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INTRODUCTION: The purpose of the study was to investigate gender differences in attrition rate between male and female physicians working in academia. METHODS: All physicians who billed Medicare from a teaching hospital in March 2014 were included and were followed up until December 2019. Physicians who retired during the study period were excluded. The primary outcome was leaving academia and was defined as not having billed Medicare from a teaching hospital for more than 1 year. The primary independent variable was physician gender. Multivariate logistic regression was conducted, adjusting for physician experience, medical school ranking, specialty (surgery vs nonsurgery), and region of the country. Stratified subset analyses were also performed for the variables listed above. RESULTS: There were 294,963 physicians included, 30.5% female. The overall attrition rate was 34.2% after 5 years, 38.3% and 32.4% for female and male physicians, respectively. Female physicians had higher attrition rate than their male counterparts across every career stage (Figure). On the adjusted analysis, female physicians were 25% more likely to leave academia than their male counterparts (odds ratio [OR] = 1.25, 95% CI = 1.23, 1.28). The results were qualitatively similar on all subset analyses. CONCLUSION: Female physicians are more likely to leave academia than male physicians at all career stages, in all regions of the country, in both surgical and nonsurgical specialties, and regardless of medical school ranking. Successful diversity, equity, and inclusion efforts should address attrition in addition to pipeline issues.

INTRODUCTION: COVID-19 has led to exacerbated levels of traumatic stress and moral distress experienced by emergency nurses. This study contributes to understanding the perspectives of emergency nurses’ perception of psychological trauma during COVID-19 and protective mechanisms used to build resilience. METHOD: The primary method was qualitative analysis of semistructured interviews, with survey data on general resilience, moral resilience, and traumatic stress used to triangulate and understand qualitative findings. Analyses and theme development were guided by social identity theory and informed by the middle range theory of nurses’ psychological trauma. RESULTS: A total of 14 emergency nurses were interviewed, 11 from one site and 3 from the other. Almost all nurses described working in an emergency department throughout the pandemic as extraordinarily stressful, morally injurious, and exhausting at multiple levels. Although the source of stressors changed throughout the pandemic, the culmination of continued stress, moral injury, and emotional and physical exhaustion almost always exceeded their ability to adapt to the ever-changing landscape in health care created by the pandemic. Two primary themes were identified: losing identity as a nurse and hopelessness and self-preservation. DISCUSSION: The consequences of the pandemic on nurses are likely to be long lasting. Nurses need to mend and rebuild their identity as a nurse. The solutions are not quick fixes but rather will require fundamental changes in the profession, health care organizations, and the society. These changes will require a strategic vision, sustained commitment, and leadership to accomplish.

Two years into the arrival of COVID, we have witnessed the impact of this virus to our lives. COVID initially created chaos, since our knowledge of the virus was very limited. Health care workers experienced the isolation of everyone else but had the added stress from work. Health care workers were dealing with the unknown, taking care of the ill, often with limited equipment available for protection. Family members of patients were unable to stay with their loved ones and we could see, hear and feel their fear. This created for many a moral injury (a type of psychological distress one feels when unable to deliver the normal type of care). Then we added in our own concern of bringing COVID home to our family. Even as the initial emergency subsided, the environment never returned to ‘normal,’ and it probably will not. Too many nurses are still struggling mentally with fall-out from the pandemic.

Emergency responders (ERs), often termed First Responders, such as police, fire and paramedic roles are exposed to occupational stressors including high workload, and exposure to trauma from critical incidents, both of which can affect their mental health and wellbeing. Little is known about the impact of the ER occupation on the mental health and wellbeing of their families. The aim of the current study was to investigate what mental health and wellbeing outcomes and experiences have been researched internationally in ER families, and to examine the prevalence and associated risk and protective factors of these outcomes. We conducted a systematic review in accordance with an a priori PROSPERO approved protocol (PROSPERO 2019 CRD42019134974). Forty-three studies were identified for inclusion. The majority of studies used a quantitative, cross-sectional design and were conducted in the United States; just over half assessed police/law enforcement families. Themes of topics investigated included: 1) Spousal/partner mental health and wellbeing; 2) Couple relationships; 3) Child mental health and wellbeing; 4) Family support and coping strategies; and 5) Positive outcomes. The review identified limited evidence regarding the prevalence of mental health and wellbeing outcomes. Family experiences and risk factors described were ER work-stress spillover negatively impacting spousal/partner wellbeing, couple relationships, and domestic violence. Traumatic exposure risk factors included concerns family had for the safety of their ER partner, the negative impact of an ER partners' mental health problem on the couples' communication and on family mental health outcomes. Protective factors included social support; however, a lack of organisational support for families was reported in some studies. Study limitations and future research needs are discussed. Progressing this area of research is important to improve knowledge of baseline needs of ER families to be able to target interventions, improve public health, and support ER's operational effectiveness.

