Professional Fulfillment Index Research Articles

Implementation of a Virtual Asynchronous Scribe Program to Reduce Physician Burnout.

Administrative burden is one of many potential root causes of physician burnout. Scribe documentation assistance can reduce this burden. However, traditional in-person scribe services are challenged by consistent staffing because the model requires the physical presence of a scribe and limits the team to a single individual. In addition, in-person scribes cannot provide the flexible support required for virtual care encounters, which can now pivot geographically and temporally. To respond to these challenges, our health network implemented an asynchronous virtual scribe model and evaluated the program's impact on clinician perceptions of burnout across multiple outpatient specialties. Using a mixed-methods, pre-/postdesign, this evaluation measured the impact of an asynchronous virtual scribe program on physician burnout. Physicians were given the Professional Fulfillment Index tool (to self-assess their mental state) and free-text comment surveys before virtual scribe initiation and again at 3-, 6-, and 12-month intervals after program implementation. Descriptive statistics of survey results and qualitative review of free-text entries were analyzed for themes of facilitation and barriers to virtual scribe use. Of 50 physician participants in this study, 42 (84%) completed the preintervention survey and 15 (36%) completed all 4 surveys; 25 participants (50%) discontinued scribe use after 12 months. Burnout levels-as defined by dread, exhaustion, lack of enthusiasm, decrease in empathy, and decrease in colleague connection-all trended toward improvement during this study. Importantly, quality, time savings, burnout, and productivity moved in positive directions as well. The cost burden to physicians and the COVID-19 pandemic inhibited the continued use of asynchronous virtual medical scribes. Nevertheless, those who continued in the program have reported positive outcomes, which indicates that the service can be a viable and effective tool to reduce physician burnout.

Development and Validation of a Novel Instrument to Measure the Community Well-Being of Residency Programs.

To develop and validate the Residency Community Well-Being (RCWB) instrument, a novel instrument to measure the subjective community well-being of an individual residency program, and to explore differences in RCWB scores between demographic groups. An initial questionnaire to measure a residency program's community well-being was developed after literature review. Items were pilot tested, and the questionnaire was reviewed by experts in the fields of residency education, survey design, and sociology. The questionnaire was administered electronically between March and July 2021 to U.S. residents in 18 specialties recruited through convenience and snowball sampling using social media, a listserv, and personal emails to residency program leaders. Three previously validated instruments were administered as well to examine criterion validity: the Professional Fulfillment Index, the Brief Inventory of Thriving, and a single-item burnout measure. Data were analyzed with descriptive statistics, and exploratory factor analysis was performed using principal axis factoring with direct oblimin rotation to reduce the items and identify subscales. Of the 366 participants who opened and started the survey, 219 completed it (completion rate: 59.8%). Most respondents were women (133, 60.7%), 26-30 years old (132, 60.3%), and White (149, 68.0%). Three subscales emerged with 18 items: program leadership, structures, and practices (PLSP); resident interpersonal relationships (RIR); and resident mistreatment (RM). The Cronbach's alphas were 0.96 for PLSP, 0.92 for RIR, 0.82 for RM, and 0.95 for the overall RCWB. RCWB score positively correlated with professional fulfillment ( r = .52, P < .001) and thriving ( r = .45, P < .001) and inversely correlated with burnout ( r = -.39, P < .001). The RCWB instrument demonstrates strong internal consistency and content and criterion validity that shows that a residency program's subjective community well-being is primarily composed of program leadership quality, supportive interpersonal relationships, and the absence of mistreatment.

Prevalence of burnout in private practice radiology leaders

Rationale and objectivesTo evaluate prevalence and demographic factors associated with both burnout and fulfillment of private practice radiologist leaders within the United States. Materials and methodsThe study cohort was the largest coalition of wholly radiologist owned, independently practicing radiology groups within the United States. Two designated leaders within each of the 30 radiology private practices within the organization Strategic Radiology were electronically mailed a weblink to a confidential IRB-approved survey in July 2021. Surveys included questions from the Stanford Professional Fulfillment Index, individual and practice demographics, and self-care. ResultsThe overall response rate was 67% (40/60). Fulfillment and burnout scores were calculated from the individual questions, and radiologists were classified as being fulfilled or not and burned out or not based upon score cutoffs previously validated from the Stanford Professional Fulfillment Index (PFI). The overall professional fulfillment rate of staff was 43% and the overall burnout rate was 33%. (Cronbach's α = 0.90 for fulfillment and 0.91 for burnout). The inverse correlation between professional fulfillment and burnout was highly significant (r = −0.42, p = 0.007). No statistically significant association was seen between either burnout or fulfillment and age, gender, ethnicity, practice geography or practice size. ConclusionUtilizing the validated Stanford PFI for assessment, the prevalence of burnout in private practice radiologist leaders was 33%. The prevalence of professional fulfillment was 43%, with a mild inverse association between professional fulfillment and burnout. SummaryIn private practice leaders, the prevalence of burnout was 33% and the prevalence of professional fulfillment was 43%.

