Clinical Work Hours Research Articles

Wellness and Stress Management Practices Among Healthcare Professionals and Health Professional Students.

Healthcare professionals experience stressors that begin during training and persist into their careers that adversely impact their well-being. This study aims to identify students' and professionals' stress levels, satisfaction with wellness domains, barriers to wellness, and stress management practices. This study was a cross-sectional self-reported survey study. The study included students (N = 242) and professionals (N = 237) from medicine, nursing, pharmacy, physical therapy, social work, and counseling/psychology. The Managing Health & Wellness in Health Professions Training and Practice survey was used to capture wellness practices and barriers among participants. Results: Students reported significantly higher perceived stress compared to professionals (P < 0.001). Total wellness is significantly higher among professionals compared to students (P < 0.001). A higher stress rate is significantly related to being female, having a lower wellness score, and facing more barriers (P < 0.001). Intellectual health is the most valuable wellness domain for providers (M = 3.71, SD = 0.9) and students (M = 3.43, SD = 0.85), followed by spiritual health for providers (M = 3.4, SD = 1.1), and work/learning environment for students (M = 3.33, SD = 0.93). Professionals and students are least satisfied with their physical and financial health. Barriers include fatigue, workload/productivity in clinical practice, work hours, and burnout. Healthcare professionals exhibit a variety of stress management practices, encounter barriers, and prioritize different wellness domains. Healthcare systems should incorporate self-care education into their curricula and implement systemic changes to foster a thriving healthcare workforce.

Career Plans of US Physicians After the First 2 Years of the COVID-19 Pandemic

ObjectiveTo assess the career plans of US physicians at the end of 2021 relative to 2011 and 2014. MethodsPhysicians in the United States were surveyed from December 9, 2021, to January 24, 2022, using methods similar to prior studies in 2011 and 2014. Responding physicians in active practice (n=1884) were included in the analysis. At all time-points, physicians indicated the likelihood they would (1) reduce clinical work hours in the next 12 months and (2) leave their current practice within 24 months. ResultsIn 2021, 542 of 1344 (40.3%) indicated that it was “likely” or “definite” they would reduce clinical work hours in the next 12 months compared with 1120 of 6950 (16.1%) and 1275 of 6452 (19.8%) in 2011 and 2014. In 2021, 466 of 1817 (25.6%) indicated it was “likely” or “definite” they would leave their current practice in the next 24 months compared with 1284 of 6975 (18.4%) and 1726 of 6496 (26.6%) in 2011 and 2014. On multivariable analysis pooling responders from 2011, 2014, and 2021, physicians who responded in 2021 had higher odds of reporting intent to reduce clinical work hours compared with those who responded in 2014 (OR, 3.12; 95% CI, 2.73 to 3.57), whereas those responding in 2011 had lower odds relative to 2014 (OR, 0.81; 95% CI, 0.74 to 0.89). ConclusionRoughly two of every five US physicians intend to reduce their clinical work hours in the next year, more than double previous rates. These findings have potentially profound implications for the adequacy of a US physician workforce already facing substantial shortages.

The state of workforce retention among US oncologists.

