Grit, a positive psychological trait comprised of perseverance and passion, has been correlated with physician burnout but has not been extensively studied among medical students. Identification of the relationship between grit and burnout as well as between burnout and other demographics could help to identify students at risk of burnout, while informing educational strategies to increase grit in the medical occupation. For this cross-sectional study, an online, email-based survey including demographic questions, the Maslach Burnout Inventory-Human Services (Medical Personnel) Survey, and the Short Grit Scale was distributed to an entire student body of allopathic medical students via a schoolwide listserv in 2019. The response rate was 39.6% (177/444). Negative correlations were displayed between grit and emotional exhaustion, depersonalization, and overall burnout. Positive correlation was demonstrated between grit and personal accomplishment. Male participants had higher depersonalization than female participants and fourth year medical students had higher depersonalization than other years of training. Fourth year medical students had higher personal accomplishment than other years of training and married students had higher personal accomplishment than those who had never been married. These findings are important not only for potential identification of students at risk of burnout, but also for development of strategies to bolster grit and mitigate distressing experiences in the medical occupation. Future studies are necessary to gauge how this relationship may evolve throughout a medical career.
The Relationships Between Grit, Burnout, and Demographic Characteristics in Medical Students
[This is an excerpt.] The consolidation of hospital systems and physician practices under a single corporate umbrella has resulted in major structural changes to the practice of medicine. In 2012, 60% of practices in the US were physician-owned, 23.4% of practices had some hospital ownership, and only 5.6% of physicians were direct hospital employees.1 After a surge in acquisitions of physician practices over the decade, and in response to the COVID-19 pandemic, the fraction of physicians employed by hospitals or health systems reached 52.1% and 21.8% by other corporate entities in 2022, for a total of an estimated 74% of practicing physicians.2 Many physicians now are employed by consolidated corporate health care systems that span many different communities and increasingly are spread across multiple states. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Workers & Learners
The Rise and Potential of Physician Unions
[This is an excerpt.] Since the beginning of the COVID- 19 pandemic, healthcare workers- especially those caring for the acute and critically ill- have faced constant, often unimaginable and unending pressure from working in settings that were all-too-often understaffed, underresourced, and seemingly under siege. Aside from the stress and fatigue of being overworked from taking care of profoundly ill patients with a new and highly contagious virus, clinicians were further burdened by the very real risk of contracting the disease themselves and placing their loved ones at risk illness as well. These pressures are likely worse in the ICU and in related high acuity settings, where the most seriously ill patients are treated and where physicians and other providers already labor under conditions of heightened stress that make them even more prone to burnout, moral distress, and emotional angst. [To read more, click View Resource.]
The Smoldering Embers of Physician Burnout: The Pandemic Within the Pandemic
There are more than 160 million people who are a part of the U.S. workforce today.1 Work is one of the most vital parts of life, powerfully shaping our health, wealth, and well-being.2 At its best, work provides us the ability to support ourselves and our loved ones, and can also provide us with a sense of meaning, opportunities for growth, and a community. When people thrive at work, they are more likely to feel physically and mentally healthy overall, and to contribute positively to their workplace.3 This creates both a responsibility and unique opportunity for leaders to create workplace environments that support the health and well‑being of workers. Although the COVID-19 pandemic may have accelerated the evolution of work and the conversation around workplace mental health and well-being, broad recognition and appreciation for the relationship between the work environment, culture, community, and our health preceded the pandemic.4, 5, 6, 7 While many challenges outside the workplace may impact well-being—from economic inequality, food insecurity, and housing insecurity to household, educational, and medical debt—there are still many ways that organizations can function as engines for mental health and well-being.8, 9 Organizational leaders, managers, supervisors, and workers alike have an unprecedented opportunity to examine the role of work in our lives and explore ways to better enable all workers to thrive within the workplace and beyond.