Adaptive and maladaptive humor styles are closely associated with burnout and professional fulfillment in members of the Society of Gynecologic Oncology (356)

<b>Objectives:</b> Individual differences in humor styles (adaptive: affiliative, self-enhancing; maladaptive: aggressive, self-defeating) are associated with numerous mental health measures. Burnout (BO) and professional fulfillment (PF) are two distinct measures that affect personal and professional well-being. This study examined the relationship of humor styles with PF and BO among Society of Gynecologic Oncology (SGO) members. <b>Methods:</b> SGO members were surveyed in November 2020. The survey included 64 questions (32-item Humor Styles Questionnaire, 16-item Stanford Professional Fulfillment Index, and 16-item demographic and practice characteristics). Differences among faculty physicians (FAC), physician trainees (Res/Fel), and advanced practice providers (APP) were compared using two-tailed t-tests for continuous variables and Chi-square tests for categorical variables. Multivariable linear regression adjusted the association of humor styles with BO and PF for possible confounders. <b>Results:</b> Of 1982 SGO members invited to participate, 321 (16.2%) returned surveys, including 222 (69.4%) FAC, 75 (23.4%) Res/Fel, and 23 (7.2%) APP. All categories of respondents scored highest for affiliative humor and lowest for aggressive humor. There were no significant differences between provider types in the use of adaptive humor styles. For maladaptive styles, Res/Fel were significantly more likely to employ both aggressive (FAC vs Res/Fel, p=0.017; Res/Fel vs APP, p=0.011) and self-defeating (FAC vs Res/Fel, p=0.011; Res/Fel vs APP, p=0.004) styles than FAC and APP. Ninety-five (29.7%) respondents met the criteria for BO, and 163 (50.9%) had professional fulfillment. There were no differences in BO among provider types. FAC was significantly more fulfilled than Res/Fel (2.83±0.88 vs 2.59±0.83, p=0.038). For adjusted BO analyses, BO was negatively associated with self-enhancing humor and positively associated with self-defeating humor (Table 1). Further, being a trainee (p=0.010) and being >55 years old (p=0.008) were protective for BO, whereas working >60 hours per week was led to higher BO (p=0.008). In adjusted analyses, PF was positively associated with self-enhancing humor and negatively associated with self-defeating humor (Table 1). Spending over 10% of work hours on non-patient care activities was negatively associated with PF (p=0.008). Table 1 <b>Conclusions:</b> Among SGO respondents, 29.7% were burned out, and 50.9% were fulfilled. Beyond advocating for less working hours and less administrative duties, humor-based interventions focused on increasing the use of self-enhancing and reducing the use of selfdefeating humor may lead to less BO and greater PF in SGO members, especially among trainees.

Nearly One-Fourth of Physicians in Large Academic Medical Center Experienced Mistreatment

Nearly One-Fourth of Physicians in Large Academic Medical Center Experienced Mistreatment

Temporal Associations Between EHR-Derived Workload, Burnout, and Errors: a Prospective Cohort Study.

The temporal progression and workload-related causal contributors to physician burnout are not well-understood. To characterize burnout's time course and evaluate the effect of time-varying workload on burnout and medical errors. Six-month longitudinal cohort study with measurements of burnout, workload, and wrong-patient orders every 4 weeks. Seventy-five intern physicians in internal medicine, pediatrics, and anesthesiology at a large academic medical center. Burnout was measured using the Professional Fulfillment Index survey. Workload was collected from electronic health record (EHR) audit logs and summarized as follows: total time spent on the EHR, after-hours EHR time, patient load, inbox time, chart review time, note-writing time, and number of orders. Wrong-patient orders were assessed using retract-and-reorder events. Seventy-five of 104 interns enrolled (72.1%) in the study. A total of 337 surveys and 8,863,318 EHR-based actions were analyzed. Median burnout score across the cohort across all time points was 1.2 (IQR 0.7-1.7). Individual-level burnout was variable (median monthly change 0.3, IQR 0.1-0.6). In multivariable analysis, increased total EHR time (β=0.121 for an increase from 54.5 h per month (25th percentile) to 123.0 h per month (75th percentile), 95%CI=0.016-0.226), increased patient load (β=0.130 for an increase from 4.9 (25th percentile) to 7.1 (75th percentile) patients per day, 95%CI=0.053-0.207), and increased chart review time (β=0.096 for an increase from 0.39 (25th percentile) to 0.59 (75th percentile) hours per patient per day, 95%CI=0.015-0.177) were associated with an increased burnout score. After adjusting for the total number of ordering sessions, burnout was not statistically associated with an increased rate of wrong-patient orders (rate ratio=1.20, 95%CI=0.76-1.89). Burnout and recovery were associated with recent clinical workload for a cohort of physician trainees, highlighting the elastic nature of burnout. Wellness interventions should focus on strategies to mitigate sustained elevations of work responsibilities.