The Mini Z is a psychometrically sound measure of worklife and wellness in practicing clinicians. Measures in residents address slightly different issues and are moderately longer, potentially limiting response rates. We adapted the Mini Z for use in residents (the Mini ReZ), using the Mini Z core 10 questions and 5 additional questions reflecting domains identified by Trockel. Validating the new variation on the Mini Z would provide program directors the means to assess well-being within their programs (in collaboration with their residents), and determine actionable steps for improvement. The objective of this report is to demonstrate the validation of the Mini ReZ.

[This is an excerpt.] Stress and burnout among healthcare workers are at alarming levels. The Mini Z (Zero Burnout Program) worklife measure for clinicians was derived from validated instruments with the factor structure published in JGIM in 2016. The 1.0 version included 4 work conditions (work ambience (chaos), work control, teamwork effectiveness, and values alignment), 3 clinician reactions (stress, satisfaction, and burnout), and 3 items related to electronic medical record (EMR) stress (time pressure, home EMR time, and EMR proficiency). This paper investigates the psychometric structure of the 2.0 version which (1) changes EMR proficiency to EMR frustration, (2) aligns positive scores for calculation of a summary (joy) score, and (3) has two 5-item subscales (supportive work environment and work pace/EMR stress). Mini Zs have been adapted for residents, nurses, and administrators, and administered to thousands of healthcare workers in multiple languages across 5 continents. Concurrent validity of the burnout item was assessed with the Maslach Burnout Inventory (MBI) emotional exhaustion (EE) subscale. A subsequent study assessed convergent validity of the remaining items against EE and depersonalization MBI subscales. To provide a brief, valid measure for healthcare organizations to address clinician satisfaction and burnout, we determined the reliability and validity of the Mini Z 2.0’s two-subscale structure. [To read more, click View Resource.]

Research suggests that Canadian police officers are exposed to trauma at a greater frequency than the general population. This, combined with other operational stressors, such as risk of physical injury, high consequence of error, and strained resources, can leave officers less resilient to organizational stressors. In my experience, a significant and impactful organizational stressor is ineffective leadership, which include leaders who are non-supportive, inconsistent, egocentric, and morally ambiguous. Ineffective leadership in the context of paramilitary police culture has been recognized as psychologically distressing. Further, moral injury may result when leadership fails to meet officers’ needs, expectations, and values. Ineffective leadership and resulting moral injuries are an understudied area in the literature. This review will help provide a comprehensive context of policing and the impact of ineffective leadership on police mental health.

[This is an excerpt.] The National Health Service Corps (NHSC) is a clinician recruitment and retention program that aims to reduce health workforce shortages in underserved areas. The NHSC has three components: (1) a federal scholarships program, (2) a federal loan repayment program, and (3) astate-operated loan repayment program. Under each of these programs, health providers receive either scholarships or loan repayments in exchange for a service commitment at an NHSC-approved facility located in a federally designated health professional shortage area (HPSA, see text box).1 Participants in the state loan repayment programs may also serve in state-designated shortage areas; federal program participants may not. NHSC-approved facilities are generally nonprofit or government-operated (federal, state, local, or tribal) organizations that provide care to patients without regard for the patient’s ability to pay. The program’s clinicians provided careto an estimated 23.6 million patients in calendar year 2021. This is an increase from FY 2019,when the program estimated that its clinicians provided care to 13.7 million patients.2 [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Strengthen Worker Compensation and Benefits).

OBJECTIVE Burnout and work-life balance have been noted to be problems for residents across all fields of medicine, including neurosurgery. No studies to date have evaluated how these factors may contribute to issues outside of the hospital, specifically residents’ home lives. This study aimed to evaluate the interplay between home life and work life of neurosurgical residents, specifically from the point of view of residents’ significant others. METHODS Online surveys were distributed to the significant others of neurosurgical residents at 12 US neurosurgery residencies. Residents’ partners were asked about relationship dynamics, their views on neurosurgery residency (work-life balance and burnout), and their views of neurosurgery as a career. RESULTS The majority of residents’ significant others (84%) reported being satisfied with their relationship. Significant others who reported dissatisfaction with their relationship were more likely to report frustration with work-life balance and more likely to report their resident partner as having higher levels of burnout. CONCLUSIONS From the perspective of neurosurgery residents’ significant others, higher perceived levels of burnout and lower satisfaction with work-life balance are correlated with lower levels of relationship satisfaction. These findings speak to the complex interplay of work life and home life and can be used to inform future interventions into improving the quality of life for both the resident and the significant other.

