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PURPOSE: This article assesses the prevalence of burnout among ophthalmology educators and identifies opportunities to improve well-being in this population. METHODS: The research team conducted a cross-sectional study using an institutional review board-exempt survey addressing the domains of the Maslach Burnout Inventory, intent to leave, and interest in wellness activities. Survey participants included ophthalmology residency program directors (PDs) and associate PDs (APDs) who are members of the Association of University Professors of Ophthalmology (AUPO). Analysis involved a top-box approach. RESULTS: Surveys were sent to 175 members with a response rate of 38.9%. Percentages of survey respondents reporting either (1) “never” or (2) “less than a few times per year” when asked to self-assess for certain manifestations of burnout are as follows: “considering residents as impersonal objects” (95.2%), “becoming more callous towards people” (90.3%), and “becoming emotionally hardened” (80.6%). Approximately 65% of ophthalmology educators reported never considering or rarely considering leaving their position in the year prior to completing the survey. For wellness promotion among AUPO educators, the greatest interest was in small group mentoring sessions (85%) and webinars on wellness-related topics (70%). CONCLUSION: The prevalence of burnout symptoms among ophthalmology educators compares favorably to educators from other specialties. Ophthalmology PDs and APDs demonstrate a greater degree of personal accomplishment than do their cohorts within other specialties, suggesting a decreased likelihood of burnout onset among ophthalmology educators. Furthermore, our study’s job satisfaction data reveal a high degree of satisfaction among ophthalmology PDs and APDs.

BACKGROUND: High burnout is reported among health professionals providing in-patient care to patients with coronavirus disease 2019 (COVID-19). Data are lacking on job stressors and burnout among health providers working in dedicated outpatient facilities for patients with suspected or confirmed COVID-19. METHODS: This cross-sectional study, using a parallel mixed-methods design, was carried out in 2021−2022 among 22 nurses and 22 primary-care physicians working at a COVID Outpatient Respiratory Center (CORC) (100% participation). Work conditions were assessed via the nurse- and physician-specific Occupational Stressor Index (OSI) and occupational records. Measures of the outcome included the Copenhagen Burnout Index and current tobacco use. RESULTS: Time working in CORC displayed significant multivariate associations with personal, work- and patient-related burnout among physicians and current tobacco use among nurses. Total OSI scores showed adjusted odds ratios for work-related (1.35 (1.01 ± 1.79))(1.31 (0.99 ± 1.75)) and patient-related burnout (1.35 (1.01 ± 1.81))(1.34 (1.01 ± 1.78)) among physicians and nurses, respectively. Numerous work stressors showed significant multivariate associations with burnout and smoking. Among the stressors were: being contacted outside work hours about patients, inadequate rest breaks, many patients/shifts, difficulty taking time off, insufficient pay, frequently listening to emotionally disturbing accounts, interruptions, increased workload, time pressure, and responsibility. Heavy patient burden/time pressure was most often cited as the hardest part of work in CORC. Increased employment of staff was the most frequently suggested workplace modification. Integrative assessment reveals that increased staff could ameliorate many work stressors associated with burnout and smoking in this cohort. CONCLUSIONS: Working in CORC is an extra burden. In crisis situations such as the COVID pandemic, more staff is needed. Lowering the total job stressor load is vital.

The prevalence of burnout among emergency physicians is among the highest of any specialty. Multiple studies have described factors that contribute to physician burnout, such as age, institutional support, and the electronic medical record (EMR). However, there have been few studies that investigate those physicians who are satisfied with their career and their personal lives. This qualitative study evaluated emergency physicians who were satisfied with both their career and personal lives to propose a model for physician well-being. Physicians were recruited using email solicitation and referral by their peers from June-September 2020. Inclusion criteria involved those physicians who were satisfied with their life and their job and did not meet the criteria for burnout. A qualitative, non-structured interview with open-ended questions was performed with each participant. Emergent themes were identified using standard practice for qualitative studies. Twenty-three physicians participated with a mean age of 45.4 years old (range 32–65), 17 (73.9%) were men, 13 (56.5%) were Caucasian, 6 (26.0%) were Asian/South Asian, 1 (4.3%) were Latino, and 3 (13.0%) were another ethnicity. Several important themes emerged. Physicians satisfied with their lives and their jobs tended to be personally resilient, socially connected, with significant outside interests. These physicians self-identified their personality type as having both introverted and extroverted features. Threats to thriving included ineffective leadership and the EMR. This project proposes a model for job and life satisfaction among emergency physicians. Encouraging these qualities, while fostering supportive leadership, and optimizing the EMR, may improve satisfaction among physicians experiencing burnout.