The U.S. Surgeon General’s Framework for Workplace Mental Health & Well-Being
BACKGROUND: Mental health problems are common in healthcare workers as they are exposed to a variety of risk factors. Healthcare professionals face extraordinary stressors in the medical environment. They demonstrate high levels of stress, anxiety, depression and burnout, and sleep disorders, which inevitably lead to medication errors and lower standards of care. METHODS: We conducted a wide-ranging review to analyze how the use of yoga and mindfulness-based interventions reduce stress, anxiety, and burnout in healthcare workers. The main scientific databases we consulted, such as PubMed, Scopus, Cochrane Library, Web of Sciences, APA PsycInfo, and CINAHL, contain all the systematic reviews present in the literature. No restrictions of year, publication, or language were applied. Based on PRISMA guidelines, 12 reviews were included in this paper. Quality assessment of the systematic reviews included in the research was done using the AMSTAR checklist. RESULTS: In accordance with the literature, the study shows that increasing the use of yoga and mindfulness-based interventions can provide support to healthcare workers in achieving stable psycho-physical well-being, which can enhance their value within their work environment. CONCLUSION: Employers in the healthcare industry should consider implementing workplace wellness programs that integrate these methods to promote the well-being of their staff. MBI and yoga are effective interventions that can help the psychological functioning of healthcare professionals; however, further high-quality research is needed before this finding can be confirmed.
The Use of Yoga and Mindfulness-based Interventions to Reduce Stress and Burnout in Healthcare Workers: An Umbrella Review
Agitation is a common and potentially dangerous condition requiring rapid recognition and treatment in acute psychiatric units. Prompt intervention can prevent a patient with agitation from harming themselves, harming others, or needing restraints or seclusion. After the review of numerous guidelines, the Modified Agitation Severity Scale (MASS) agitation treatment protocol was developed to identify and manage agitation in an inpatient adult psychiatric setting. This protocol involved modifying an existing agitation scale and pairing scores with a treatment algorithm to indicate which behavioral and medication interventions would be most appropriate. All scoring and interventions were recorded in the electronic medical record (EMR). Three months of data were collected before and after the protocol was implemented. The new, modified scale had high reliability and correlated well with another validated agitation scale. Perceived patient safety was high during both study phases. Nurses’ perceptions of safety trended upward after the protocol was implemented, though these differences were not significant, likely due to insufficient power. Although there was no decrease in seclusion events after implementation of the treatment protocol, there was a 44% decrease in restraint events and average restraint minutes per incident. Despite a potential increase in workload for nursing staff, implementation of the protocol did not increase burnout scores. Physicians continued to order the protocol for 55% of patients after the study period ended. These findings suggest that including a rapid agitation assessment and protocol within the EMR potentially improves nurses’ perceptions of unit safety, helps assess treatment response, reduces time patients spend restrained, and supports decision making for nurses.
The Utilization of a Rapid Agitation Scale and Treatment Protocol for Patient and Staff Safety in an Inpatient Psychiatric Setting
The Vitruvian Man is a metaphor for the “ideal man” by feminist posthuman philosopher Rosi Braidotti (2013) as a proxy for eurocentric humanist ideals. The first half of this paper extends Braidotti's concept by thinking about the metaphor of the “ideal nurse” (Vitruvian nurse) and how this metaphor contributes to racism, oppression, and burnout in nursing and might restrict the professionalization of nursing. The Vitruvian nurse is an idealized and perfected form of a nurse with self-sacrificial language (re)producing self-sacrificing expectations. The second half of this paper looks at how regulatory frameworks (using the example of UK's Nursing and Midwifery Council Code of Conduct) institutionalize the conditions of possibility through collective imaginations. The domineering expectations found within the Vitruvian nurse metaphor and further codified by regulatory frameworks give rise to boredom and burnout. The paper ends by suggesting possible ways to diffract regulatory frameworks to practice with affirmative ethics and reduce feelings of self-sacrifice and exhaustion among nurses.
