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OBJECTIVE: Little is known about the scope and role of discriminatory experiences in dentistry. The purpose of this study is to document the experiences that American Indian/Alaska Native (AI/AN), Black, and Hispanic dentists have had with discrimination. METHODS: This study reports data from a 2012 nationally representative study of dentists documenting experiences with discrimination during their dental careers or during dental school by the setting of the discrimination, the providers’ education, and geographic location. This study does not differentiate between levels of discrimination and focuses holisticly on the experience of any discrimination. RESULTS: Seventy-two percent of surveyed dentists reported any experience with discrimination in a dental setting. The experiences varied by race/ethnicity, with 49% of AI/AN, 86% Black, and 59% of Hispanic dentists reporting any discriminatory experiences. Racial/ethnic discrimination was reported two times greater than any other type. CONCLUSIONS: Experiences with racial/ethnic discrimination are prevalent among AI/AN, Black, and Hispanic dentists, suggesting that as a profession work is needed to end discrimination and foster belonging.

The COVID-19 pandemic has exposed and amplified the longstanding occupational circumstances of nurses. In this article, the authors provide updates to their 2020 institutional recommendations and craft a national plan to tackle burnout and moral suffering.

This qualitative study investigated turnover intention and its influence on the public service motivation of U.S. police officers. The study was completed using a phenomenological design to elicit the lived experience of 21 retired and active police officers using face-to-face and telephonic interviews. The theoretical frameworks of turnover intention and public service motivation supported the research. Deductive thematic analysis was utilized to examine the results using NVivo 12. Furthermore, the findings supported the theoretical frameworks of turnover intention and public service motivation. The results revealed that each participant had different turnover intentions influencing distinct public service motivation characteristics. The turnover intentions that were most common amongst the participants were a lack of perceived organizational support (90%, 19 of 21) and increased stress (90%, 19 of 21). The characteristics of public service motivation that were most influenced were self-sacrifice (33%, 7 of 21), attraction to policy making (90%, 19 of 21), and compassion (33%, 7 of 21). Increased turnover intention did not always change the characteristics of public service motivation. Further research is needed to evaluate police participants, such as examining non-retired individuals who self-terminated and did not return to the profession, different genders to identify variations, longitudinal studies to explore police officers' public service motivation, and mixed research designs to provide a quantitative descriptive dimension with qualitative evidence that offers a holistic perspective.

Background: The workloads of emergency medical service personnel (EMS) are varied. In the absence of recovery, health consequences can result. The aim of this review was to analyze the literature on the associations between psychosocial or physical work factors on one hand and the well-being outcomes and job satisfaction on the other hand. Methods: A systematic literature review examining the workloads, behavior, and well-being of EMS including emergency physicians, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for the reporting systematic reviews, was performed. The PubMed, Ovid Medline, Cochrane Library, Scopus, Web of Science, PsycINFO, Psyndex, and Embase electronic databases were used. Results: Thirty-three studies were included. These were divided into studies that predominantly focused on the behavior (6), stress and strain (22), and well-being (5) of EMS. Only four studies also examined emergency physicians. The studies indicated a high prevalence of psychological and physical stress factors. Burnout and posttraumatic stress disorders have been the most studied consequences of mismatched stress. The health status variable performs better in conjunction with higher qualifications. Age is not a protective variable in some studies. Conclusions: EMS workloads are varied and must be assessed on an individual basis. Studies on emergency physicians are needed. Organizational and personal measures must become the focus of health promotion and prevention in the workplace.

A psychologically safe environment for healthcare teams is desirable for optimal team performance, team member well-being, and favorable patient safety outcomes. This piece explores facilitators of and barriers to psychological safety across healthcare settings. Future research directions examining psychological safety in healthcare are discussed.

