrimental impact to patients. Data on the impact of burnout on workforce staffing are limited and could help build a financial case for action to address system-level contributors to burnout. OBJECTIVE To explore the association of burnout and professional satisfaction with changes in work effort over 24 months in a large cohort of nonphysician HCWs. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study was conducted in Rochester, Minnesota; Scottsdale and Phoenix, Arizona; Jacksonville, Florida; and community-based hospitals and health care facilities in the Midwest among nonphysician HCWs who responded to 2 surveys from 2015 to 2017. Analysis was completed November 25, 2020. EXPOSURES Burnout, as measured by 2 items from the Maslach Burnout Inventory, and professional satisfaction. MAIN OUTCOMES AND MEASURES The main outcome was work effort, as measured in full-time equivalent (FTE) units, recorded in payroll records. RESULTS Data from 26 280 responders (7293 individuals aged 45-54 years [27.8%]; 20 263 [77.1%] women) were analyzed. A total of 8115 individuals (30.9%) had worked for the organization more than 15 years, and 6595 individuals (25.1%) were nurses. After controlling for sex, age, duration of employment, job category, baseline FTE, and baseline burnout, overall burnout (odds ratio [OR], 1.53; 95% CI, 1.38-1.70; P < .001), high emotional exhaustion at baseline (OR, 1.54; 95% CI, 1.39-1.71; P < .001), and high depersonalization at baseline (OR, 1.40; 95% CI, 1.21-1.62; P < .001) were associated with an HCW reducing their FTE over the following 24 months. Conversely, satisfaction with the organization at baseline was associated with lower likelihood of reduced FTE (OR, 0.73; 95% CI, 0.65-0.83; P < .001). Findings were similar when emotional exhaustion (OR per 1-point increase, 1.12; 95% CI, 1.10-1.16; P < .001), depersonalization (OR per 1-point increase, 1.10; 95% CI, 1.06-1.14; P < .001) and satisfaction with the organization (OR per 1-point increase, 0.83; 95% CI, 0.79-0.88; P < .001) were modeled as continuous measures. Nurses represented the largest group (1026 of 1997 nurses [51.4%]) reducing their FTE over the 24 months. CONCLUSIONS AND RELEVANCE This cohort study found that burnout and professional satisfaction of HCWs were associated with subsequent changes in work effort over the following 24 months. These findings highlight the importance of addressing factors contributing to high stress among all HCWs as a workforce retention and cost reduction strategy.
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Affiliation(s)
- Liselotte N. Dyrbye
- Mayo Clinic Program on Physician Well-Being, Mayo Clinic, Rochester, Minnesota
| | | | - Prabin Thapa
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - J. Taylor Hays
- Mayo Clinic Leadership and Workforce Development, Mayo Clinic, Rochester, Minnesota
| | | | - Steven J. Buskirk
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Colin P. West
- Mayo Clinic Program on Physician Well-Being, Mayo Clinic, Rochester, Minnesota
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Abstract
IMPORTANCE Previous studies have shown that medical student mistreatment and burnout are common. However, few longitudinal data exist to describe how mistreatment and other learning environment experiences are associated with subsequent burnout and other student characteristics. OBJECTIVE To examine the association between mistreatment and perceptions of the learning environment with subsequent burnout, empathy, and career regret among US medical students. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from the 2014-2016 Association of American Medical Colleges (AAMC) Medical School Year 2 Questionnaire (Y2Q) and 2016-2018 AAMC Graduation Questionnaire (GQ). Medical students from 140 allopathic medical schools who responded to both AAMC surveys were included in the analysis. Data were analyzed from December 1, 2019, to January 11, 2021. EXPOSURES Self-reported medical student mistreatment (eg, experiences of negative behaviors and discrimination related to sex, race/ethnicity, and sexual orientation) and perceptions of the learning environment (Medical School Learning Environment Survey subscales for faculty, emotional