The COVID-19 pandemic has presented an array of novel issues for hospitals and their staff, 1 of the most noted being increased patient isolation due to visitation restrictions. This has created new challenges for health care systems and their workers. To leverage the expertise of Palliative Care Practitioners (PCP) as described here to improve patient/provider communication, patient experience, and quality of care during the COVID-19 pandemic. To address these new obstacles to patient care presented by the pandemic, a PCP was incorporated into the physician team caring for COVID-19 patients at the time of admission. Members of the care team were surveyed and interviewed regarding their experiences with this added support. During a period of peak hospital strain from COVID-19, team members consistently reported that daily PCP involvement led to improvement in communication with patients and families, greater provider awareness of psychosocial stressors, and decreased physician burnout. Integration of a PCP into a clinical care team during the COVID-19 pandemic was perceived as a valuable asset to patients, families, and clinicians.

BACKGROUND: Levels of stress and burnout continue to rise amongst healthcare workers. In addition to systemic and institution-level changes to healthcare practice environments, well-being interventions, resources, and support to assist healthcare providers are necessary. Meditation practices like Heart Rhythm Meditation (HRM) may provide benefits to healthcare workers, but healthcare worker experiences with HRM are not well understood. OBJECTIVE: To explore healthcare worker experiences with HRM using a journey mapping approach. METHODS: An exploratory cross-sectional online survey was administered between May and July of 2020 to a purposeful sample of 25 healthcare workers currently practicing HRM. Surveys consisted of 5 open-ended and 36 multiple-choice items mapped to five journey mapping domains: Discover, Search, Assess, Decide, Assist. Descriptive statistics for survey items were generated in addition to a visual representation of a Persona and associated journey map for HRM. Content analysis was performed on open-ended responses using a general inductive approach to code responses and identify representative quotes. RESULTS: Twenty surveys were completed for a response rate of 80%. The majority of respondents identified as women (n = 14). From the journey mapping output, the overall emotional experience score was an 8.2/10, suggesting respondents had positive experiences with HRM. Open-ended comments suggest that HRM provides important benefits to the personal and professional lives of healthcare workers. A small number of participants reported challenges like feeling difficult emotions during HRM practice. CONCLUSION: Mapping the healthcare worker journey with HRM identified generally positive experiences with personal and professional benefits. While experiences were largely positive, HRM elicited difficult emotions from some individuals, suggesting that appropriate resources and support are required when considering HRM and other meditation forms.

[This is an excerpt.] Cardiothoracic surgery is a demanding field that requires technical skills, mental agility, and emotional resilience. Performing operations on vital organs in high-stress situations carries significant risks for patients and providers alike. Despite the rewards of saving lives and improving patients’ quality of life, cardiothoracic surgeons are vulnerable to burning out, wherein they feel emotionally, mentally, and physically exhausted. Burnout has far-reaching consequences for individual surgeons, their teams, and the broader healthcare system, yet it remains an under-recognized and under-addressed challenge in the field. Therefore, we examined the prevalence and impact of cardiothoracic surgeon burnout, by exploring potential contributing factors and discussing strategies for prevention and intervention. [To read more, click View Resource.]

PURPOSE: To evaluate lesbian, gay, bisexual, transgender, questioning, and other sexual/gender minority (LGBTQ+) orientation as a burnout risk factor among an international ophthalmologist cohort. METHODS: An anonymous, cross-sectional electronic survey was distributed via an Internet platform to characterize the relationship among demographic factors, including LGBTQ+ orientation, and burnout as measured by the Copenhagen Burnout Inventory (CBI). Univariable data analysis (linear) by sexual orientation was performed and variables with an association with a P value of <0.15 in univariable analysis were included in the multiple linear regression modeling. RESULTS: A total of 403 ophthalmologists participated in the survey. The majority self-identified as "White" (69.2%), were from North America (72.0% United States, 18.6% Canada) and were evenly distributed between age of 30 and 65 years. Overall, 13.2% of participants identified as LGBTQ+ and 98.2% as cisgender. Approximately 12% had witnessed or experienced LGBTQ+-related workplace discrimination or harassment. The personal and work-related burnout scores and confidence limits of persons identified as LGBTQ+ were higher and nonoverlapping compared with those reported as non-LGBTQ+. Multivariable analysis identified significant risk factors for higher personal and work-related burnout scores: LGBTQ+ (11.8 and 11.1, P = .0005 and .0023), female gender (5.36 and 4.83, P = .0153 and .0434), older age (19.1 and 19.2, P = .0173 and .0273). and caretaker stress (6.42 and 5.97, P = .0085 and .0239). CONCLUSIONS: LGBTQ+ orientation is a burnout risk factor among ophthalmologists, and LGBTQ+ workplace discrimination may be a contributing factor. Support from ophthalmology organizations to address LGBTQ+-, gender-, and age-related workplace discrimination may decrease burnout. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

This cross-sectional study examines the association between labor unions and health care staff turnover in the US using data from 2021.