BACKGROUND: Newly licensed registered nurses (NLRNs) are a vital health human resource necessary for the sustainability of the nursing workforce. There are challenges associated with the transition of NLRNs into practice; yet, new nurses continue to leave their positions within the first year. To compound the situation, a global pandemic hit in 2020. To leverage a sustainable future for our nursing workforce we must examine workforce data of NLRNs. PURPOSE: The purpose of this descriptive study was to review the most recent national source of workforce data to determine if the data reveals insight to help renew the focus on the NLRN workforce. METHODS: This descriptive study was a secondary analysis of demographic, education, employment, and work environment variables from the 2018 National Sample Survey of Registered Nurses. FINDINGS: The NLRN workforce is slightly more diverse, seeking a BSN as the first degree, and funding their initial education with federal loans. NLRNs cite inadequate staffing, stressful work environments, burnout, and salary as the reasons for leaving the first job. NLRNs cite a balanced schedule, experience in the job, and a sense of community with peers as reasons why they stay. DISCUSSION: This study joins the decades of literature that points to a small group of problems that account for the overwhelming majority or nursing turnover and attrition. After analyzing the data, the authors pose several questions to readers for consideration about the NLRN workforce. The authors' hope is to garner renewed attention to the issues facing NLRNs.

[This is an excerpt.] Now 2 years old, the unprecedented coronavirus disease 2019 (COVID-19) pandemic produced a medical response that was equally unprecedented. Starting with nearly no knowledge about diagnosis, transmission, prevention, treatment, or predictors of outcome, physicians and hospitals were forced to develop real time answers for a new and unfamiliar disease. Particularly, challenging medical aspects of COVID-19 included multisystem involvement, extremely high transmissibility, rapid mutation, and an extraordinarily wide spectrum of clinical presentation from asymptomatic carrier to fatal respiratory failure. [To read more, click View Resource.]

Clinicians are reluctant to seek mental health services. They fear loss of livelihood and disciplinary action. The Oregon Wellness Program (OWP) is a state-wide consolidated mental health initiative formally established in 2018 as a physician, physician assistant, acupuncturist, and podiatrist program. OWP is self-referral, not-mandated, strictly confidential, and free. Reporting to oversight bodies is forbidden. Utilization increased from 228 clients to 349 clients (a 53% increase) and 405 visits to 625 visits (a 54% increase) from 2019 to 2020 respectively, coinciding with the first COVID-19 pandemic surge. Between April 2019 and the end of August 2020, 41 of 433 (9.5%) individuals who were provided mental health services returned 77 program evaluation surveys, indicating satisfaction with the program (96%), its helpfulness to them personally (99%), and changes made in their personal lives (80%). The burnout response rate fell with increased visits and reallocation of activities within their practices increased (39%). A survey of mental health professionals corroborated positive results of their clients. The OWP can serve as a model for healthcare professional support programs. Collaboration among healthcare organizations, professional, and oversight bodies is essential. Increasing sustainable funding to pay for expanding services for dentists and nurses, assuring access for rural clinicians, and developing research tools to capture a more robust sample of responses remain priorities.

BACKGROUND: As more women begin to enter the traditionally male-dominated field of orthopaedics, it is critical to examine their experiences in navigating gender-based conflicts in the workplace. METHODS: An anonymous survey was distributed via a web link to approximately 1,100 members of Ruth Jackson Orthopaedic Society (RJOS) and 1,600 members of Women in Orthopaedics (WIO) Facebook group, with an estimated response rate of 50% and 50% respectively and protocols to mitigate duplicate response. Questions included demographics and presented several workplace scenarios. RESULTS: Of the 373 respondents, 72% described experiencing some type of workplace conflict self-attributed to being female. Additionally, 8% reported either being forced out or leaving their previous job due to workplace conflict, leading to depression, anxiety, and burnout. 17% of respondents would not choose the same career again if given the opportunity. CONCLUSIONS: Workplace conflict diminishes a surgeon's career satisfaction and may ultimately contribute to burnout. Understanding the relationship between gender bias and orthopaedic surgery is essential in moving towards change, and addressing these issues will create a more positive working environment for female surgeons.