climate, and student-student interactions). MAIN OUTCOMES AND MEASURES Burnout, empathy, and career regret as measured by Oldenburg Burnout Inventory data for burnout, Interpersonal Reactivity Index scores for empathy, and a single item assessing career regret. RESULTS Data from 14 126 medical students were analyzed; 52.0% were women, and the mean (SD) age was 27.7 (2.9) years at graduation. Mistreatment was reported by 22.9% of respondents on the Y2Q. In multivariable analysis adjusted for Y2Q measures, mistreatment reported on the Y2Q was associated with a higher exhaustion score (1.81 [95% CI, 1.60-2.02]), a higher disengagement score (0.71 [95% CI, 0.58-0.84]), and higher likelihood of career regret on the GQ (186 of 989 [18.8%]; all P < .001). A more positive emotional climate reported on the Y2Q was associated with a lower exhaustion score (for each 1-point increase, -0.05 [95% CI, -0.08 to -0.02]; P = .001) and lower disengagement score (for each 1-point increase, -0.04 [95% CI, -0.06 to -0.02]; P < .001) on the GQ. More positive faculty interactions on the Y2Q were associated with higher empathy score on the GQ (for each 1-point increase, 0.02 [95% CI, 0.01-0.05]; P = .04). Better student-student interactions were associated with lower odds of career regret during year 4 of medical school (odds ratio for each 1-point increase, 0.97 [95% CI, 0.95-1.00]; P = .04). CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that medical students who experienced mistreatment and perceived the learning environment less favorably were more likely to develop higher levels of exhaustion and disengagement, lower levels of empathy, and career regret compared with medical students with more positive experiences. Strategies to improve student well-being, empathy, and experience should include approaches to eliminate mistreatment and improve the learning environment.
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Affiliation(s)
- Liselotte N. Dyrbye
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel Satele
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Colin P. West
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Trockel M, Sinsky C, West CP, Dyrbye LN, Tutty M, Carlasare L, Wang H, Shanafelt T. Self-Valuation Challenges in the Culture and Practice of Medicine and Physician Well-being. Mayo Clin Proc 2021; 96:2123-2132. [PMID: 34210511 DOI: 10.1016/j.mayocp.2020.12.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare physicians with workers in other fields on measures of self-valuation (SV) and determine the effect of adjusting for SV on the relationship between being a physician and risk for burnout. PATIENTS AND METHODS A random sample of physicians from the American Medical Association Physician Masterfile and a probability sample from the general US population were used. Data were collected for this cross-sectional study between October 12, 2017 and March 15, 2018. Burnout was indicated by a score of 27 or higher on Emotional Exhaustion or 10 or higher on Depersonalization, using the Maslach Burnout Inventory. Self-valuation was measured with Self-valuation Scale items. RESULTS Physicians (248/832=29.8%) more than workers in other fields (1036/5182=20.0%) "often" or "always" felt more self-condemnation than self-encouragement to learn from the experience when they made a mistake. Physicians (435/832=52.3%) more than workers in other fields (771/5182=14.9%) "often" or "always" put off taking care of their own health due to time pressure. Physicians had greater odds of burnout before (odds ratio [OR], 1.51; 95% CI, 1.30 to 1.76) but not after adjusting for SV responses (OR, 0.93; 95% CI, 0.78 to 1.11). After adjustment for SV, work hours, sex, and age, physicians had lower odds of burnout than workers in other fields (OR, 0.82; 95% CI, 0.68 to 0.99). CONCLUSION Self-valuation is lower in physicians compared with workers in other fields and adjusting for SV eliminated the association between being a physician and higher risk for burnout. Experimental design research is needed to determine whether the association of SV with burnout is causal and the degree to which SV is malleable to intervention at individual, organization, and professional culture levels.