The Vitruvian Nurse and Burnout: New Materialist Approaches to Impossible Ideals
BACKGROUND: Substance use (SU) or substance use disorder (SUD) prevalence among U.S. nurses has not been assessed for almost 25 years. PURPOSE: The purpose of this current study, known as the Nurse Worklife and Wellness Study, is to generate population-based prevalence estimates for SU and related problems, including SUDs, among registered nurses and to examine other personal and work characteristics related to nurse SU. METHODS: A mixed-mode survey of a nationally representative sample of randomly selected nurses in nine states, using a cross-sectional design, obtained 1,215 responses (30.6% response rate), with 1,170 usable surveys for analysis. Substance use and problems were assessed based on standardized criteria. RESULTS: Past year illicit drug use was 5.7%, and prescription-type drug misuse was 9.9%, with nurses working in home health/hospice (19%) and nursing homes (15.8%) having the highest rates. Energy drink use was reported by 23.7% of nurses younger than 45 years, with emergency and multi-specialty nurses having three to five times the odds of use versus the reference group. Overall, 18.0% of nurses screened positive for SU problems, with one-third of those (6.6% of the total) screening positive for SUD. Staff, charge nurses/coordinators/nurse managers, and other administrators had 9 to 12 times the odds of having a SUD as opposed to educators and researchers. CONCLUSION: Prescription-type drug misuse rates exceeded the U.S. population rates, and rates varied by specialty. Energy drink use and SUD risk were significantly higher among nurses in certain positions and specialties. Focusing on higher risk groups can help target nurse prevention and treatment efforts and guide policy for identifying and addressing SU problems among nurses.
The prevalence of substance use and substance use problems in registered nurses: Estimates from the Nurse Worklife and Wellness Study
INTRODUCTION: Pediatric residents and subspecialty fellows experience a significant number of stressors during training, but they have rarely been self-reported or compared between groups. This qualitative study aimed to identify and compare themes of stressors experienced by pediatric residents and subspecialty fellows at a single large children’s hospital. MATERIALS AND METHODS: Using an open-ended survey at single time point for each group, we asked residents and fellows to list the stressors they face in training. The survey data was iteratively analyzed using thematic analysis then quantified by its frequency in each group and compared using a chi-square distribution or a Fisher’s exact test, as appropriate. RESULTS: Twenty-eight of 159 residents (18%) and 38 of 180 fellows (21%) answered the survey question, and an average of 2.8 stressors were identified by each resident and fellow. Two major themes and five major subthemes were shared between both groups. The theme Stressors at Home included the subthemes Difficulty Maintaining Overall Health and External Stressors. The theme Stressors at Work encompassed the subthemes Clinical Stressors Innate to Patient Care, Demanding Workload and Schedule, and Stressors Related to Culture of Work Environment. Within the subthemes, there were differences in categories of stressors between the groups. While there was no statistically significant difference in the distribution of themes, subthemes, or categories of stressors mentioned between groups, in general residents identified stressors associated with lack of autonomy and control whereas fellows focused on clinical uncertainty and complex situations. CONCLUSIONS: While residents and fellows shared similar themes and subthemes for stressors, there was variability between individual categories. This study identified individual self-reported stressors that can be used by programs to design interventions to improve trainee well-being, but it also implies that programmatic support at different levels of training should be tailored to the target group. KEY MESSAGE: At our hospital, we found that some self-reported stressors facing pediatric residents and fellows were common and some unique. Stressors included those that can be eliminated or diminished as well as those that cannot. With knowledge that these disparities exist, training programs should use unique strategies to provide support for the two groups and their stressors.
Thematic Analysis Comparing Stressors for Pediatric Residents and Subspecialty Fellows at a Large Children’s Hospital
[This is an excerpt.] One recent night a nurse at UC Davis Medical Center in Sacramento, California, awakened a patient to provide anti-seizure medication and got a frightening response. The patient “became verbally aggressive” toward the staff, and when the patient’s roommate said, “Don’t be rude to your nurse,” the patient snapped at him, pushed aside the curtain separating their beds, threw something at him, and resumed resisting the staff. Thus began another assault against health care workers, whom the federal government reports are five times more likely to experience workplace violence than employees in all other industries. In the past, staff options in such confrontations were typically limited to some form of calming the patient on their own or calling security. In this case, the UC Davis staff called the hospital’s new Behavioral Escalation Support Team (BEST), comprising care providers trained in mental health care and de-escalating conflicts. The BEST staff calmed the patient and, with the nurse present, explained that nurses must visit frequently to check vital signs and well-being. The patient quieted and agreed to cooperate with the nurses. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Ensuring Physical & Mental Health).