Adaptive and maladaptive humor styles are closely associated with burnout and professional fulfillment in members of the Society of Gynecologic Oncology

Differences in individual humor styles (adaptive: affiliative, self-enhancing; maladaptive: aggressive, self-defeating) are associated with various wellness measures. This study examines the association of humor styles with professional fulfillment (PF) and burnout (BO) among Society of Gynecologic Oncology (SGO) members. SGO members were surveyed in 11/2020. The survey included 64 questions (32-item Humor Styles Questionnaire, 16-item Professional Fulfillment Index, and 16-item demographic and practice characteristics). Differences among faculty physicians (FAC), physician trainees (Res/Fel), and advanced practice providers (APP) were compared. Multivariable linear regression adjusted the association of humor styles with BO and PF for possible confounders. Of 1982 members invited to participate, 320 (16.1%) returned completed surveys (69.4% FAC, 23.4% Res/Fel, and 7.2% APP). All provider types scored highest for affiliative and lowest for aggressive humor. Res/Fel were more likely to employ aggressive and self-defeating humor styles than FAC and APP. One-third of respondents met criteria for BO and half experienced PF. FAC were more fulfilled than Res/Fel (p = 0.038). BO was negatively associated with self-enhancing and positively associated with self-defeating humor. Working > 60 h/week was associated with increased BO (p = 0.008) while trainee status (p = 0.010) and age > 55 (p = 0.008) were associated with decreased BO. PF was positively associated with self-enhancing and negatively associated with self-defeating humor. Spending > 10% of work hours on administrative duties led to lower PF (p = 0.008). Beyond advocating for less working hours and administrative duties, humor-based interventions to increase self-enhancing and reducing self-defeating humor use may lead to less BO and greater PF in SGO members, especially among trainees.

Piloting virtual mentorship: Evaluating acceptability and influence on wellness and professional identity in medical oncology (MO).

11022 Background: Despite extensive literature on the value of mentorship in academic medicine, little evidence exists to inform mentorship practices in MO. In 2021, the Canadian Association of Medical Oncologists (CAMO) piloted a national, 6-month virtual mentorship program consisting of 2 group mentoring events and additional 1-on-1 mentoring activities, to better support the needs of MO trainees. Feedback was obtained from participants to gain insight into how virtual mentorship might impact physician wellness and formation of professional identity, and to inform future iterations of CAMO’s virtual mentorship strategy. Methods: All Canadian MO residents/fellows were invited to participate in the program. Electronic surveys were completed by participants at baseline, after each group event, and at program completion. Surveys evaluated the program content and format, and used validated questionnaires for evaluating physician wellness/burnout (Stanford Professional Fulfillment Index [SPFI]), and professional identity (Macleod Clark Professional Identity Scale [MCPIS]). Cohort characteristics and survey responses were summarized using descriptive statistics. Procedures for survey data collection and analysis were ethics approved. Results: At baseline, respondents (n = 38) were predominantly female (63%), and &lt; 35 years (76%). 50% were married. On average, 78% of respondents ranked the virtual group mentoring events as meeting expectations. Program strengths identified by participants included meeting mentors outside of their own centre, meeting other trainees from across the country, and learning more about work-life balance/physician wellness. The main critique was insufficient time for interaction. Of the 34 MCPIS respondents, 94% were pleased to belong to the profession of MO, 91% identified positively with members of their profession and 77% felt like a member of the profession themselves. The average score on the SPFI scale was 2.73±0.71 (n = 34). Although 85% of respondents found their work meaningful, 71% satisfying, and 50% felt they were contributing professionally in valued ways, only 38% met criteria for professional fulfilment (score ≥3.00). 27% met criteria for burnout (score ≥1.33), 15% found their work physically exhausting and 9% found their work emotionally exhausting. Conclusions: CAMO’s pilot virtual mentorship program highlights that technology can be successfully leveraged to facilitate mentoring. The majority of MO trainees identified positively with their profession, yet only 38% reached the threshold for professional fulfillment and nearly a third met criteria for burnout. Longitudinal follow-up among mentored trainees is needed to provide insight into whether mentorship may influence physician wellness and professional identity over time.