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Affiliation(s)
| | | | | | | | | | | | - Hanhan Wang
- Stanford University School of Medicine, Palo Alto, CA
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Shanafelt TD, Dyrbye LN, West CP, Sinsky C, Tutty M, Carlasare LE, Wang H, Trockel M. Suicidal Ideation and Attitudes Regarding Help Seeking in US Physicians Relative to the US Working Population. Mayo Clin Proc 2021; 96:2067-2080. [PMID: 34301399 DOI: 10.1016/j.mayocp.2021.01.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the prevalence of suicidal ideation (SI) and attitudes regarding help seeking among US physicians relative to the general US working population. PARTICIPANTS AND METHODS A secondary analysis of a cross-sectional survey of US physicians and a probability-based sample of the US working population was conducted between October 12, 2017, and March 15, 2018. Among 30,456 invited physicians, 5197 (17.1%) completed the primary survey. Suicidal ideation in the last year, attitudes regarding help seeking, symptoms of depression, and burnout were assessed by standardized questions. RESULTS Among the 4833 physicians who responded regarding SI, 316 (6.5%) reported having suicidal thoughts in the last 12 months. Most physicians (3527 [72.9%]) reported that they would seek professional help if they had a serious emotional problem. Physicians with SI were less likely to report that they would seek help (203/316 [64.2%]) than physicians without SI (3318/4517 [73.5%]; P=.001). On multivariable analysis, symptoms of depression (odds ratio [OR], 4.42; 95% CI, 1.89 to 11.52), emotional exhaustion (OR, 1.07 each 1-point increase; 95% CI, 1.03 to 1.11), and self-valuation (OR, 0.84 each 1-point increase; 95% CI, 0.70 to 0.99) were associated with SI. Among individuals aged 29 to 65 years, physicians were more likely than workers in other fields to report SI (7.1% vs 4.3%; P<.001), a finding that persisted on multivariable analysis. CONCLUSION In this national study conducted before the COVID-19 pandemic, 1 in 15 US physicians had thoughts of taking their own life in the last year, which exceeded the prevalence of SI among US workers in other fields.
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Affiliation(s)
- Tait D Shanafelt
- Department of Medicine, Division of Hematology, Stanford University, Palo Alto, CA.
| | - Lotte N Dyrbye
- Department of Medicine, Division of Primary Care, Mayo Clinic, Rochester, MN
| | - Colin P West
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Hanhan Wang
- Department of Medicine, Division of Hematology, Stanford University, Palo Alto, CA
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
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Dyrbye LN, West CP, Herrin J, Dovidio J, Cunningham B, Yeazel M, Lam V, Onyeador IN, Wittlin NM, Burke SE, Hayes SN, Phelan SM, van Ryn M. A Longitudinal Study Exploring Learning Environment Culture and Subsequent Risk of Burnout Among Resident Physicians Overall and by Gender. Mayo Clin Proc 2021; 96:2168-2183. [PMID: 34218879 DOI: 10.1016/j.mayocp.2020.12.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore the relationship between learning environment culture and the subsequent risk of developing burnout in a national sample of residents overall and by gender. METHODS From April 7 to August 2, 2016, and May 26 to August 5, 2017, we surveyed residents in their second (R2) and third (R3) postgraduate year. The survey included a negative interpersonal experiences scale (score range 1 to 7 points, higher being worse) assessing psychological safety and bias, inclusion, respect, and justice; an unfair treatment scale (score range 1 to 5 points, higher being worse), and two items from the Maslach Burnout Inventory. Individual responses to the R2 and R3 surveys were linked. RESULTS The R2 survey was completed by 3588 of 4696 (76.4%) residents; 3058 of 3726 (82.1%) residents completed the R3 survey; and 2888 residents completed both surveys. Women reported more negative interpersonal experiences (mean [SD], 3.00 [0.83] vs 2.90 [0.85], P<.001) and unfair treatment (66.5% vs. 58.7%, P<.001) than men at R2. On multivariable analysis, women at R3 were more likely than their male counterparts to have burnout (odds ratio, 1.23; 95% CI, 1.02 to 1.48; P=.03). Both men and women who reported more negative interpersonal experiences at R2 were more likely to have burnout at R3 (odds ratio, 1.32; 95% CI, 1.14 to 1.52; P<.001). The factors contributing to burnout did not vary in effect magnitude by gender. CONCLUSION These findings indicate women residents are more likely to have burnout relative to men in the third year of residency. Negative culture predicted subsequent burnout 1 year later among both men and women. Differences in burnout were at least partly due to differing levels of exposure to negative interactions for men versus women rather than a negative interaction having a differential impact on the well-being of men versus women.