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

PURPOSE: Working in a hospital setting during a global health pandemic can lead to increased levels of anxiety, stress, burnout, and depression. Anecdotal evidence exists, but there is little research utilizing clinically validated tools to measure hospital staff psychological distress. METHODS: In Summer 2021, 771 hospital staff in North Dakota responded to an electronic survey collecting demographic data and employing validated behavioral health screening tools to assess anxiety, depression, emotional distress, and work-related quality of life. FINDINGS: Compassion satisfaction was significantly higher for those who worked in rural areas than urban [t(769) = –1.99, P = .0467]. The burnout rating was significantly higher for those who worked in urban areas than rural [t(769) = 2.23, P = .0261)]. There was no significant geographic variation in stress, anxiety, or depression. Anxiety, depression, burnout, and stress were all significantly higher for those who worked directly with COVID-19 patients than those who did not, regardless of hospital location. CONCLUSIONS: Hospital staff caring for COVID-19 patients experienced equitable (and high) levels of depression and anxiety. However, data indicate that rural providers experienced greater protective factors, resulting in lower rates of burnout and higher compassion satisfaction. Rural communities, hospitals, and health systems may have characteristics that could be duplicated in urban areas to support hospital staff well-being. Support and promotion of mental wellness must also come from the hospital system, and health care and policy leaders. If we do not care for our hospital staff, there will not be hospital staff left to care for the community.

[This is an excerpt.] Despite extensive literature measuring the prevalence and the consequences of burnout among resident physicians, effective interventional controlled trials are lacking.1,2 Mindfulness, therapy, and schedule changes have shown small benefits, but require learning a new skill, significant institutional resources, or organizational change.2 Additionally, ability to safely participate in many group or self-care activities has been limited by the recent COVID-19 pandemic. Gratitude3 and 3 good things3 (G/3GT) journaling are low-cost, individual-level interventions that have been shown to significantly improve measures of burnout, happiness, depression, gratitude, and stress; studies so far have not focused on resident burnout.3,  4,  5,  6 We piloted an app-based G/3GT journaling intervention for four weeks with pediatric residents measuring adherence and burnout as primary outcomes, with gratitude and life satisfaction as secondary outcomes. [To read more, click View Resource.]

While some surveyed nurses said they plan to leave direct patient care, the effects of COVID-19 on the nursing workforce may be leveling off.

BACKGROUND: The prevalence estimates of burnout among residents vary widely. Resident physicians working overnight have additional stressors and therefore, may be at higher risk of developing burnout. OBJECTIVE: To determine the rates of burnout among residents working night rotations versus day rotations. METHODS: This is a prospective, cross sectional, survey-based assessment of the prevalence of burnout among Obstetrics and Gynecology (OBGYN) residents on nights versus days rotations conducted at a large academic residency program that spans two separate hospitals in New York. All residents in the residency program were asked to complete the Maslach Burnout Inventory - Human Services Survey for Medical Personnel (MBI-HSS (MP)) after the first rotation of the academic year in 2018, 2019, and 2020. The results for each of the three aspects of the MBI-HSS (MP): emotional exhaustion, depersonalization, and personal accomplishment, were then compared for those on nights versus day rotations using students t-test. RESULTS: A total of 76 responses were received, 13 from residents on night rotations and 63 from residents on day rotations with a response rate of 61.8%. Comparing resident responses for a night versus day rotation, the residents averaged a low level of emotional exhaustion (a score of 17?±?9) on day shift, compared to a moderate level of emotional exhaustion (a score of 18?±?14) on nights (p?=?0.37). Similarly, 55.6% of respondents reports low personal accomplishment on days, compared to 76.9% while on nights. CONCLUSIONS: Emotional exhaustion scores were lower for residents on daytime rotations (mean score 17, SD 9), compared to those on nights rotations (mean 18, SD 14). Although there was no difference in depersonalization when comparing the day and night shift, 45% of the responses indicated high levels of depersonalization regardless of the type of shift. These results highlight the need to continue efforts to minimize burnout in medical training.