With a Little Help From My Friends: The Negating Impact of Social Community and Mentorship on Burnout

IntroductionPhysician burnout has been demonstrated at high rates among surgeons. Research has shown that physicians experiencing burnout have higher rates of depression, substance abuse, attrition, and medical errors. Surgical culture often promotes self-reliance; however, lacking social connections may worsen burnout. Therefore, we aimed to determine if struggling to develop a professional or personal community is associated with worsened burnout in surgeons. MethodsWe conducted a survey of surgical residents and faculty at seven institutions in the United States in the spring of 2021. Variables measured included mentorship experience, presence of a social community outside work, burnout levels (Professional Fulfillment Index [PFI], 15: high professional fulfillment, 75: low professional fulfillment), average weekly hours worked over the previous 2 mo, and demographics (race, gender, and role: faculty or resident). ResultsA total of 218 participants completed the survey (50% residents and 54% male). Participants’ PFI scores were an average of 36.29/75, indicating poor professional fulfillment (standard deviation [SD] = 11.80). A multiple linear regression revealed that struggling to find a mentor (β = 0.20, P = 0.004) and not having a social community exterior to the hospital (β = −0.25, P < 0.001) were independently associated with significantly higher PFI scores (P < 0.001, R2 = 0.13). Gender, race, role, and hours worked were not associated with the PFI score. ConclusionsStruggling to find a mentor and a lack of social community outside of work are associated with higher levels of burnout in this multi-institutional study. These findings suggest that targeting an improved support for building professional and personal relationships may be a strategy for improving burnout levels in both faculty and resident surgeons.

Mistreatment Experiences, Protective Workplace Systems, and Occupational Distress in Physicians

Reducing physician occupational distress requires understanding workplace mistreatment, its relationship to occupational well-being, and how mistreatment differentially impacts physicians of diverse identities. To assess the prevalence and sources of mistreatment among physicians and associations between mistreatment, occupational well-being, and physicians' perceptions of protective workplace systems. This survey study was administered in September and October 2020 to physicians at a large academic medical center. Statistical analysis was performed from May 2021 to February 2022. Primary measures were the Professional Fulfillment Index, a measure of intent to leave, and the Mistreatment, Protection, and Respect Measure (MPR). Main outcomes were the prevalence and sources of mistreatment. Secondary outcomes were the associations of mistreatment and perceptions of protective workplace systems with occupational well-being. Of 1909 medical staff invited, 1505 (78.8%) completed the survey. Among respondents, 735 (48.8%) were women, 627 (47.1%) were men, and 143 (9.5%) did not share gender identity or chose "other"; 12 (0.8%) identified as African American or Black, 392 (26%) as Asian, 10 (0.7%) as multiracial, 736 (48.9%) as White, 63 (4.2%) as other, and 292 (19.4%) did not share race or ethnicity. Of the 1397 respondents who answered mistreatment questions, 327 (23.4%) reported experiencing mistreatment in the last 12 months. Patients and visitors were the most common source of mistreatment, reported by 232 physicians (16.6%). Women were more than twice as likely as men to experience mistreatment (31% [224 women] vs 15% [92 men]). On a scale of 0 to 10, mistreatment was associated with a 1.13 point increase in burnout (95% CI, 0.89 to 1.36), a 0.99-point decrease in professional fulfillment (95% CI, -1.24 to -0.73), and 129% higher odds of moderate or greater intent to leave (odds ratio, 2.29; 95% CI, 1.75 to 2.99). When compared with a perception that protective workplace systems are in place "to a very great extent," a perception that there are no protective workplace systems was associated with a 2.41-point increase in burnout (95% CI, 1.80 to 3.02), a 2.81-point lower professional fulfillment score (95% CI, -3.44 to -2.18), and 711% higher odds of intending to leave (odds ratio, 8.11; 95% CI, 3.67 to 18.35). This survey study found that mistreatment was common among physicians, varied by gender, and was associated with occupational distress. Patients and visitors were the most frequent source, and perceptions of protective workplace systems were associated with better occupational well-being. These findings suggest that health care organizations should prioritize reducing workplace mistreatment.

