Abstract
ObjectiveThe objective of this study was to evaluate the performance of the Professional Fulfillment Index (PFI), a 16-item instrument to assess physicians’ professional fulfillment and burnout, designed for sensitivity to change attributable to interventions or other factors affecting physician well-being.MethodsA sample of 250 physicians completed the PFI, a measure of self-reported medical errors, and previously validated measures including the Maslach Burnout Inventory (MBI), a one-item burnout measure, the World Health Organization’s abbreviated quality of life assessment (WHOQOL-BREF), and PROMIS short-form depression, anxiety, and sleep-related impairment scales. Between 2 and 3 weeks later, 227 (91%) repeated the PFI and the sleep-related impairment scale.ResultsPrincipal components analysis justified PFI subscales for professional fulfillment, work exhaustion, and interpersonal disengagement. Test-retest reliability estimates were 0.82 for professional fulfillment (α = 0.91), 0.80 for work exhaustion (α = 0.86), 0.71 for interpersonal disengagement (α = 0.92), and 0.80 for overall burnout (α = 0.92). PFI burnout measures correlated highly (r ≥ 0.50) with their closest related MBI equivalents. Cohen’s d effect size differences in self-reported medical errors for high versus low burnout classified using the PFI and the MBI were 0.55 and 0.44, respectively. PFI scales correlated in expected directions with sleep-related impairment, depression, anxiety, and WHOQOL-BREF scores. PFI scales demonstrated sufficient sensitivity to detect expected effects of a two-point (range 8–40) change in sleep-related impairment.ConclusionsPFI scales have good performance characteristics including sensitivity to change and offer a novel contribution by assessing professional fulfillment in addition to burnout.
Highlights
The majority (52.4%) identified their race as white or Caucasian; 39.6% identified themselves as Asian; 6.4% identified themselves as part of another racial category (i.e., Indian or South Asian, Black or African, or Latino); and 1.6% elected not to answer the question on race
With a response to this item of “very good” set at the positive state, ROC analysis demonstrated the Professional Fulfillment Index (PFI) professional fulfillment scale estimated area under the curve (AUC) was 0.81
The Physician Fulfillment Index (PFI) was developed to meet the need for a more robust and balanced approach to assessing wellness variables that (1) are relevant to physicians and are relatively short and easy to use, (2) are well suited to assessment of changes that occur across time in relation to interventions, and (3) include a focus on positive aspects of the role and work of physicians, i.e., professional fulfillment, as well as negative aspects, i.e., burnout
Summary
Of all 250 participants who completed baseline survey measures, 48.8% identified themselves as women, 50.4% identified themselves as men, and 0.8% elected not to answer the question on gender. MBI emotional exhaustion, PFI work exhaustion and PFI overall burnout (average score across all PFI burnout items) all had small (> 0.1 < 0.3) but statistically significant correlations with self-reported medical errors. Professional fulfillment scale sensitivity and specificity for identifying physicians who indicate their quality of life is “very good” using an average-item score cut-point of 3.0 (scale range = 0 to 4) or greater was 0.73 and 0.79, respectively. Note that in this context, sensitivity refers to the portion of participants who test positive for “Quality of Life” who are identified as having “professional fulfillment.”.
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