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Affiliation(s)
- Liselotte N Dyrbye
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Colin P West
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jeph Herrin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | | | - Brooke Cunningham
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Mark Yeazel
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | | | - Ivuoma N Onyeador
- Department of Management and Organizations, Kellogg School of Management, Northwestern University, Kirkland, WA
| | | | - Sara E Burke
- Department of Psychology, Syracuse University, Syracuse, NY
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sean M Phelan
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN
| | - Michelle van Ryn
- School of Nursing, Oregon Health & Science University, Portland, OR
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Melnick ER, West CP, Nath B, Cipriano PF, Peterson C, Satele DV, Shanafelt T, Dyrbye LN. The association between perceived electronic health record usability and professional burnout among US nurses. J Am Med Inform Assoc 2021; 28:1632-1641. [PMID: 33871018 PMCID: PMC8324227 DOI: 10.1093/jamia/ocab059] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To measure nurse-perceived electronic health records (EHR) usability with a standardized metric of technology usability and evaluate its association with professional burnout. METHODS A cross-sectional survey of a random sample of US nurses was conducted in November 2017. EHR usability was measured with the System Usability Scale (SUS; range 0-100) and burnout with the Maslach Burnout Inventory. RESULTS Among the 86 858 nurses who were invited, 8638 (9.9%) completed the survey. The mean nurse-rated EHR SUS score was 57.6 (SD 16.3). A score of 57.6 is in the bottom 24% of scores across previous studies and categorized with a grade of "F." On multivariable analysis adjusting for age, gender, race, ethnicity, relationship status, children, highest nursing-related degree, mean hours worked per week, years of nursing experience, advanced certification, and practice setting, nurse-rated EHR usability was associated with burnout with each 1 point more favorable SUS score and associated with a 2% lower odds of burnout (OR 0.98; 95% CI, 0.97-0.99; P < .001). CONCLUSIONS Nurses rated the usability of their current EHR in the low marginal range of acceptability using a standardized metric of technology usability. EHR usability and the odds of burnout were strongly associated with a dose-response relationship.
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Affiliation(s)
- Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Bidisha Nath
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Pamela F Cipriano
- Office of the Dean, University of Virginia School of Nursing, Charlottesville, Virginia, USA
- American Nurses Association, Silver Spring, Maryland, USA
| | | | - Daniel V Satele
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tait Shanafelt
- Department of Medicine, Stanford School of Medicine, Palo Alto, California, USA
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Dyrbye LN, Leep Hunderfund AN, Moeschler S, Vaa B, Dozois E, Winters RC, Satele D, West CP. Residents' Perceptions of Faculty Behaviors and Resident Burnout: a Cross-Sectional Survey Study Across a Large Health Care Organization. J Gen Intern Med 2021; 36:1906-1913. [PMID: 33483819 PMCID: PMC8298727 DOI: 10.1007/s11606-020-06452-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Data suggests the learning environment factors influence resident well-being. The authors conducted an assessment of how residents' perceptions of faculty-resident relationships, faculty professional behaviors, and afforded autonomy related to resident burnout. METHODS All residents at one organization were surveyed in 2019 using two items from the Maslach Burnout Inventory and the faculty relationship subscale of the Johns Hopkins Learning Environment Scale (JHLES, range 6 to 30). Residents were also asked about faculty professional behaviors (range 0 to 30), and satisfaction with autonomy across various clinical settings. RESULTS A total of 762/1146 (66.5%) residents responded to the survey. After adjusting for age, gender, postgraduate year, and specialty, lower (less favorable) JHLES-faculty relationship subscale score (parameter estimate, - 3.08, 95% CI - 3.75, - 2.41, p < 0.0001), fewer observed faculty professional behaviors (parameter estimate, - 3.34, 95% CI - 4.02, - 2.67, p < 0.0001), and lower odds of satisfaction with autonomy in the intensive care settings (OR 0.46, 95% CI 0.30, 0.70, p = 0.001), but not other care settings, were reported by residents with burnout in comparison to those without. Similar relationships were observed when emotional exhaustion and depersonalization were analyzed separately as continuous variables. CONCLUSION In this cohort, resident perceptions of faculty relationships, faculty professional behaviors, and satisfaction with autonomy in the intensive care unit were associated with resident burnout. Additional longitudinal studies are needed to elucidate the direction of these relationships and determine if faculty development can reduce resident burnout.