Burnout in Radiation Oncology Physician Workforce: The Effect of Mindfulness and Fulfillment

PurposeMindfulness, defined as awareness of the moment while acknowledging and accepting one's feelings, thoughts, and sensations, is the aim of mindfulness meditation. Our objective was to investigate the relationship between burnout, mindfulness, fulfillment, and other personal characteristics in radiation oncology (RO) residents/attendings compared with other specialties. Methods and MaterialsFrom December 2019 to February 2020, residents and attendings in multiple specialties at a single tertiary care academic institution were sent surveys, including the mindfulness attention awareness scale, Stanford professional fulfillment index, and a personal questionnaire. A Pearson correlation was conducted on the relationship between mindfulness, fulfillment, disengagement, and exhaustion. To determine risk factors for burnout (overall burnout ≥ 1.33), a univariate analysis was conducted to yield odds ratios (ORs) on debt, specialty, income, sleep, exercise, marital status, number of children, work hours, mindfulness (mindfulness attention awareness scale ≥ 4), fulfillment (professional fulfillment ≥ 3), and time with family/friends. Significant factors on univariate analysis were entered into multivariate analysis. ResultsThere were 180 surveys completed by 60 residents and attendings across 17 specialties. Eighteen (30%) respondents were in RO. Mindfulness positively correlated with fulfillment (P < .001, r = 0.534), negatively correlated with exhaustion (P < .001, r = -0.578), and negatively correlated with disengagement (P < .001, r = -0.483). Univariate analysis for factors associated with burnout was significant for mindfulness (OR = 0.065, P < .001), RO versus other specialty (OR = 0.024, P = .044), working >60 h/wk (OR = 5.091, P = .018), spending >10 h/wk with family or friends (OR = 0.120, P = .001), and fulfillment (OR = 0.103, P < .001). Multivariate analysis showed mindfulness and fulfillment to significantly decrease odds of burnout. ConclusionsRO physicians experienced less burnout than physicians in other specialties at our institution. Mindfulness, professional fulfillment, moderate work hours, and spending time with loved ones protected against burnout. Further study of interventions to promote mindfulness and fulfillment may help us understand how best to improve the mental and emotional health of RO physicians.

Validity Evidence of Brazilian Portuguese Version of the Professional Fulfillment Index.

The questionnaire "Professional Fulfillment Index" (PFI) was validated to assess emotional exhaustion, interpersonal disengagement, and professional achievement among physicians. This study presents the process of cross-cultural adaptation of the PFI to the Brazilian context. Analytical cross-sectional study carried out between July and October 2020. Settings: For conceptual equivalence, a panel of experts was constituted who conducted analyzes on the translation and back-translation processes from English to Brazilian Portuguese. For the operational equivalence, 432 physicians in the field of Occupational Medicine were invited. They answered the PFI in an online platform. Analysis: Both exploratory and confirmatory factor analysis were performed to seek evidence of the hypothesized structure of PFI item responses. Reliability was assessed using three indicators. The Brazilian version can be considered similar to the original. Most of participants were female (57.6%) and mean age 49.6years-SD 14.0. The mean time since graduation was 18.5years-SD 9.67. Most of them had a full-time job (88.0%) and were trained through post-graduation courses 83.8%. The most frequent job task was to perform worker´s clinical evaluations (84.9%). Exploratory and confirmatory analyzes showed the adequacy of the items in measuring the instrument's construct, with stability for use in other populations and samples. The PFI was developed to evaluate positive and negative aspects of physicians' role and performance. The process described in this article was the first cross-cultural adaptation of the questionnaire. The PFI can help in mapping potential risk situations for negative impacts on physicians' occupational well-being and performance at work, in order to propose interventions that reduce exhaustion and expand professional fulfillment.

Mental health disorders among post graduate residents in Kenya during the COVID-19 pandemic.