BACKGROUND: During the COVID-19 pandemic, health care provider well-being was affected by various challenges in the work environment. The purpose of this study was to evaluate the relationship between the perceived work environment and mental well-being of a sample of emergency physicians (EPs), emergency medicine (EM) nurses, and emergency medical services (EMS) providers during the pandemic. METHODS: We surveyed attending EPs, resident EPs, EM nurses, and EMS providers from 10 academic sites across the United States. We used latent class analysis (LCA) to estimate the effect of the perceived work environment on screening positive for depression/anxiety and burnout controlling for respondent characteristics. We tested possible predictors in the multivariate regression models and included the predictors that were significant in the final model. RESULTS: Our final sample included 701 emergency health care workers. Almost 23% of respondents screened positive for depression/anxiety and 39.7% for burnout. Nurses were significantly more likely to screen positive for depression/anxiety (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.11–3.86) and burnout (aOR 2.05, 95% CI 1.22–3.49) compared to attendings. The LCA analysis identified four subgroups of our respondents that differed in their responses to the work environment questions. These groups were identified as Work Environment Risk Group 1, an overall good work environment; Risk Group 2, inadequate resources; Risk Group 3, lack of perceived organizational support; and Risk Group 4, an overall poor work environment. Participants in the two groups who perceived their work conditions as most adverse were significantly more likely to screen positive for depression/anxiety (aOR 1.89, 95% CI 1.05–3.42; and aOR 2.04, 95% CI 1.14–3.66) compared to participants working in environments perceived as less adverse. CONCLUSIONS: We found a strong association between a perceived adverse working environment and poor mental health, particularly when organizational support was deemed inadequate. Targeted strategies to promote better perceptions of the workplace are needed.

BACKGROUND: Reducing burnout is a priority for many organizations. This paper investigates if mentoring has an impact on employee burnout in a large comprehensive cancer hospital. METHODS: Utilizing data from an organizational survey with self-identification of burnout and self-disclosed participation in mentoring relationships, a chi-square test was conducted to analyze the data from 14,500 employees. RESULTS: We found employees participating in a mentoring relationship were significantly less likely to report burnout than employees who were not participating in a mentoring relationship (χ2 (1, 14,500) = 17.204, p < 0.001). This same pattern was found within subsets of employees, examining across gender, ethnicity, generation, and different job classifications. CONCLUSION: Implementing and promoting mentoring programs should be an organizational strategy to help improve overall work satisfaction and professional fulfillment for mentors and mentees. Best practices and institutional mentoring programs are outlined to exhibit the multitude of opportunities for mentoring within the organization that contribute to a reduction of burnout.

The high degree of burnout in physicians, including oncologists, is detrimental to physicians themselves, their families, patients, health care organizations, and the health care systems as a whole. This dire situation has significantly worsened during the COVID-19 pandemic. It is well established that both organizational and individual measures are urgently needed to mitigate the negative consequences of physician burnout. Here, we review the research that has begun to indicate potential evidence-based individual approaches to promote physician well-being. We give an overview of these emerging programs and their importance, provide an example from our own experience, and enumerate considerations for future research. We also discuss the need for developing new approaches that are evidence-based and the best ways in which they can be incorporated in the health care setting. When judiciously combined with organizational approaches, preferentially as an integral part of them, individual wellness programs for physicians are poised to contribute significantly toward the much needed relief from physician burnout.

BACKGROUND: This study investigated the association between fair and supportive leadership and symptoms of burnout and insomnia in police employees. Burnout and insomnia can have negative consequences for health, performance, and safety among employees in the police profession, and risk and protective factors should be thoroughly investigated. METHODS: Data were collected in a police district in Norway through questionnaires administered in October 2018 and May 2019. The sample consisted of 206 police employees (52% males), with an average age of 42 years and 16 years of experience in the police occupation. RESULTS: The results showed that a high degree of fair and supportive leadership was associated with lower levels of burnout and insomnia six months later. Fair and supportive leadership explained a greater amount of variance in burnout compared to insomnia. This finding indicates that fair and supportive leadership is a more important buffer factor against burnout than it is against insomnia. Stress was positively associated with burnout and insomnia, whereas quantitative job demands had no significant association with the concepts. CONCLUSION: Fair and supportive leadership can help protect employees from adverse consequences of stress and contribute to improved occupational health, whereas a low degree of support and fair treatment from leaders can both represent a stressor by itself and contribute to poorer coping of stressful events at work. The important role of leadership should be incorporated in measures aimed at preventing and reducing burnout and sleep problems.