INTRODUCTION: Several factors may affect student wellbeing, including tolerance for ambiguity, burnout, empathy, quality of life, and stress. A better understanding of how pharmacy students score on these scales relative to other health professional students could help educators and schools address and improve student wellbeing. The study objective was to determine a baseline measure of pharmacy student tolerance for ambiguity, burnout, empathy, quality of life, and stress. METHODS: A voluntary survey including several assessment scales (Tolerance for Ambiguity, Oldenburg Burnout Inventory, Interpersonal Reactivity Index [empathy], Quality of Life Scale, and Perceived Stress Scale) was sent by email to all pharmacy students within a standalone college of pharmacy. RESULTS: Two hundred thirty-one pharmacy students completed all aspects of the survey. Comparing each scale with sex, female students trended higher in Interpersonal Reactivity Index and scored significantly higher on the Oldenburg Burnout Inventory (disengagement), while male students scored significantly higher for Quality of Life. Fourth-year students scored significantly higher on the Tolerance for Ambiguity scale as compared to first- and second-year students and on the Quality of Life scale as compared with third-year students. Third-year students experienced the greatest levels of burnout. Differences were also noted based on students' anticipated area of practice (empathy) and desire to work with an underserved population (empathy and stress). CONCLUSIONS: Pharmacy students' responses to the included scales varied greatly when considering various demographic parameters. The significant differences identified are illuminating and represent potential areas for curricular improvement, student support, and further study within pharmacy school curricula.

OBJECTIVES: Assess the association of residents’ exam performance and transient emotions with their reports of burnout, suicidality, and mistreatment. BACKGROUND: An annual survey evaluating surgical resident well-being is administered following the American Board of Surgery In-Training Examination (ABSITE). One concern about administering a survey after the ABSITE is that stress from the exam may influence their responses. METHODS: A survey was administered to all general surgery residents following the 2018 ABSITE assessing positive and negative emotions (scales range from 0 to 12), as well as burnout, suicidality over the past 12 months, and mistreatment (discrimination, sexual harassment verbal/emotional or physical abuse) in the past academic year. Multivariable hierarchical regressions assessed the associations of exam performance and emotions with burnout, suicidality, and mistreatment. RESULTS: Residents from 262 programs provided complete responses (N = 6987, 93.6% response rate). Residents reported high mean positive emotion (M = 7.54, SD = 2.35) and low mean negative emotion (M = 5.33, SD = 2.43). While residents in the bottom ABSITE score quartile reported lower positive and higher negative emotion than residents in the top 2 and 3 quartiles, respectively (P < 0.005), exam performance was not associated with the reported likelihood of burnout, suicidality, or mistreatment. CONCLUSIONS: Residents’ emotions after the ABSITE are largely positive. Although poor exam performance may be associated with lower positive and higher negative emotion, it does not seem to be associated with the likelihood of reporting burnout, suicidality, or mistreatment. After adjusting for exam performance and emotions, mistreatment remained independently associated with burnout and suicidality. These findings support existing evidence demonstrating that burnout and suicidality are stable constructs that are robust to transient stress and/or emotions.

Professional healthcare worker burnout is a crisis in the United States healthcare system. This crisis can be viewed at any level, from the national to local communities, but ultimately, must be understood at the level of the individual who is caring for patients. Thus, interventions to reduce burnout symptoms must prioritize the mental health of these individuals by alleviating some of the symptoms of depression, grief, and anxiety that accompany burnout. The practice of Shinrin-Yoku (Forest Bathing) is a specific evidence-based practice which research has shown can improve an individual's mental health and, when performed in a group, can support a sense of social connection. We investigated the impact of a three-hour, guided Shinrin-Yoku (Forest Bathing) nature-based intervention on burnout symptoms among physicians and other healthcare workers by using a randomized, controlled trial. The Oldenburg Burnout Inventory (OLBI) and Mini-Z assessments were used to collect baseline burnout scores and participants were randomized into the intervention group, which completed the assessment again after the Shinrin-Yoku walk, or into a control group, which completed the assessments again after a day off from any clinical duties. A total of 34 participants were enrolled in the intervention group and a total of 22 participants were enrolled in the control group. Ultimately, no statistically significant differences were detected between the pre-test and post-test scores for the intervention group or between the post-test scores of the intervention group compared to the control group. However, the subjective responses collected from participants after participating in the Shinrin-Yoku walk overwhelmingly reported decreased feelings of stress and increased mental wellbeing. This raises important questions about the difference between symptoms of burnout and other aspects of mental health, as well as the limitations of a one-time nature-based intervention on levels of chronic burnout symptoms. Thus, further research on the effects of engaging healthcare providers in an ongoing practice of Shinrin-Yoku is warranted.