42 Background: With increasing incidence rate of human malignancy, it is critical to maintain an adequate oncologist workforce to meet the societal need for expected oncologic care. Methods: In January-February 2023, ASCO emailed a novel 36 item REDCap survey to 5892 U.S.-based ASCO physician members to evaluate career intentions. The survey included 2 questions from the Maslach Burnout Inventory (MBI). The survey was distributed through multiple ASCO channels in February-March 2023. Survey responses were compared to findings from a 2013 survey of 1345 oncologists by Shanafelt et al.1 Per convention, those with high levels of emotional exhaustion and/or depersonalization were categorized as having burnout. Results: 410 eligible responses were analyzed. Demographic characteristics of oncologists in active practice (ACs) (≥ 6 hours/week) and oncologists no longer in active practice (FCs) are summarized in the Table. Most ACs reported that their total work hours (57%) and hours spent on administrative work (68%) had increased since 2019 (pre-COVID). 49% reported an increase in patient care hours. Compared to ACs surveyed in 2013, a higher percentage of ACs surveyed in 2023 reported it was “likely” or “definite” they would leave their current practice within 2 years (21% vs. 17%, p=.049) or reduce their clinical work hours in the next 12 months (22% vs 16%; p=.009). High likelihood of leaving or reducing hours were associated with burnout (p=.002 and .003, respectively). When ACs were asked to identify up to 2 major work stressors, "Staffing levels” and “Use of the electronic health record” were the most common responses (47% of responders each) with “Payer policies and interactions” close behind (42%). Among retired FCs (42%, n=33), the median retirement age was 67 [IQR: 7]. A high proportion (42%, n=14) of these oncologists indicated they retired 2-4 years earlier than planned. Among FCs who had transitioned to non-clinical roles (56%, n=46), the median age to leave clinical practice was 58 [IQR: 21]. Among oncologists who had transitioned to non-clinical roles, the top reason for leaving clinical practice before age 50 was “Lack of satisfaction with clinical practice” (35%, n=6), while for those 50 or older it was “Desire for more work flexibility” (31%, n=9). Conclusions: The proportion of oncologists who intend to reduce clinical care hours or leave their current practice has risen over the past decade and is associated with professional burnout. Dissatisfaction with the practice environment has led some oncologists to leave clinical practice and/or retire earlier than planned. These trends have implications for the adequacy of the oncologist workforce to meet the needs of patients. (1) Shanafelt et al: J Clin Oncol 32(27), 2014. [Table: see text]

What motivates radiographers to start working with research?

IntroductionThis study aimed to investigate the motivation and barriers of clinical radiographers to work with research in a Danish clinical setting. MethodsThe project was designed as a mixed method explorative study, including survey and focus group interviews. A paper based survey was distributed to clinical radiographers, with a bachelor's degree (few with a diploma in Radiography), at three departments of radiology. The survey collected data on motivation, challenges, and barriers in relation to research in clinical practice. Thematic analyses were performed according to the nature of the survey and used to categorize statements. The focus group interview included five managing radiographers (3 with a bachelor's degree) who formed part of the clinical management at their respective departments. ResultsThe survey resulted in 39 responses with an overall response rate of 56%. The majority of clinical radiographers were female (69%, n = 27) and 12 were male.Most radiographers (77%, n = 30) reported interest in research projects and 89% of them (n = 27) found it difficult to dedicate time to research projects next to the clinical work. ConclusionThe study increases the understanding of the motivation and current barriers to start working with research in clinical settings including dependent and independent projects. Clinical radiographers reported to have interest in research. Improvements should focus on department culture, skills, and management support. Clinical Radiographers can be motivated when the departments offer training and support, the projects are relevant to clinical practice and research working hours are provided. Implications for practiceThe study offers an insight into current perspectives and obstacles for clinical radiographers in relation to research. The literature on the perception and interest in research by clinical radiographers and managers is limited and further investigation of the field is warranted.

Cross-sectional analysis of the clinical work hours of early-career general practitioners.

The clinical working hours of early-career general practitioners (GPs) are an important factor in Australian GP workforce planning. This study aimed to establish the prevalence and associations of early-career GPs working full time (nine or more sessions per week) inclinical practice. This was a cross-sectional questionnaire-based study ofalumni (from six months to two years post-Fellowship) from three regional training organisations. Multivariable logistic regression was used to establish factors associated with alumni working full time. Of 356 currently practising early-career alumni participants, 30% worked full time. Factors associated with working full time included spouse/partner employment and family structure and any examination failure. Factors associated with working less than full time included female gender, being an Australian medical graduate, provision of other medical work and having taken additional leave during training. A high proportion of early-career GPs working part time in clinical general practice has implications for workplace planning, as GPs seek workload diversity and flexibility across their career stages.

216 Impact of Proposed Core Faculty Protected Time Requirements: National Survey of Emergency Medicine Faculty on Work Hours and Associated Job Satisfaction

216 Impact of Proposed Core Faculty Protected Time Requirements: National Survey of Emergency Medicine Faculty on Work Hours and Associated Job Satisfaction

The 2021 Pediatric Hospital Medicine Workforce: Results of a National Survey of Program Leaders.