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Affiliation(s)
| | | | | | | | | | | | - Daniel Satele
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Abstract
OBJECTIVE To understand the relationships between burnout, job satisfaction, and career plans among physician assistants in the United States. METHODS The authors surveyed PAs in 2016. The survey included the Maslach Burnout Inventory and items on job satisfaction and career plans. RESULTS Overall 82.7% of PAs were satisfied with their job, 32.2% indicated intent to leave their current position, and 19.5% reported intent to reduce work hours. On multivariate analysis, burnout increased the odds of job dissatisfaction, intent to reduce work hours within the next year, and intent to leave the current practice in the next 2 years. CONCLUSIONS About a third of PAs indicated intent to leave their current practice and one in five indicated intent to reduce their clinical hours. Burnout was an independent predictor of job satisfaction and career plans.
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Affiliation(s)
- Michael P Halasy
- Michael P. Halasy is an assistant professor in health care administration at the Mayo Clinic in Rochester, Minn. Colin P. West is a professor of medicine, medical education, and biostatistics and codirector of the Mayo Clinic Program on Physician Well-Being. Tait Shanafelt is a professor of medicine and associate dean of the Stanford (Calif.) University School of Medicine. Danielle J. O'Laughlin is an assistant professor in the Division of Community Internal Medicine, Department of Medicine at the Mayo Clinic. Daniel Satele is a statistician in the Department of Health Sciences Research at the Mayo Clinic. Liselotte N. Dyrbye is a professor of medicine and medical education and codirector of the Mayo Clinic Program on Physician Well-Being. Funding for this study was provided by the Mayo Clinic Program on Physician Well-Being. Funding sources had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The authors have disclosed no other potential conflicts of interest, financial or otherwise
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Gautham KS, West CP. The Role of Leaders in Promoting Health Professional Wellness and Improving the Culture of Safety: Does a Positive Approach Matter? Jt Comm J Qual Patient Saf 2021; 47:399-400. [PMID: 34120874 DOI: 10.1016/j.jcjq.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Benjamin IJ, Valentine CM, Oetgen WJ, Sheehan KA, Brindis RG, Roach WH, Harrington RA, Levine GN, Redberg RF, Broccolo BM, Hernandez AF, Douglas PS, Piña IL, Benjamin EJ, Coylewright MJ, Saucedo JF, Ferdinand KC, Hayes SN, Poppas A, Furie KL, Mehta LS, Erwin JP, Mieres JH, Murphy DJ, Weissman G, West CP, Lawrence WE, Masoudi FA, Jones CP, Matlock DD, Miller JE, Spertus JA, Todman L, Biga C, Chazal RA, Creager MA, Fry ET, Mack MJ, Yancy CW, Anderson RE. 2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report. Circulation 2021; 143:e1035-e1087. [PMID: 33974449 DOI: 10.1161/cir.0000000000000963] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Benjamin IJ, Valentine CM, Oetgen WJ, Sheehan KA, Brindis RG, Roach WH, Harrington RA, Levine GN, Redberg RF, Broccolo BM, Hernandez AF, Douglas PS, Piña IL, Benjamin EJ, Coylewright MJ, Saucedo JF, Ferdinand KC, Hayes SN, Poppas A, Furie KL, Mehta LS, Erwin JP, Mieres JH, Murphy DJ, Weissman G, West CP, Lawrence WE, Masoudi FA, Jones CP, Matlock DD, Miller JE, Spertus JA, Todman L, Biga C, Chazal RA, Creager MA, Fry ET, Mack MJ, Yancy CW, Anderson RE. 2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report. J Am Coll Cardiol 2021; 77:3079-3133. [PMID: 33994057 DOI: 10.1016/j.jacc.2021.