BACKGROUND: The COVID-19 global pandemic has put health care professionals under immense pressure and hindered their ability to provide quality services. PURPOSE: This study aimed to examine the professional quality of life (ProQOL) among Georgia nurse practitioners during the COVID-19 global pandemic. METHODOLOGY: The ProQOL survey was distributed to nurse practitioners in Georgia by the professional organization's listserv. Multiple analysis of variance (ANOVA) analyses were performed to assess differences between employment settings, geographic location, and other relevant demographic qualifiers and levels of compassion satisfaction, burnout, and secondary traumatic stress. RESULTS: Hundred nurse practitioners (NPs) (n = 100) responded to the survey. Ninety-one percent were female and ages 25–35 years. Male NPs showed higher rates of compassion fatigue and secondary traumatic stress. CONCLUSIONS: A ProQOL survey demonstrated increased burnout and secondary traumatic stress among frontline practitioners in Georgia due to increased workloads, feelings of inadequacy, fear of being infected by the virus, and prolonged exposure to deaths. IMPLICATIONS: Ensuring effective communication, team collaboration, emotional, adequate staffing, and psychological support can help reduce compassion fatigue among NPs.

OBJECTIVE: This study aimed to examine the COVID-19 pandemic's impact on fire service safety culture, behavior and morale, levers of well-being, and well-being outcomes. METHODS: Two samples (Stress and Violence against fire-based EMS Responders [SAVER], consisting of 3 metropolitan departments, and Fire service Organizational Culture of Safety [FOCUS], a geographically stratified random sample of 17 departments) were assessed monthly from May to October 2020. Fire department–specific and pooled scores were calculated. Linear regression was used to model trends. RESULTS: We observed concerningly low and decreasing scores on management commitment to safety, leadership communication, supervisor sensegiving, and decision-making. We observed increasing and concerning scores for burnout, intent to leave the profession, and percentage at high risk for anxiety and depression. CONCLUSIONS: Our findings suggest that organizational attributes remained generally stable but low during the pandemic and impacted well-being outcomes, job satisfaction, and engagement. Improving safety culture can address the mental health burden of this work.

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This resource is found in our Actionable Strategies for Public Safety Organizations: Drivers (Relational Breakdown) AND Drivers (Operational Breakdown)

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INTRODUCTION: Hospital departments of pharmacy are experiencing significant challenges in the recruitment and retention of trained hematology-oncology pharmacists. The reasons for these challenges are varied, but one consistent challenge is the growing attrition of clinically-trained pharmacists from the patient care environment. METHODS: An electronic 21-item survey was distributed to oncology pharmacists across the United States. The survey assessed work environment, board certification, clinical commitment, and other factors. How those factors might be associated with reported job satisfaction and risk for attrition was examined. RESULTS: A total of 607 individuals responded to at least one of the survey questions, with the majority representing those actively in clinical practice. The results demonstrate that the oncology pharmacy workforce is a highly trained and capable one, with a high level of satisfaction with their work. That said, over 60% of those who responded indicated that they were either actively seeking or open to alternate employment outside of the patient care environment. The largest contributing factors to attrition risk include untenable work burdens, burnout, lack of work-life integration, and ineffective leadership, while commitments to clinical work were associated with improved job satisfaction and decreased attrition risk. CONCLUSION: These results bring to light the current state of satisfaction and attrition risk for the oncology pharmacy workforce nationwide. A significant opportunity exists to improve the experience of these pharmacists, particularly in the patient care environment. Based on these findings, departmental, organizational, and national leadership must pursue more tenable work burdens, better value and recognition measures, and more accurate and meaningful metrics for clinical pharmacists in order to retain this important workforce.