Pediatric Hospital Medicine (PHM) is a young subspecialty with practice models that continue to evolve. To inform program and workforce planning, it is essential to understand the current state. This study sought to delineate current work models for PHM. In the spring of 2021, we conducted a survey-based cohort study of individuals identifying as PHM program leaders. Individuals were invited based on membership in the 3 PHM sponsoring societies. Additional respondents were recruited through society listservs. One hundred ninety-eight program leaders responded to the program model survey. One-half covered only community sites, 21.2% covered only university sites, and 21.2% covered both university and community sites. Programs provided a diverse set of services, with community sites covering more services, including newborn nurseries, emergency department consultation, and delivery room care. Median total hours for 1.0 clinical full time equivalent were 1849 across all sites, 1800 at university-only sites, and 1900 at community-only sites. Inpatient floor patient caps, when present, were higher for resident covered versus noncovered teams (16 vs 13). Similarly, back-up activation was higher for resident-covered teams (15-16) than noncovered teams (12-13.5). Current data on clinical work hours for pediatric hospitalists are consistent with recent, smaller studies, suggesting that the current national median for a 1.0 FTE clinical position at university-based sites is 1800 annual hours. Community hospitalists often work more clinical hours than university sites and more commonly provide a broader range of service lines. More studies are needed to explore the differences between community and university site work models.

Impact of the COVID-19 Pandemic on Resident Physician Clinical and Educational Work Hours at a Large Sponsoring Institution.

The COVID-19 pandemic affected graduate medical education (GME) by decreasing elective procedures and disrupting didactic learning activities in 2020. Editorials have hypothesized that resident physicians worked fewer hours, therefore losing valuable experience, but we are not aware of studies that have objectively assessed changes in hours worked. This study aims to identify differences secondary to the COVID-19 pandemic in resident work hours across all specialties at 3 geographically dispersed, integrated academic hospitals in a large sponsoring institution. We obtained de-identified work hour data from all residency programs at Mayo Clinic in Arizona, Florida, and Minnesota. Resident work hours were compared between 2020 and 2019 from March to May. Work hours for 1149 and 1118 residents during the pandemic and control periods respectively were compared. Decreases in resident work hours were seen, with the largest decrease demonstrated in April 2020 when 19 of 43 programs demonstrated significantly decreased work hours. Residents worked more hours from home in April 2020 compared to the previous year (Arizona: mean 1 hour in 2019 vs 5.2 hours in 2020, P<.001; Florida: mean 0.7 hour in 2019 vs 6.5 hours in 2020, P<.001; Minnesota: mean 0.8 hour in 2019 vs 10.2 hours in 2020, P<.001). The COVID-19 pandemic was associated with a decrease in work hours in some, but not all, specialties. The decrease in on-site work was only partially offset by an increased number of hours worked from home.

Assessment of Knowledge and Practice of Ergonomics among Dental Practitioners in Riyadh City in Saudi Arabia.

Aim:The present study was undertaken to assess the knowledge and practice of ergonomics among dental practitioners in Riyadh, Saudi Arabia.Methodology:A self-administered questionnaire was distributed among dental practitioners through Google Forms. Link of the questionnaire was sent through social media and e-mail. The questionnaire was focused on the awareness of ergonomics and practice of ergonomics during dental practice.Results:About 97.9% of participants are aware of different operating positions. About 71.7% of participants rate their operating procedure chair positions as good. 52.5% admit they feel numb fingers while working. Many questions were statistically significant according to educational qualification and type of practice (P < 0.050.Conclusion:Majority of the study population were aware of proper chair positions, correct operating procedures and were practicing four-handed dentistry, maintained proper back support while working, and even performed stretching exercises during clinical working hours.

Characterizing styles of clinical note production and relationship to clinical work hours among first-year residents.