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This resource is found in our Actionable Strategies for Government: Empowering Workers & Strengthening Leadership and Governance (Strengthening Protections to Speak Up)

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OBJECTIVES: Few studies have elucidated the impact of work-related trauma on labor and delivery clinician or considered whether it may be a cause of burnout. This study aims to elicit labor and delivery clinician perspectives on the impact of exposure to traumatic births on their professional quality of life. METHODS: Labor and delivery clinicians (physicians, midwives, nurse practitioners, and nurses; n = 165) were recruited to complete an online questionnaire on experiences with traumatic births. The questionnaire contained measures from the Maslach Burnout Inventory and the professional quality of life scale version 5. Some participants completed an optional free-text prompt to recommend ways to support clinicians after traumatic births (n = 115). others opted into a semi-structured phone interview (n = 8). Qualitative data was analyzed using a modified grounded theory approach. RESULTS: Self-reported adequate institutional support for clinicians after a traumatic birth was positively correlated with compassion satisfaction (r = 0.21, p < 0.01) and negatively correlated with secondary traumatic stress (r = - 0.27, p < 0.01), and burnout (r = - 0.26, p < 0.01). Qualitative themes included lack of system-wide and leadership support, lack of access to mental-health resources, and suboptimal workplace culture as contributors toward secondary traumatic stress and burnout. Participants recommended proactive leadership, consistent debriefing protocols, trauma education, and improved access to counseling. CONCLUSIONS FOR PRACTICE: Multi-level barriers prevented labor and delivery clinicians from accessing needed mental health support after exposure to traumatic births. Proactive investment in healthcare system supports for clinicians may improve clinician professional quality of life.

[This is an excerpt.] Before the COVID-19 pandemic and going as far back as the Harvard Medical Practice Study,1 it has been common to hear leaders lament the seemingly tedious discussions about health care worker (HCW) burnout and work-life integration. Fast forward post pandemic and it is hard to imagine a leader who is not routinely discussing workforce well-being. How are leaders supposed to navigate these new well-being responsibilities? In this issue of Mayo Clinic Proceedings, Hurtado and colleagues2 offer some empirical insights to inform well-being leadership efforts, saying that the burden of emotional exhaustion management “often falls back on clinic leaders who desperately need urgent guidance to implement swift, low-effort, practical and meaningful strategies to manage an afflicted workforce.” We agree. This has been our experience at Duke Health and across hundreds of US hospitals in which we have surveyed safety culture and workforce well-being since the start of the global health crisis. What leaders want and need right now are specific actions to help recover from pandemic exhaustion, to rebuild trust—and by the way, whatever that entails, it needs to be quick and fit into increasingly shrinking budgets. Furthermore, this is against a backdrop of growing numbers of frustrated HCWs adopting the refrain “Just fix the system!” as their exhaustion worsens. Meanwhile, frustrated health care leaders manage the combination of financial constraints and workforce challenges as a gordian knot, consuming all energy while too complex to be untied. Currently, there are few system fixes that are broadly applicable across all of health care, but Hurtado et al are shining a light on one with broad potential. [To read more, click View Resource.]

Gender parity has been reached in graduation rates from medical school, yet women in medicine continue to face obstacles in promotion, compensation and opportunities, leading to leadership inequity, higher burnout and lower engagement. These complex issues with gender are just one aspect of the wide challenges related to diversity, equity and inclusion among medical professionals. While there are no “one size fits all” approaches, psychologists are well positioned to lead efforts related to promoting leadership equity, reducing burnout and raising engagement because of their training in communication skills, programmatic development and empathetic listening. This paper details several evidence-based efforts in which psychologists can lead in these ongoing issues for women in medicine.

Mental fatigue and burnout are concerns for healthcare organizations, but their effects on leaders have not been thoroughly studied. Infectious diseases teams and leaders are at risk for mental fatigue and burnout due to the increased demands from the coronavirus disease 2019 (COVID-19) pandemic, additive effects of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (omicron) and δ (delta) variant surges, and unique pre-existing pressures. No single intervention can reduce stress and burnout in healthcare workers. Work-hour limitations may have the biggest impact in physician burnout mitigation. Institutional and individual programs focused on mindfulness may improve well-being in the workplace. Leading during times of stress requires a multimodal approach and an understanding of goals and priorities. Greater awareness of burnout and fatigue across the healthcare spectrum and continued research are required to advance healthcare worker well-being.