The aim of this cross-sectional study is to investigate the effect of self-esteem on burnout symptoms and depression, using a path analysis approach. A total of 396 Greek police officers, 145 female and 251 male, with a mean age of 37.7 years, participated in the study. The questionnaire included: (a) social?demographic characteristics, (b) Rosenberg's self-esteem scale, (c) Zung's depression scale, and (d) Maslach's burnout scale. Analysis of variance was applied to find whether the demographic variables of gender, age and urban/rural location had a significant effect on the examined psychometric scales. A path model was then tested, aiming to quantify the direct and indirect effects of age, working location and self-esteem on depression and burnout symptoms. Emotional exhaustion and personal accomplishment scores were found to have a direct effect on depression and completely explained the effect of urban area on depression. Self-esteem was found to be a significant regressor on depression and the three burnout subscales, while older and more experienced officers had significantly lower burnout symptoms. The findings of the study confirm the protective role of self-esteem. The findings also confirmed that police officers working in an urban environment are at a greater risk of developing burnout and depression symptoms, while the depressed feelings of police officers in an urban area are completely explained by increased feelings of burnout. The ability of police officers to counteract the psycho-emotional pressure of their profession as they age in service is demonstrated. The need for initiatives aiming to support young officers and police personnel working in large cities is indicated.

OBJECTIVES: The current study aimed to guide the assessment and improvement of psychological safety (PS) by (1) examining the psychometric properties of a brief novel PS scale, (2) assessing relationships between PS and other safety culture domains, (3) exploring whether PS differs by healthcare worker demographic factors, and (4) exploring whether PS differs by participation in 2 institutional programs, which encourage PS and speaking-up with patient safety concerns (i.e., Safety WalkRounds and Positive Leadership WalkRounds). METHODS: Of 13,040 eligible healthcare workers across a large academic health system, 10,627 (response rate, 81%) completed the 6-item PS scale, demographics, safety culture scales, and questions on exposure to institutional initiatives. Psychometric analyses, correlations, analyses of variance, and t tests were used to test the properties of the PS scale and how it differs by demographic factors and exposure to PS-enhancing initiatives. RESULTS: The PS scale exhibited strong psychometric properties, and a 1-factor model fit the data well (Cronbach α = 0.80; root mean square error approximation = 0.08; Confirmatory Fit Index = 0.97; Tucker-Lewis Fit Index = 0.95). Psychological Safety scores differed significantly by role, shift, shift length, and years in specialty. The PS scale correlated significantly and in expected directions with safety culture scales. The PS score was significantly higher in work settings with higher rates of exposure to Safety WalkRounds or Positive Leadership WalkRounds. CONCLUSIONS: The PS scale is brief, diagnostic, and actionable. It exhibits strong psychometric properties; is associated with better safety, teamwork climate, and well-being; differs by demographic factors; and is significantly higher for those who have been exposed to PS-enhancing initiatives.

OBJECTIVE: Faculty development is designed to facilitate career advancement of junior faculty but there is limited empirical evidence on how to design an effective program. METHODS: As a first step in the design of an effective program, a needs assessment was conducted. Participants were faculty members of an academic psychiatry department. Participants completed a quantitative and qualitative survey assessing their experience with mentors, academic self-efficacy, career burnout and satisfaction, academic productivity, and perceived barriers to scholarship. RESULTS: Eighty percent (N = 104) of eligible faculty members completed the study survey (54% female; 81% White, 10% underrepresented in medicine). Less than half of the respondents (44%) reported having a current mentor. Number of mentors (r = .33; p < .01), mentorship meetings (r = .35; p < .01), and mentorship quality (r = .33; p < .01) were significantly correlated to a standardized measure of academic self-efficacy. Self-efficacy was significantly associated with academic productivity (r = .44; p < .001) and career satisfaction (r = .29; p < .05). The top barriers to scholarship productivity were time and lack of access to resources. Faculty members without a mentor endorsed more barriers to scholarship (p < .001) than those with a mentor. Themes that emerged from the qualitative data suggest that mentorship supports career advancement through coaching and professional development, invitations to collaborate and resource share, networking, and active teaching. CONCLUSION: Based on the relationship of mentoring to career outcomes, a robust faculty development program needs a formal academic mentorship program to improve career satisfaction and academic productivity.