Abstract
Physician wellness is vital to career satisfaction, provision of high quality patient care, and the successful education of the next generation of physicians. Despite this, the number of physicians experience symptoms of burnout is rising. To assess the impact of organizational culture on physicians' professional fulfillment and burnout, we surveyed full-time Department of Medicine members at the University of Toronto. A cross-sectional survey assessed: physician factors (age, gender, minority status, disability, desire to reduce clinical workload); workplace culture (efforts to create a collegial environment, respectful/civil interactions, confidence to address unprofessionalism without reprisal, witnessed and/or personally experienced unprofessionalism); professional fulfillment and burnout using the Stanford Professional Fulfillment Index. We used multivariable linear regression to examine the relationship of measures of workplace culture on professional fulfillment and burnout (scores 0-10), controlling for physician factors. Of 419 respondents (52.0% response rate), we included 400 with complete professional fulfillment and burnout data in analyses (60% ≤ age 50, 45% female). Mean scores for professional fulfillment and burnout were 6.7±1.9 and 2.8±1.9, respectively. Controlling for physician factors, professional fulfillment was associated with satisfaction with efforts to create a collegial environment (adjusted beta 0.45, 95% CI 0.21 to 0.70) and agreement that colleagues were respectful/civil (adjusted beta 0.85, 95% CI 0.53 to 1.17). Lower professional fulfillment was associated with higher burnout scores. Controlling for professional fulfillment and physician factors, lower confidence in taking action to address unprofessionalism (adjusted beta -0.22, 95% CI -0.40 to -0.03) was associated with burnout. Organizational culture and physician factors had an impact on professional fulfillment and burnout. Professional fulfillment partially mediated the relationship between organizational culture and burnout. Strategies that promote inclusion, respect and civility, and safe ways to report workplace unprofessionalism are needed in academic medicine.
Highlights
Physician wellness is vital to career satisfaction, provision of high quality patient care, and the successful education of the generation of physicians [1,2,3,4,5,6,7,8,9,10,11]
We examined the relationship between measures of the organizational culture and professional fulfillment and burnout
Controlling for identified risk factors for burnout, including gender, career stage, and clinical workload, we found that physicians’ satisfaction with efforts made to encourage a supportive/collegial workplace and level of agreement that colleagues were respectful/civil were significant contributors to professional fulfillment
Summary
Physician wellness is vital to career satisfaction, provision of high quality patient care, and the successful education of the generation of physicians [1,2,3,4,5,6,7,8,9,10,11]. Research supports that almost half of all physicians experience burnout symptoms [12,13,14], characterized by work-related emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment [15]. The rates of burnout among physicians are rising [15]. Healthcare organizational factors, including excessive workloads, workflow inefficiencies, increased time spent in documentation, lack of input or control, and loss of meaning at work, contribute to physician burnout [16]. Unprofessional workplace behavior, and intimidation, harassment and discrimination, have been linked to lower work satisfaction and higher burnout [17]. Whether workplace unprofessionalism independently contributes to burnout among academic physicians is unknown
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