The COVID-19 pandemic has had an unprecedented impact on the US health care system which was already experiencing higher levels of personal burnout among health care workers than the average US worker. Well-being efforts to support the workforce have become a critical countermeasure during the pandemic. This work was presented at the Thomas Jefferson University, College of Population Health Seminar Series: Clinical Lessons from the Northeast Surge, COVID-19: Spread the Science, not the Virus, held August 18, 2020. The entire series was held virtually from July 21 to September 29, 2020. The authors describe issues impacting health care workers during this early period of the pandemic with two examples of concrete strategies to approach well-being at the organizational level and lessons learned.

This resource is found in our Actionable Strategies for Health Organizations: Establishing Commitment & Shared Governance (Organizational Infrastructure for Well-Being).

BACKGROUND: Burnout continues to impact health care workers and its effect takes a toll on their lives and wellbeing, especially in primary care. Relatively few studies have focused specifically on the perspective of clinicians in Federally Qualified Health Centers (FQHCs), which offer crucial, preventative health care services to vulnerable and underserved patient populations. OBJECTIVE: To examine the perspectives of clinicians working at an FQHC in the Northeast United States after the implementation of a year-long wellness initiative. DESIGN: A qualitative analysis of clinician's discussion during focus groups conducted after the wellness initiative. SUBJECTS AND SETTING/LOCATION: A total of 28 clinicians (primary care physicians and nurse practitioners) in an FQHC in the Northeast United States. INTERVENTIONS: A one-year wellness initiative with programs and activities designed to bolster wellness. OUTCOME MEASURES: Analyzed NVIVO-coded transcripts of focus group discussion to generate codes and used modified grounded theory to extrapolate meaningful themes. RESULTS: Five key themes emerged from the qualitative analysis: (1) clinicians often felt burdened by their workload and personally responsible when they were not able to provide optimal care to patients; (2) burnout was exacerbated by systemic problems at the FQHC; (3) medical assistants, medical scribes, schedulers, and other support staff played a crucial role in the wellness of the entire team; (4) perceived differences in priorities between administration and health care workers may have contributed to burnout; and (5) a communicative and stable team helped clinicians effectively care for their patients. CONCLUSIONS: Clinician burnout is a complex problem at FQHCs with many root causes. Addressing burnout and improving clinician wellness at FQHCs will require a multifaceted approach encompassing systemic, team, and individual components. The perspectives from the clinicians at our FQHC may inform wellness strategies for other safety net, clinical institutions in the primary care setting.

[This is an excerpt.] We know from the literature that residents experience high rates of burnout, the consequences of which include the erosion of empathy, worse patient outcomes, and threatened professional endurance. In their qualitative study of resident thriving, Hyman and Doolittle attempt to broaden our gaze as researchers of physician well-being beyond a disease model of burnout toward a health model of thriving. Much of the research on resident well-being has relied on unidimensional measures, such as life or work satisfaction or overall quality-of-life scales. This approach leaves gaps in our understanding of physician thriving. [To read more, click View Resource.]

PURPOSE: To identify reasons for burnout, characterize the effect of lifestyle medicine (LM) practice on burnout, and assess the risk of burnout in relation to the proportion of LM practice. DESIGN: Analysis of mixed methods data from a large, cross-sectional survey on LM practice. SETTING: Web-based survey platform. PARTICIPANTS: Members of an LM medical professional society at the time of survey administration. METHODS: Practitioner members of a medical professional society were recruited to a cross-sectional, online survey. Data were collected on LM practice and experiences with burnout. Free-text data were thematically grouped and counted, and the association of burnout with the proportion of lifestyle-based medical practice was analyzed using logistic regression. RESULTS: Of 482 respondents, 58% reported currently feeling burned out, 28% used to feel burned out but no longer do, and 90% reported LM had positively impacted their professional satisfaction. Among LM practitioners surveyed, practicing more LM was associated with a 43% decrease (0.569; 95% CI: 0.384, 0.845; P = 0.0051) in the odds of experiencing burnout. Top reasons for positive impact included professional satisfaction, sense of accomplishment, and meaningfulness (44%); improved patient outcomes and patient satisfaction (26%); enjoyment of teaching/coaching and engaging in relationships (22%); and helps me personally: quality of life and stress (22%). CONCLUSION: Implementing LM as a greater proportion of medical practice was associated with lower likelihood of burnout among LM practitioners. Results suggest that increased feelings of accomplishment due to improved patient outcomes and reduced depersonalization contribute to reduced burnout.