Threats Against Health Care Workers are Rising. Here's How Hospitals are Protecting Their Staffs
AIMS: This study assessed the feasibility of delivering three good things (3GTs) practice as part of professional nurse residency program, measured the degree to which it influenced work–life balance, resilience, and burnout, and explored what newly licensed nurses (NLRNs) identified as good things. BACKGROUND: Burnout occurs in response to chronic work-related emotional and interpersonal stress, negatively impacting nurses and patients. However, research shows that 3GT practice can increase positive emotions, enhance resilience, and reduce burnout. METHODS: In this study, 3GT was introduced to a convenience sample of 115 NLRNs during their professional residency program. For 14 days, participants received daily 3GT prompts. Individualized survey links were sent via SMS message at baseline, postsurvey (T1), and 6 months (T2). Survey data were collected about work–life balance, burnout, and resilience, and text data from participants' daily 3GT notations from March through November 2021. RESULTS: Seventy-one participants were recruited. T1 survey results indicated significant improvements in survey measures but only emotional recovery improvement was sustained at T2. Burnout was the only variable that correlated to participants' number of 3GT days practice. Simple joys, reflections about work, self-care activities, and relationships were major identified themes. CONCLUSIONS: The results demonstrate the generalizability, value, and feasibility of implementing a web-based 3GT intervention in a nurse residency program. Additional benefits may be those gained by the reflection that is prompted, thereby facilitating professional development among NLRNs.
Three Good Things: Promote Work–Life Balance, Reduce Burnout, Enhance Reflection among Newly Licensed RNs
The amount of time spent on the electronic health record is often cited as a contributing factor to burnout and work-related stress in nurses. Increased electronic health record use also reduces the time nurses have for direct contact with patients and families. There has been minimal investigation into the amount of time intensive care unit nurses spend on the electronic health record.To quantify the amount of time spent by intensive care unit nurses on the electronic health record.In this observational study, active electronic health record use time was analyzed for 317 intensive care unit nurses in a single institution from January 2019 through July 2020. Monthly data on electronic health record use by nurses in the medical, neurosurgical, and surgical-trauma intensive care units were evaluated.Full-time intensive care unit nurses spent 28.9 hours per month on the electronic health record, about 17.5% of their clinical shift, for a total of 346.3 hours per year. Part-time nurses and those working as needed spent 20.5 hours per month (17.6%) and 7.4 hours per month (14.2%) on the electronic health record, respectively. Neurosurgical and medical intensive care unit nurses spent 25.0 hours and 19.9 hours per month, respectively. Nurses averaged 23 clicks per minute during use. Most time was spent on the task of documentation at 12.3 hours per month, which was followed by medical record review at 2.6 hours per month.Intensive care unit nurses spend at least 17% of their shift on the electronic health record, primarily on documentation. Future interventions are necessary to reduce time spent on the electronic health record and to improve nurse and patient satisfaction.
Time Spent by Intensive Care Unit Nurses on the Electronic Health Record
As the 2021–2022 IHI Leadership Alliance year concludes, we are excited to share a member- led toolkit on preventing verbal and physical violence across the health care workforce that represents input from the member organizations and is supplemented with external industry scanning. This toolkit is intended to be a starting place for health care organizations on their journey to address workplace violence and is by no means all-encompassing. The recommendations and examples from Alliance organizations that are included in the toolkit offer system-level strategies and tactics that hospitals and health systems can implement, organized in the following categories:
• Prevention and Prediction
• Prioritization and Measurement
• System Designs
• Leadership and Policy
• Community Partnerships and Strategic Relationships
Toolkit: Preventing Verbal and Physical Violence Across the Health Care Workforce
INTRODUCTION: Computed Tomography (CT) involves larger radiation dose than the more common conventional x-ray imaging procedures. Existing DRLs have been established based on anatomical locations. However, some limitations of this approach have been identified. CT examinations, for the same anatomical location, could have several clinical indications with consequently different protocols corresponding to different radiation exposure levels. The objective of the study was to establish adult CT Clinical Indication Diagnostic Reference Level (DRLCI) and determine its Relationship with age, weight and Gender in Enugu State, Nigeria. METHODS: Dose values and technical parameters were obtained using International Commission on Radiological Protection (ICRP) Publication 135. Quality control checks were carried out on the machines. 2490 adult patients with weight 50±10 kg, the distribution was 1200 brain scans (48.2%), 420 chest scans (16.9%) and 870 abdominal scans (34.9%) were studied from the 5 participating centers. Head - CVA (300), Trauma (300), Metastasis/abscess (300), Infection (180), Seizure (120). Chest - Lung disease (240), Lung cancer/mass (180). Abdomen/Pelvis - Abdominal cancer/metastasis (120), Abdominal mass (300), Liver disease (240), Urography (210). RESULTS: DRLci for trauma, CVA, metastasis, infection and seizure are 43, 43, 43, 34 and 28 mGy respectively. Their corresponding DLP includes; 907, 879, 1689, 969, 995 mGy.cm. In the chest, the CTDI for lung disease and mass are 13 and 13 mGy. Their corresponding DLP includes; 763 and 1531 mGy.cm. In the abdomen, the CTDI for liver disease, malignancy, mass and urography are 16, 12, 16, and 15 mGy. CONCLUSION: DRLci for 10 common CT examination were established. Radiographers should focus on clinical DRLs rather than anatomical DRLs.