To characterize variation in clinical documentation production patterns, how this variation relates to individual resident behavior preferences, and how these choices relate to work hours. We used unsupervised machine learning with clinical note metadata for 1265 progress notes written for 279 patient encounters by 50 first-year residents on the Hospital Medicine service in 2018 to uncover distinct note-level and user-level production patterns. We examined average and 95% confidence intervals of median user daily work hours measured from audit log data for each user-level production pattern. Our analysis revealed 10 distinct note-level and 5 distinct user-level production patterns (user styles). Note production patterns varied in when writing occurred and in how dispersed writing was through the day. User styles varied in which note production pattern(s) dominated. We observed suggestive trends in work hours for different user styles: residents who preferred producing notes in dispersed sessions had higher median daily hours worked while residents who preferred producing notes in the morning or in a single uninterrupted session had lower median daily hours worked. These relationships suggest that note writing behaviors should be further investigated to understand what practices could be targeted to reduce documentation burden and derivative outcomes such as resident work hour violations. Clinical note documentation is a time-consuming activity for physicians; we identify substantial variation in how first-year residents choose to do this work and suggestive trends between user preferences and work hours.

The professional resilience of mid-career GPs in the UK: a qualitative study.

BackgroundWith a continued crisis of increasing workload and reduced workforce in general practice, supporting resilience is a key strategy for sustaining the profession into the future.AimHow do GPs perceive professional resilience, and what workplace factors influence it?Design and settingA UK-based qualitative study of the perspectives of GPs currently practicing in mainly urban locations across the UK with ≥5 years’ experience after completion of GP training.MethodParticipants were recruited using convenience sampling, which included social media forums, and underwent semi-structured interviews undertaken in May and June 2020 (n = 27). Data were analysed using thematic analysis.ResultsParticipants offered definitions of and influences on resilience that largely fit with existing research, but in addition, may result in the perception that GPs are obstructive, or that resilience may be a ‘surface act’. GPs agree that the current focus on methods of improving resilience does support them, but there is significantly more to be done in this field. Social media activity aiming at GP support may be counterproductive. Reduction of clinical working hours is a common strategy to improve resilience.ConclusionThat GPs feel to improve resilience they need to work fewer clinical hours may have huge implications for a workforce already in crisis, and ultimately, for the health care of the UK population. Urgent research is needed to formulate a bespoke assessment for measuring GP resilience to assess potential interventions, and to identify GPs at risk of mental ill-health or leaving the profession.

Evaluating Quality Improvement and Patient Safety Amongst Practicing Urologists: Analysis of the 2018 American Urological Association Census

To describe factors associated with Quality improvement and patient safety (QIPS) participation using 2018 American Urological Association Census data. QIPS have become increasingly important in medicine. However, studies about QIPS in urology suggest low levels of participation, with little known about factors predicting non-participation. Results from 2339 census respondents were weighted to estimate 12,660 practicing urologists in the United States. Our primary outcome was participation in QIPS. Predictor variables included demographics, practice setting, rurality, fellowship training, QIPS domains in practice, years in practice, and non-clinical/clinical workload. QIPS participants and non-participants significantly differed in distributions of age (P=.0299), gender (P=.0013), practice setting (P <.0001), employment (employee vs partner vs owner vs combination; P <.0001), and fellowship training (P <.0001). QIPS participants reported fewer years in practice (21.3 vs 25.9, P=.018) and higher clinical (45.2 vs 39.2, P=.022) and non-clinical (8.76 vs 5.28, P=.002) work hours per week. Non-participation was associated with male gender (OR=2.68, 95% CI 1.03-6.95) and Asian race (OR=2.59, 95% CI 1.27-5.29) for quality programs and private practice settings (ORs=8.72-27.8) for patient safety initiatives. QIPS was associated with academic settings. Interventions to increase rates of quality and safety participation should target individual and system-level factors, respectively. Future work should discern barriers to QIPS engagement and its clinical benefits.

Smart-phone Based Geofencing: A Novel Approach to Monitoring Clinical Work Hours in Surgery Residency