[This is an excerpt.] Nearly every minute in Alberta, paramedics are called to a potential emergency that may require the use of medical and pharmaceutical interventions, as well as a variety of psychosocial skills, to save lives and prevent further illness. Hence, paramedics and the work they do on the streets (in ever-changing and unpredictable environments) and off the streets (in hospitals and other facilities) are central to the provision of health care in Alberta. For many Albertans, paramedics are the first point of contact in the health and social care system in the province. Suffice it to say, paramedics are a key component of this system. Prehospital emergency medical services and the workers central to the system — the paramedics — are in a state of crisis in Alberta. This is evidenced by increased rates of paramedic burnout/moral injury, staff retention issues, increased response times, increased number of code reds/red alerts” (which refers to instances where no ambulances are available for emergency calls for a specific community), and paramedics being “parked”/stuck in emergency departments. While SARS-COV-2 (hereafter COVID-19) and the opioid and overdose crisis (hereafter overdose crisis) have exacerbated the challenges experienced by paramedics in Alberta, the root of the current crisis dates back at least to the amalgamation of emergency medical services in the province in 2009. [To read more, click View Resource.]

[This is an excerpt.] This toolkit offers a blueprint for crafting a well-organized Listening Campaign, provides a framework to prioritize and execute improvement initiatives, and sheds light on strategies to overcome common challenges in engaging leaders and physicians, fostering active involvement in improvement work. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Worker & Learner Engagement).

Research shows that healthcare providers encounter stress in their workplaces whether in a home or a healthcare facility that results in reduced job satisfaction, burnout, and inadequate care of patients. There is a gap in the literature regarding the lived experiences of nurses caring for children in all work settings, including the home care setting, regarding stress and burnout. The lived experiences of pediatric nurses working in home care settings were explored to discover conditions that contribute to their occupational stress and burnout. The occupational stress model with a major focus on the job demands-resources occupational stress model was used to guide the qualitative, transcendental phenomenological study. Data were collected through semistructured interviews with 17 pediatric nurses from a northeaster U.S. state. Results showed that poor condition of homes causes stress and burnout and that patients’ families, uncooperative parents, fear of losing patients, lack of equipment, patient load, and solo decision making all contributed to stress. Long working hours caused burnout. Nurses should be supported to deal with stress, and self-care is critical in the mitigation of stress and burnout. Implications for positive social change including providing information to healthcare administrators that can lead to creating programs that can help eliminate stress and burnout among pediatric home care nurses and hence improve overall patient quality of care.

INTRODUCTION: Emotional intelligence (EI) as a concept is becoming increasingly relevant in the healthcare industry. In order to examine the relationship between EI, burnout, and wellness, we administered these measures quarterly in resident physicians and analyzed the variables in each subset to gain insights and understanding of their relationship. METHODS: In 2017 and 2018, all residents entering the training programs in year one (PGY-1) were administered The Emotional Intelligence Questionnaire - Short Form (TEIQue-SF), The Maslach Burnout Inventory (MBI), and The Physician Wellness Inventory (PWI). The questionnaires were completed quarterly. Statistical analysis included ANOVA and ANCOVA. RESULTS: The overall combined PGY-1 resident year (n = 80) had an EI global trait mean score of 5.47 (SD: 0.59) at the beginning of their first year. The domains of burnout and physician wellness were examined across four different time points during the resident's first year. Domain scores changed significantly over the four time points during the first year. There was a relative 46% increase in exhaustion (P < .001), 48% increase in depersonalization (P < .001), and an 11% decrease in personal achievement (P < .001). Physician wellness domains also changed significantly between time 1 and the end of the year (time 4). There was a relative 12% decrease in career purpose (P < .001), a 30% increase in distress (P < .001), and 6% decrease in cognitive flexibility (P < .001). Each burnout domain and physician wellness domain were highly correlated with emotional quotient (EQ). Emotional quotient was independently assessed with each domain at baseline and with changes overtime. The lowest EQ group reported their distress increased significantly over time (P = .003) and a decline in career purpose (P < .001) and cognitive flexibility (P = .04). The response rate was 100%. CONCLUSION: Emotional intelligence is associated with well-being and burnout in individual residents; therefore, it is important to identify those who require increased support during residency in order to succeed.