Tools to Manage Burnout and Compassion Fatigue
BACKGROUND: Hospitalists are physicians trained in internal medicine and play a critical role in delivering care in in-patient settings. They work across and interact with a variety of sub-systems of the hospital, collaborate with various specialties, and spend their time exclusively in hospitals. Research shows that hospitalists report burnout rates above the national average for physicians and thus, it is important to understand the key factors contributing to hospitalists' burnout and identify key priorities for improving hospitalists' workplace. METHODS: Hospitalists at an academic medical center and a community hospital were recruited to complete a survey that included demographics, rating the extent to which socio-technical (S-T) factors contributed to burnout, and 22-item Maslach Burnout Inventory - Human Services Survey (MBI-HSS). Twelve contextual inquiries (CIs) involving shadowing hospitalists for ?60 h were conducted varied by shift type, length of tenure, age, sex, and location. Using data from the survey and CIs, an affinity diagram was developed and presented during focus groups to 12 hospitalists to validate the model and prioritize improvement efforts. RESULTS: The overall survey participation rate was 68%. 76% of hospitalists reported elevated levels on at least one sub-component within the MBI. During CIs, key breakdowns were reported in relationships, communication, coordination of care, work processes in electronic healthcare records (EHR), and physical space. Using data from CIs, an affinity diagram was developed. Hospitalists voted the following as key priorities for targeted improvement: improve relationships with other care team members, improve communication systems and prevent interruptions and disruptions, facilitate coordination of care, improve workflows in EHR, and improve physical space. CONCLUSIONS: This mixed-method study utilizes participatory and data-driven approaches to provide evidence-based prioritization of key factors contributing to hospitalists' burnout. Healthcare systems may utilize this approach to identify workplace factors contributing to provider burnout and consider targeting the factors identified by providers to best optimize scarce resources.
Towards Better Understanding of Workplace Factors Contributing to Hospitalist Burden and Burnout Prior to COVID-19 Pandemic
Importance The health care sector lost millions of workers during the COVID-19 pandemic and job recovery has been slow, particularly in long-term care.
Objective To identify which health care workers were at highest risk of exiting the health care workforce during the COVID-19 pandemic.
Design, Setting, and Participants This was an observational cross-sectional study conducted among individuals employed full-time in health care jobs from 2019 to 2021 in the US. Using the data from the Current Population Survey (CPS), we compared turnover rates before the pandemic (preperiod, January 2019-March 2020; 71 843 observations from CPS) with the first 9 months (postperiod 1, April 2020-December 2020; 38 556 observations) and latter 8 months of the pandemic (postperiod 2, January 2021-October 2021; 44 389 observations).
Main Outcomes and Measures Health care workforce exits (also referred to as turnover) defined as a health care worker's response to the CPS as being unemployed or out of the labor force in a month subsequent to a month when they reported being actively employed in the health care workforce. The probability of exiting the health care workforce was estimated using a logistic regression model controlling for health care occupation, health care setting, being female, having a child younger than 5 years old in the household, race and ethnicity, age and age squared, citizenship status, being married, having less than a bachelor’s degree, living in a metropolitan area, identifier for those reporting employment status at the first peak of COVID-19, and select interaction terms with time periods (postperiods 1 and 2). Data analyses were conducted from March 1, 2021, to January 31, 2022.