The Accreditation Council for Graduate Medical Education specifies strict requirements for clinical work hours during residency training, with serious consequences for violations. Self-reporting of work hours by trainees can be inaccurate due to recall bias, giving program directors limited data to influence change. We aimed to assess the impact of a smart-phone based geofencing application on submission rates for work hours and reported violations in a general surgery residency program at a university-based medical center. We also examined resident perceptions surrounding implementation and use of the application. We compared clinical work hours submitted and violations reported during the pilot period (October-November 2019) with the months prior to the launch of the application (July-August 2019). PGY1 and PGY2 residents were eligible to use the application during and after this pilot period. Semi-structured interviews were used to assess resident perceptions. A retrospective review was conducted to compare reporting during the same time period from the prior academic year (2018-2019) for historical reference. Paired t-tests were used to analyze the data. Twenty-six residents (15 PGY1, 11 PGY2) were eligible for the intervention and 23 residents (88%) used the application. The mean number of violations reported decreased significantly during the pilot period compared with the months prior to the intervention (4.5 vs. 11, p = 0.04). The total rate of submissions was not significantly different after the intervention (85% vs. 82%, p = 0.42). The PGY1 mean submission rate decreased during the pilot period (91%-75%, p = 0.21) while the PGY2 submission rate increased (77%-91%, p = 0.07). Compared with historical data, there was an increase in overall total submission rates between academic years 2018/2019 and 2019/2020 (74% vs. 79%, p = 0.047) and an associated decrease in the mean number of monthly violations (14 vs. 6.25, p = 0.004). Thirteen (50%) residents (8 PGY1, 5 PGY2) volunteered for semi-structured interviews. Most participants found the application useful for recording and reporting clinical work hours. They noted an ease in the administrative burden as well as more accurate reporting associated with automated logging. Use of the application was not perceived to limit engagement with patient care; however, there were privacy concerns and some technical barriers were identified. The messaging regarding the application's use was identified as critical for implementation. The "real-time" data provided by a geofencing application in our program helped to reduce the number of work-hour violations reported and did not diminish resident engagement with patient care. Decreasing the administrative burden of recording work hours coupled with improving transparency and accuracy of submissions may be important mechanisms.

Retaining doctors and reducing burnout through a flexible work initiative in a rural South African training hospital.

BackgroundSouth African doctors work up to 60 h per week to ensure 24-h service delivery. Many doctors are physically and emotionally exhausted, neglecting families, self-care, patient empathy and innovative thinking about complex health issues. Exposure to clinical work hours demonstrated a dose effect with burnout, suggesting cause and effect, affecting up to 80% of doctors. To retain good doctors, their complex needs must be recognised and allowances made for flexible work options.Taking a riskGeorge Hospital, a large regional training hospital in a rural district, converted some full-time medical officer posts to part-time posts. This was in response to doctors’ requests for more flexible work options, often after returning from maternity leave or in response to burnout. Perceived risks revolved around institutional resource security and that part-time post vacancies would be difficult to fill.Reaping the benefitsEmploying doctors in part-time posts has created stability and continuity in the health team. The hospital had generated a cohort of young professionals who care with empathy and have emotional resilience to train others and plough their skills back into the healthcare service.ConclusionReducing working hours and creating flexible options were concrete ways of promoting resilience and retaining competent doctors. We recommend that training and work of doctors be structured towards more favourable options to encourage retention, which may lead to better patient care.

The impact of time spent on the electronic health record after work and of clerical work on burnout among clinical faculty.

To identify specific thresholds of daily electronic health record (EHR) time after work and daily clerical time burden associated with burnout in clinical faculty. We administered an institution-wide survey to faculty in all departments at Mount Sinai Health System from November 2018 to February 2019. The Maslach Burnout Inventory and Mayo Well-Being Index assessed burnout. Demographics, possible confounding variables, and time spent on EHR work/clerical burden were assessed. Of 4156 eligible faculty members, 1781(42.9%) participated in the survey. After adjustment for background factors, EHR frustration (odds ratio [OR]=1.64-1.66), spending >90 minutes on EHR-outside the workday by self-report (OR = 1.41-1.90) and >1 hour of self-reported clerical work/day (OR = 1.39) were associated with burnout. Reporting that one's practice unloads clerical burden (OR = 0.50-0.66) and higher resilience scores (OR = 0.77-0.84) were negatively associated with burnout.Spending >90 minutes/day on EHR-outside work (OR = 0.66-0.67) and >60 minutes/day on clerical work (OR = 0.54-0.58) was associated with decreased likelihood of satisfactory work-life integration (WLI) and professional satisfaction (PS). Greater meaning in work was associated with an increased. of achieving WLI (OR = 2.51) and PS (OR = 21.67). Results suggest there are thresholds of excessive time on the EHR-outside the workday (>90 minutes) and overall clerical tasks (>60 minutes), above which clinical faculty may be at increased risk for burnout, as well as reduced WLI and PS, independent of demographic characteristics and clinical work hours. These thresholds of EHR and clerical burden may inform interventions aimed at mitigating this burden to reduce physician burnout.

