Utility of the Stanford Professional Fulfillment Index as a single survey instrument to assess holistic physician wellbeing

Abstract

<h3>Objectives:</h3> There has been increasing interest in measuring physician wellness and burnout; however, there are a variety of assessment tools being used in the literature making it challenging to compare results between studies as well as conduct longitudinal research. Furthermore, to best assess holistic wellbeing, multiple instruments are combined leading to lengthy surveys that contribute to poor participant compliance and are difficult to repeat over time. Therefore, it would be of great interest to identify a brief but comprehensive tool to assess wellness and burnout. Here we sought to assess the utility of the Stanford Professional Fulfillment Index (PFI) as a single survey instrument of composite physician wellbeing. <h3>Methods:</h3> This was a cross-sectional study of physicians employed at the James Cancer Hospital at The Ohio State University in December of 2019 using a 115-question instrument that included the following measures: PFI, a two-question burnout measure, Barriers to Physician Compassion (BPI), Neff Self-Compassion Scale (SCS), self-reported medical errors, Workplace Engagement (UWES), and the Depression, Anxiety, and Stress Scales (DASS). The PFI is a validated 16-item survey that measures burnout (work exhaustion [WE] and interpersonal disengagement [ID]) and professional fulfillment (PF) using a five-point Likert scale. Data were analyzed using Chi-square, independent t-tests and Pearson's correlations. <h3>Results:</h3> A total of 173 physicians responded (46.6% response rate) with 141 respondents completing at least 75% of the survey. Sixty-three percent of respondents were males (n=90), while 70% between the ages of 30-49 (n=100, 69.9%). Respondents most commonly reported between 11-20 years (n=40, 29.9%) of clinical practice. The mean numbers of hours worked per week was 62.1 (range 8-120) with over half of the cohort providing direct clinical care for > 50% of this time (n=88, n=59.1%). Thirty-four percent of respondents were medical oncologists (n=48) while 31.7% were surgeons (n=45). Twenty percent were hospital-based (radiation oncology, anesthesiologist, and hospitalists) leaving 14.1% of respondents classified as other (n=20). All PFI subscales were significant correlated with all BPI subscales and both single-item Burnout measures (Table 1). Self-reported medical errors were only weakly correlated with the PFI ID subscale, and there were no correlations with WE or PF. All PFI subscales were highly significantly correlated with all UWES, SCS, and DASS subscales and composite scales. <h3>Conclusions:</h3> Performance on the PFI was correlated with all the previously validated measures used in this study with the exception of self-reported medical errors. This suggests that the PFI, a simple 16-item measure, could serve as a single measure of composite physician wellbeing that can more easily be applied on an iterative basis. Additionally, this offers the opportunity to standardize physician wellness research for more comparable results.