Results The study population comprised 125 717 unique health care workers with a mean (SD) age of 42.3 (12.1) years; 96 802 (77.0%) were women; 84 733 (67.4%) were White individuals. Estimated health care turnover rates peaked in postperiod 1, but largely recovered by post period 2, except for among long-term care workers and physicians. We found a 4-fold difference in turnover rates between physicians and health aides or assistants. Rates were also higher for health workers with young children (<5 years), for both sexes and highest among women. By race and ethnicity, persistently higher turnover rates were found among American Indian/Alaska Native/Pacific Islander workers; White workers had persistently lower rates; and Black and Latino workers experienced the slowest job recovery rates.
Conclusions and Relevance The findings of this observational cross-sectional study suggest that although much of the health care workforce is on track to recover to prepandemic turnover rates, these rates have been persistently high and slow to recover among long-term care workers, health aides and assistants, workers of minoritized racial and ethnic groups, and women with young children. Given the high demand for long-term care workers, targeted attention is needed to recruit job-seeking health care workers and to retain those currently in these jobs to lessen turnover.
This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Adequate Compensation)
Tracking Turnover Among Health Care Workers During the COVID-19 Pandemic: A Cross-sectional Study
BACKGROUND: Empathic communication skills have a growing presence in graduate medical education to empower trainees in serious illness communication. OBJECTIVE: Evaluate the impact, feasibility, and acceptability of a shared communication training intervention for residents of different specialties. DESIGN: A randomized controlled study of standard education v. our empathic communication skills-building intervention: VitalTalk-powered workshop and formative bedside feedback using a validated observable behavioral checklist. SETTING/SUBJECTS: During the 2018–2019 academic year, our intervention was implemented at a large single-academic medical center in the United States involving 149 internal medicine and general surgery residents. MEASUREMENTS: Impact outcomes included observable communication skills measured in standardized patient encounters (SPEs), and self-reported communication confidence and burnout collected by surveys. Analyses included descriptive and inferential statistics, including independent and paired t tests and multiple regression model to predict post-SPE performance. RESULTS: Of residents randomized to the intervention, 96% (n = 71/74) completed the VitalTalk-powered workshop and 42% (n = 30/71) of those residents completed the formative bedside feedback. The intervention demonstrated a 33% increase of observable behaviors (p < 0.001) with improvement in all eight skill categories, compared with the control who only showed improvement in five. Intervention residents demonstrated improved confidence in performing all elicited communication skills such as express empathy, elicit values, and manage uncertainty (p < 0.001). CONCLUSIONS: Our educational intervention increased residents' confidence and use of essential communication skills. Facilitating a VitalTalk-powered workshop for medical and surgical specialties was feasible and offered a shared learning experience for trainees to benefit from expert palliative care learning outside their field.
Training to Promote Empathic Communication in Graduate Medical Education: A Shared Learning Intervention in Internal Medicine and General Surgery
In 2020, the COVID-19 global pandemic changed the landscape of healthcare delivery and with it the need to better address team member well-being. Aside from patients and their families, healthcare professionals were among the most affected and at high risk for suffering psychological distress, including increased stress, depression, anxiety, substance use, and post-traumatic stress disorder. Prior to COVID-19, healthcare workers were already experiencing a high rate of job burnout, depression, and suicide. The pandemic brought in sharp focus the essential and urgent need for healthcare facilities to acknowledge the importance of team member well-being and the provision of spaces such as tranquility rooms for use while at work. This case study shares one health system’s evidence-based implementation plan for tranquility rooms, what was learned, and how team members responded. More research is needed to better understand team member well-being and the impact of tranquility rooms.