Evaluating the Influence of COVID-19 Among Dental Practitioners After Lockdown.

Clinical activities at dental premises after the COVID-19 lockdown period or post-COVID-19 are likely to be a challenge for all practicing dentists. To assess the impact of the COVID-19 pandemic on dentists and change in dental practice following lockdown, a total of 1150 participants were approached through online survey forms registered on www.surveys.google. A link containing details of the questionnaire and a consent form was sent to dentists through emails and social media forums. The questionnaire included 3 domains comprising of seventeen questions. The first section focused on demographics. The second section inquired about the change in dental practice, that is, clinical hours, use of PPE, type of treatment, and patient flow. The third section investigated the impact of COVID-19 on dentistry. Means, standard deviation, and percentages were calculated using descriptive statistics. Chi-square was used to find an association between different variables. The response rate was 87%. Demographic factors revealed participants aged from 20.45 to 40.55 years. The data showed around 89.6% (896) of dentists have altered their clinical working hours post lockdown and, approximately, 59.7% (597) of dentists provided only emergency treatments. 88.1% (881) of the dentists wore PPE during dental procedures. Overall, a huge negative impact of the COVID-19 pandemic was observed among practicing dentists in terms of the dental supply chain, cost, and availability of dental equipment, treatment cost, and bill payments.COVID-19 pandemic compromised dental care. Though dentists were taking precautionary measures and have changed their practice according to the guidelines provided by the ADA and World Health Organization, they were still experiencing monetary loss due to decrease patient influx post lockdown.

Vascular surgeon wellness and burnout: A report from the Society for Vascular Surgery Wellness Task Force

IntroductionPhysician burnout has been linked to medical errors, decreased patient satisfaction, and decreased career longevity. In light of the increasing prevalence of cardiovascular disease, vascular surgeon burnout presents a legitimate public health concern owing to the impact on the adequacy of the vascular surgery workforce. The aims of this study were to define the prevalence of burnout among practicing vascular surgeons and identify factors that contribute to burnout to facilitate future Society for Vascular Surgery (SVS) initiatives to mitigate this crisis. MethodsIn 2018, active SVS members were surveyed electronically and confidentially using the Maslach Burnout Inventory. The survey was tailored to explore specialty-specific issues, and to capture demographic and practice-related characteristics. Emotional exhaustion (EE) and depersonalization (DP) were analyzed as dimensions of burnout. Consistent with convention, surgeons with a high score on the DP and/or EE subscales of the Maslach Burnout Inventory were considered to have at least one manifestation of professional burnout. Risk factors associated with symptoms of burnout were identified using bivariate analyses (χ2, Kruskal-Wallis). Multivariate logistic regression models were developed to identify independent risk factors for burnout. ResultsOf 2905 active SVS members, 960 responded to the survey (34% participation rate). After excluding retired surgeons and incomplete submissions, responses from 872 practicing vascular surgeons were analyzed. The mean age was 49.7 ± 11.0 years; the majority of respondents (81%) were male. Primary practice settings were academic (40%), community practice (41%), veteran's hospital (3.3%), active military practice (1.5%), or other. Years in practice averaged 15.7 ± 11.7. Overall, 41% of respondents had at least one symptoms of burnout (ie, high EE and/or high DP), 37% endorsed symptoms of depression in the past month, and 8% indicated they had considered suicide in the last 12 months. In unadjusted analysis, factors significantly associated with burnout (P < .05) included clinical work hours, on-call frequency, electronic medical record and documentation requirements, work-home conflict, and work-related physical pain. On multivariate analysis, age, work-related physical pain and work-home conflict were independent predictors for burnout. ConclusionsSymptoms of burnout and depression are common among vascular surgeons. Advancing age, work-related physical pain, and work-home conflict are independent predictors for burnout among vascular surgeons. Efforts to promote vascular surgeon well-being must address specialty-specific challenges, including the high prevalence of work-home conflict and occupational factors that contribute to work-related pain.