OBJECTIVE: To characterize measures of EHR use and ambulatory care quality performance among PCPs. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of PCPs with longitudinal patient panels using a single EHR vendor was conducted at Brigham and Women’s Hospital and Massachusetts General Hospital during calendar year 2021. EXPOSURES Independent variables included PCPs demographic and practice characteristics and EHR time measures (PCP-level mean of daily total EHR time, after-hours time, time from 5:30 PM to 7:00 AM and time on weekends, and daily EHR time on notes, sending and receiving patient, staff, results, prescription, or system messages [in-basket], and clinical review). MAIN OUTCOMES AND MEASURES: Outcome variables were ambulatory quality measures (yearend, PCP panel–level achievement of targets for hemoglobin A1c level control, lipid management, hypertension control, diabetes screening, and breast cancer screening). RESULTS: The sample included 291 physicians (174 [59.8%] women). Median panel size was 829 (IQR, 476-1157) patients and mean (SD) clinical full-time equivalent was 0.54 (0.27). The PCPs spent a mean (SD) of 145.9 (64.6) daily minutes on the EHR. There were significant associations between EHR time and panel-level achievement of hemoglobin A1c control, hypertension control, and breast cancer screening targets. In adjusted analyses, each additional 15 minutes of total daily EHR time was associated with 0.58 (95% CI, 0.32-0.84) percentage point greater panel-level hemoglobin A1c control, 0.52 (95% CI, 0.33-0.71) percentage point greater hypertension control, and 0.28 (95% CI, 0.05-0.52) higher breast cancer screening rates. Each daily additional 15 minutes of in-basket time was associated with 2.26 (95% CI, 1.05-3.48) greater panel-wide hemoglobin A1c control, 1.65 (95% CI, 0.83-2.47) percentage point greater hypertension control, and 1.26 (95% CI, 0.51-2.02) percentage point higher breast cancer screening rates. Associations were largely concentrated among PCPs with 0.5 clinical full-time equivalent or less. There were no associations between EHR use metrics and diabetes screening or lipid management in patients with cardiovascular disease. CONCLUSIONS AND RELEVANCE: This cross-sectional study found an association between EHR time and some measures of ambulatory care quality. Although increased EHR time is associated with burnout, it may represent a level of thoroughness or communication that enhances certain

IMPORTANCE: Physician burnout is an ongoing epidemic; electronic health record (EHR) use has been associated with burnout, and the burden of EHR inbasket messages has grown in the context of the COVID-19 pandemic. Understanding how EHR inbasket messages are associated with physician burnout may uncover new insights for intervention strategies. OBJECTIVE: To evaluate associations between EHR inbasket message characteristics and physician burnout. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study in a single academic medical center involving physicians from multiple specialties. Data collection took place April to September 2020, and data were analyzed September to December 2020. EXPOSURES: Physicians responded to a survey including the validated Mini-Z 5-point burnout scale. MAIN OUTCOMES AND MEASURES: Physician burnout according to the self-reported burnout scale. A sentiment analysis model was used to calculate sentiment scores for EHR inbasket messages extracted for participating physicians. Multivariable modeling was used to model risk of physician burnout using factors such as message characteristics, physician demographics, and clinical practice characteristics. RESULTS: Of 609 physicians who responded to the survey, 297 (48.8%) were women, 343 (56.3%) were White, 391 (64.2%) practiced in outpatient settings, and 428 (70.28%) had been in medical practice for 15 years or less. Half (307 [50.4%]) reported burnout (score of 3 or higher). A total of 1?453?245 inbasket messages were extracted, of which 630?828 (43.4%) were patient messages. Among negative messages, common words included medical conditions, expletives and/or profanity, and words related to violence. There were no significant associations between message characteristics (including sentiment scores) and burnout. Odds of burnout were significantly higher among Hispanic/Latino physicians (odds ratio [OR], 3.44; 95% CI, 1.18-10.61; P?=?.03) and women (OR, 1.60; 95% CI, 1.13-2.27; P?=?.01), and significantly lower among physicians in clinical practice for more than 15 years (OR, 0.46; 95% CI, 0.30-0.68; P?