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Tawfik DS, Shanafelt TD, Dyrbye LN, Sinsky CA, West CP, Davis AS, Su F, Adair KC, Trockel MT, Profit J, Sexton JB. Personal and Professional Factors Associated With Work-Life Integration Among US Physicians. JAMA Netw Open 2021; 4:e2111575. [PMID: 34042994 PMCID: PMC8160595 DOI: 10.1001/jamanetworkopen.2021.11575] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/01/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Poor work-life integration (WLI) occurs when career and personal responsibilities come in conflict and may contribute to the ongoing high rates of physician burnout. The characteristics associated with WLI are poorly understood. Objective To identify personal and professional factors associated with WLI in physicians and identify factors that modify the association between gender and WLI. Design, Setting, and Participants This cross-sectional study was based on electronic and paper surveys administered October 2017 to March 2018 at private, academic, military, and veteran's practices across the US. It used a population-based sample of US physicians across all medical specialties. Data analysis was performed from November 2019 to July 2020. Main Outcomes and Measures WLI was assessed using an 8-item scale (0-100 point scale, with higher scores indicating favorable WLI), alongside personal and professional factors. Multivariable linear regressions evaluated independent associations with WLI as well as factors that modify the association between gender and WLI. Results Of 5197 physicians completing surveys, 4370 provided complete responses. Of the physicians who provided complete responses, 2719 were men, 3491 were White/Caucasian (80.8%), 3560 were married (82.4%), and the mean (SD) age was 52.3 (12.0) years. The mean (SD) WLI score was 55 (23). Women reported lower (worse) mean (SD) WLI scores than men overall (52 [22] vs 57 [23]; mean difference, -5 [-0.2 SDs]; P < .001). In multivariable regression, lower WLI was independently associated with being a woman (linear regression coefficient, -6; SE, 0.7; P < .001) as well as being aged 35 years or older (eg, aged 35 to 44 years: linear regression coefficient, -7; SE, 1.4; P < .001), single (linear regression coefficient, -3 vs married; SE, 1.1; P = .003), working more hours (eg, 50 to 59 hours per week vs less than 40 hours per week: linear regression coefficient, -9; SE, 1.0; P < .001) and call nights (linear regression coefficient, -1 for each call night per week; SE, 0.2; P < .001), and being in emergency medicine (linear regression coefficient, -18; SE, 1.6, P < .001), urology (linear regression coefficient, -11; SE, 4.0; P = .009), general surgery (linear regression coefficient, -4; SE, 2.0; P = .04), anesthesiology (linear regression coefficient, -4; SE, 1.7; P = .03), or family medicine (linear regression coefficient, -3; SE, 1.4; P = .04) (reference category, internal medicine subspecialties). In interaction modeling, physician age, youngest child's age, and hours worked per week modified the associations between gender and WLI, such that the largest gender disparities were observed in physicians who were aged 45 to 54 years (estimated WLI score for women, 49; 95% CI, 47-51; estimated WLI score for men, 57, 95% CI, 55-59; P < .001), had youngest child aged 23 years or older (estimated WLI score for women, 51; 95% CI, 48-54; estimated WLI score for men, 60; 95% CI, 58-62; P < .001), and were working less than 40 hours per week (estimated WLI score for women, 61; 95% CI, 59-63; estimated WLI score for men; 70; 95% CI, 68-72; P < .001). Conclusions and Relevance This study found that lower WLI was reported by physicians who are women, single, aged 35 years or older, and who work more hours and call nights. These findings suggest that systemic change is needed to improve WLI among physicians.
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Affiliation(s)
- Daniel S. Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Tait D. Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | | | | | - Colin P. West
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alexis S. Davis
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Felice Su
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Kathryn C. Adair
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
| | - Mickey T. Trockel
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality Care Collaborative, Palo Alto
| | - J. Bryan Sexton
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, North Carolina
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