Breaking the Gender Gap: A Two-part Observational Study of the Gender Disparity Among Korean Academic Emergency Physicians.

ObjectivesDespite greater access to training positions and the presence of more women in emergency medicine, it has remained a men-dominated field. This study aims to identify the key issues causing the gender gap in Korea and establish measures to overcome them.MethodsUsing the annual statistical reports of the National Emergency Medical Center and data published on the Korean Society of Emergency Medicine website, cases that listed the current status and positions of members in its organization and its committees were analyzed. Secondary analysis was conducted using data from the 2015 Korean Society of Emergency Survey that included physicians’ demographics, academic ranking, years of experience, clinical work hours, training and board certification, core faculty status, position, and salaries.ResultsAs of September 2019, women account for only 12.7% of the total number of emergency physicians (EP) in Korea; of 119 chair/vice‐chair academic positions, women represented only 9.2%. Women EP were more often assistant professors and fellowship-trained, with fewer in core faculty. However, they worked the same numbers of clinical hours as their men counterparts. The median annual salary of women EP was less than that of men EP after adjusting for academic hospital rank, clinical hours, and core faculty status.ConclusionsA gender gap still exists among Korean EP, and women earn less than men regardless of their rank, clinical hours, or training. Future studies should evaluate more data and develop system-wide practices to eliminate gender disparities.

Effects of opting-out from federal nurse anesthetists' supervision requirements on anesthesiologist work patterns.

To estimate the impact of opting-out from Medicare supervision requirements for certified registered nurse anesthetists (CRNAs) on anesthesiologists' work patterns. Secondary data from two national surveys of anesthesiologists and the Area Health Resource File. We use a matching difference-in-difference regression which contrasts the change in work patterns for anesthesiologists in California, which dropped supervision requirements, to the change for similar anesthesiologists. Key outcome variables include the number of weekly hours worked, the type of work done, and type of care delivery teams. Self-reported national survey data drawn from members of the American Society of Anesthesiologists. Anesthesiologists in California saw no change in time spent working or time spent supervising CRNAs. There was a decrease in direct care clinical work hours along with a shift in working more in intraoperative care, a decrease in postoperative care, and an increase in the percentage of cases supervising residents. Anesthesiologists had small but real responses to California's decisions to opt-out of the physician supervision requirement for CRNAs, doing more work in intraoperative care and less outside of the operating room. Total hours worked saw no change.

Frontline Perspectives on Physician Burnout and Strategies to Improve Well-Being: Interviews with Physicians and Health System Leaders.

Nationally over 50% of physicians report symptoms of burnout. To understand the perspectives of health system leaders and frontline physicians on contributors to physician burnout and strategies to improve well-being. We conducted in-depth interviews with health system leaders and frontline physicians at a large, predominantly fee-for-service, multispecialty group practice with approximately 1300 physicians. The 17 participants included 15 physicians, (12 Internal Medicine and Family Medicine physicians and 3 from other specialties), 11 individuals in leadership roles, and 11 women. Interviews included a review of factors associated with burnout at the organization, asking participants which factors they believed contributed to burnout, questions about experiences of burnout, and what specific changes would improve well-being. All 17 participants agreed that organizational factors were key contributors to burnout, while only 9 mentioned the salience of individual factors: "It does not matter how resilient or positive you are, the work environment, especially in primary care will eventually be a problem." An increasing workload associated with the electronic health record (EHR) and a culture focused on productivity were cited as contributing to burnout, especially among physicians in Internal Medicine and Family Medicine (primary care) departments. Physicians in primary care, women, and leaders described multiple barriers to well-being. Participants described responding to increased workloads by reducing clinical work hours. Participants suggested reducing and compensating EHR work, expanding care teams/support staff, reducing use of metrics, providing more support to leaders, changing the business model, and increasing positivity and collegiality, as essential to improving well-being. Interviews reveal a variety of interacting factors contributing to physician burnout. Reducing clinical work hours has become a coping strategy. Changes recommended to improve physician well-being include increasing support staff, reducing EHR workload, changing revenue generation and compensation approaches, and shifting organizational culture to place more value on physician wellness.