IMPORTANCE: Private equity acquisitions of physician practices in the US have been increasing rapidly; however, the implications for health care delivery and spending are unclear. OBJECTIVE: To examine changes in prices and utilization associated with private equity acquisitions of physician practices across multiple specialties. DESIGN, SETTINGS, AND PARTICIPANTS: This was a difference-in-differences event study of US physician practices specialized in dermatology, gastroenterology, and ophthalmology that were acquired by private equity firms from 2016 to 2020. Within each specialty, each private equity−acquired (PE-acquired) practice was matched with as many as 5 control practices based on the preacquisition number of unique patients, encounters, risk score, share of services billed out-of-network, and spending. The PE-acquired practices were compared with matched controls through year 2 after acquisition, using a difference-in-differences event study. Data analyses were performed from March 2021 to February 2022. EXPOSURES: Private equity acquisition of physician practices. MAIN OUTCOMES AND MEASURES: Measures of spending and utilization, including the charge and price (amount paid) per claim, new and unique patients, and total encounters. RESULTS: Compared with the 2874 control practices, the 578 PE-acquired physician practices exhibited an average increase of $71 (+20.2%) charged per claim (95% CI, 13.1%-27.3%; P < .001) and $23 (+11.0%) in the allowed amount per claim (95% CI, 5.6%-16.5%; P < .001). The PE-acquired practices increased their numbers of unique patients seen by 25.8% (95% CI, 15.8%-35.6%; P < .001) compared with control practices, driven by a 37.9% increase in visits by new patients (95% CI, 25.6%-50.2%; P < .001). In aggregate, their volume of encounters increased by 16.3% (95% CI, 1.0%-32.0%; P = .04) compared with the control group, with a 9.4% increase in the share of office visits for established patients that were billed as longer than 30 minutes (95% CI, 1.7%-17.0%; P = .02). No statistically significant changes in patient risk scores were found between PE-acquired practices and controls. Within specialties, we found modest differences along selected outcomes. CONCLUSIONS AND RELEVANCE: In this difference-in-differences study, private equity acquisition of physician practices in dermatology, gastroenterology, and ophthalmology were associated with differential increases in allowed amount and charges per claim, volume of encounters, and new patients seen, as well as some changes in billing and coding.

BACKGROUND AND OBJECTIVES: Health behaviors of physical activity and sleep are critical to the prevention of numerous chronic diseases. The health behaviors of healthcare professionals are even more critical, as healthcare providers who practice positive health behaviors are more likely to promote these healthy behaviors in their patients. AIMS: To assess the health status and health behaviors of medical students, faculty, and staff in an academic health center in the US, and examine the associations between behaviors, physical and mental health outcomes and burnout. METHODS: Students, faculty, residents and staff from a large university medical system completed an online survey between late-September and mid-November 2019. Associations were examined between health behaviors and health status including mental health outcomes with burnout. RESULTS: Participating in any leisure time physical activity and having a Pittsburgh Sleep Quality Index score < 5 were associated with fewer physical health conditions and lower odds of reporting pain at any site (n = 2060; students n = 242, residents n = 32, staff n = 1425, faculty n = 361). Leisure physical activity and fewer sleep symptoms were associated with fewer reported depressive, anxiety and stress-related symptoms. Participating in leisure physical activity and good-quality sleep were associated with lower odds of burnout. CONCLUSIONS: The current study found high rates of physical inactivity and poor sleep among medical students, faculty and staff at an academic health center. These health behaviors were associated with poor mental health and high burnout. Programs and policies are needed improve these health behaviors to reduce burnout.

PURPOSE: Burnout among nurses negatively impacts patient care experiences and safety. Inpatient pediatric nurses are high-risk for burnout due to high patient volumes, inadequate staffing, and needing to balance the demands of patients, families and team members. We examined the associations of inpatient pediatric nurse burnout with their perspectives on the importance of quality at the hospital, patient experience measurement, quality improvement (QI), unit culture, and staffing. METHODS: We conducted a cross-sectional study at an urban children's hospital. We surveyed pediatric nurses about their perspectives including the single-item Maslach Burnout Inventory. We fit separate regression models, controlling for role, location and unit, predicting outcome measures from the dichotomized burnout scale. RESULTS: Twenty-seven percent of pediatric nurses reported burnout. Nurses who had more con?dence in patient experience measurement, received frequent patient experience performance reports, felt included in QI, and experienced QI efforts as integrated into patient care reported not being burned out (compared to those reporting burnout; all p-values<0.05). More open communication among nurses (e.g., about possible problems with care) and unit-level teamwork were also associated with not being burned out, whereas a larger QI workload was associated with burnout (p-values<0.05). CONCLUSIONS: Open communication among nurses and nurses being more involved and valued in QI efforts were related to not being burned out. Research is needed to further examine aspects of QI involvement that reduce burnout.