Tranquility Rooms for Team Member Well-Being: Implementation during COVID-19 Pandemic
IMPORTANCE: The COVID-19 pandemic has affected clinician health and retention. OBJECTIVE: To describe trends in burnout from 2019 through 2021 with associated mitigating and aggravating factors. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional surveys were sent to physicians and advanced practice clinicians throughout 120 large US health care organizations between February 2019 and December 2021. From 56 090 surveys, there were 20 627 respondents. EXPOSURES: Work conditions and COVID-19. MAIN OUTCOMES AND MEASURES: Surveys measured time pressure, chaos, work control, teamwork, electronic health record use, values alignment, satisfaction, burnout, intent to leave, and in 2021, feeling valued. Multivariate regressions controlling for gender, race and ethnicity, years in practice, and role determined burnout, satisfaction, and intent-to-leave correlates. RESULTS: Of the 20 627 respondents (median response rate, 58% [IQR, 34%-86%; difference, 52%]), 67% were physicians, 51% female, and 66% White. Burnout was 45% in 2019, 40% to 45% in early 2020, 50% in late 2020, and 60% in late 2021. Intent to leave increased from 30% in 2019 to more than 40% as job satisfaction decreased. Higher burnout was seen in chaotic workplaces (odds ratio [OR], 1.51; 95% CI, 1.38-1.66; P < .001) and with low work control (OR, 2.10; 95% CI, 1.91-2.30; P < .001). Higher burnout was associated with poor teamwork (OR, 2.08; 95% CI, 1.78-2.43; P < .001), while feeling valued was associated with lower burnout (OR, 0.22; 95% CI, 0.18-0.27; P < .001). In time trends, burnout was consistently higher with chaos and poor work control. For example, in the fourth quarter of 2021 burnout was 36% (95% CI, 31%-42%) in calm environments vs 78% (95% CI, 73%-84%) if chaotic (absolute difference, 42%; 95% CI, 34%-49%; P < .001), and 39% (95% CI, 33%-44%) with good work control vs 75% (95% CI, 69%-81%) if poor (absolute difference, 36%; 95% CI, 27%-44%; P < .001). Good teamwork was associated with lower burnout rates (49%; 95% CI, 44%-54%) vs poor teamwork (88%; 95% CI, 80%-97%; absolute difference, 39%; 95% CI, 29%-48%; P < .001), as was feeling valued (37%; 95% CI, 31%-44%) vs not feeling valued (69%; 95% CI, 63%-74%; absolute difference, 32%; 95% CI, 22%-39%; P < .001). CONCLUSIONS AND RELEVANCE: Results of this survey study show that in 2020 through 2021, burnout and intent to leave gradually increased, rose sharply in late 2021, and varied by chaos, work control, teamwork, and feeling valued. Monitoring these variables could provide mechanisms for worker protection.
Trends in Clinician Burnout With Associated Mitigating and Aggravating Factors During the COVID-19 Pandemic
BACKGROUND: Efforts to address the high depression rates among training physicians have been implemented at various levels of the U.S. medical education system. The cumulative effect of these efforts is unknown. OBJECTIVE: To assess how the increase in depressive symptoms with residency has shifted over time and to identify parallel trends in factors that have previously been associated with resident physician depression. DESIGN: Repeated annual cohort study. Setting: U.S. health care organizations. Participants: First-year resident physicians (interns) who started training between 2007 and 2019. Measurements: Depressive symptoms (9-item Patient Health Questionnaire [PHQ-9]) assessed at baseline and quarterly throughout internship. RESULTS: Among 16 965 interns, baseline depressive symptoms increased from 2007 to 2019 (PHQ-9 score, 2.3 to 2.9; difference, 0.6 [95% CI, 0.3 to 0.8]). The prevalence of baseline predictors of greater increase in depressive symptoms with internship also increased across cohorts. Despite the higher prevalence of baseline risk factors, the average change in depressive symptoms with internship decreased 24.4% from 2007 to 2019 (change in PHQ-9 score, 4.1 to 3.0; difference, −1.0 [CI, −1.5 to −0.6]). This change across cohorts was greater among women (4.7 to 3.3; difference, −1.4 [CI, −1.9 to −0.9]) than men (3.5 to 2.9; difference, −0.6 [CI, −1.2 to −0.05]) and greater among nonsurgical interns (4.1 to 3.0; difference, −1.1 [CI, −1.6 to −0.6]) than surgical interns (4.0 to 3.2; difference, −0.8 [CI, −1.2 to −0.4]). In parallel to the decrease in depressive symptom change, there were increases in sleep hours, quality of faculty feedback, and use of mental health services and a decrease in work hours across cohorts. The decrease in work hours was greater for nonsurgical than surgical interns. Further, the increase in mental health treatment across cohorts was greater for women than men. Limitation: Data are observational and subject to biases due to nonrandom sampling, missing data, and unmeasured confounders, limiting causal conclusions. CONCLUSION: Although depression during physician training remains high, the average increase in depressive symptoms associated with internship decreased between 2007 and 2019. PRIMARY FUNDING SOURCE: National Institute of Mental Health.