BackgroundHealthcare workers, including residents, are prone to various mental health disorders especially given the context of the COVID-19 pandemic. Residents, particularly, are already under undue stress due to their respective training program demands.MethodsThis cross-sectional, online survey-based study from August to November 2020 collected demographic and mental health measurements from all residents at the Aga Khan University Hospital, Nairobi. The questionnaire investigated demographic variables, information regarding direct care of COVID-19 patients, prior history of mental health and mental health outcomes using the Patient Health Questionnaire, Generalized Anxiety Disorder scale, Insomnia Severity Index, Impact of Event Scale–Revised Questionnaire and Stanford Professional Fulfillment Index Questionnaire.ResultsA total of 100 residents completed the survey (participation rate 77.5%). Participants were about equal in gender (women [53%]), with a median age of 31.28 years, and majority were single (66.7%). A total of 66 participants (66%) were directly engaged in COVID-19 care. Depression: 64.3%, anxiety: 51.5%, insomnia: 40.5%, distress: 35.4%, and burnout: 51.0% were reported in all participants. Statistical significance was found in median depression, professional fulfillment and interpersonal disengagement when comparing frontline resident directly involved in care of COVID-19 patient versus second line residents.ConclusionResidents directly involved with caring for COVID-19 patients had statistically higher incidences of depression and interpersonal disengagement and lower professional fulfillment compared to second line residents. Keeping in mind the limited resources in sub-Saharan Africa, urgent and geographically specific strategies are needed to help combat mental health disorders in this specific population.

Predictors of Professional Fulfillment and Burnout Among Otolaryngologists During the COVID‐19 Pandemic

ObjectiveThe goal of this study is to assess burnout and professional fulfillment during the initial weeks of the COVID-19 pandemic among otolaryngology practitioners.Study DesignCross-sectional survey.SettingInternational survey of otolaryngologists during a pandemic.MethodsA cross-sectional survey was performed from April 24 to May 8, 2020, via email and social media platforms to understand the impact of the COVID-19 pandemic on otolaryngology practitioners in academic and private practice. The Professional Fulfillment Index was used to assess professional fulfillment and burnout. Burnout was divided into work exhaustion and interpersonal disengagement.ResultsOf 243 respondents, 202 completed the Professional Fulfillment Index portion of the survey. An average score ≥3 on the professional fulfillment section correlates with fulfillment, while an average score ≥1.33 on the burnout section correlates with burnout. The average score of professional fulfillment was 2.17, with 85.6% of respondents reporting lack of professional fulfillment. The average score on burnout was 1, with 40.1% of otolaryngologists reporting burnout. In multivariable analyses, females were found to have statistically lower professional fulfillment (beta = −2.28, P = .010) with higher rates of work exhaustion (beta = 0.62, P < .001), interpersonal disengagement (beta = 2.08, P = .023), and burnout (beta = 4.49, P = .002).ConclusionEarly in the COVID-19 pandemic, most participants reported a lack of professional fulfillment while just under half experienced burnout. Female gender was associated with low professional fulfillment and high work exhaustion, interpersonal disengagement, and burnout. Attention to burnout and job satisfaction during a pandemic is critical for the appropriate well-being of otolaryngology practitioners.

Frontline physician burnout during the COVID-19 pandemic: national survey findings

BackgroundPhysician burnout and wellbeing are an ongoing concern. Limited research has reported on the impact of the COVID 19 pandemic on burnout over time among U.S. physicians.MethodsWe surveyed U.S. frontline physicians at two time points (wave one in May–June 2020 and wave two in Dec 2020-Jan 2021) using a validated burnout measure. The survey was emailed to a national stratified random sample of family physicians, internists, hospitalists, intensivists, emergency medicine physicians, and infectious disease physicians. Burnout was assessed with the Professional Fulfillment Index Burnout Composite scale (PFI-BC). Responses were weighted to account for sample design and non-response bias. Random effects and quantile regression analyses were used to estimate change in conditional mean and median PFI-BC scores, adjusting for physician, geographic, and pandemic covariates.ResultsIn the random effects regression, conditional mean burnout scores increased in the second wave among all respondents (difference 0.15 (CI: 0.24, 0.57)) and among respondents to both waves (balanced panel) (difference 0.21 (CI: − 0.42, 0.84)). Conditional burnout scores increased in wave 2 among all specialties except for Emergency medicine, with the largest increases among Hospitalists, 0.28 points (CI: − 0.19,0.76) among all respondents and 0.36 (CI: − 0.39,1.11) in the balanced panel, and primary care physicians, 0.21 (CI: − 0.23,0.66) among all respondents and 0.31 (CI: − 0.38,1.00) in the balanced panel. The conditional mean PFI-BC score among hospitalists increased from 1.10 (CI: 0.73,1.46) to 1.38 (CI: 1.02,1.74) in wave 2 in all respondents and from 1.49 (CI: 0.69,2.29) to 1.85 (CI: 1.24,2.46) in the balanced panel, near or above the 1.4 threshold indicating burnout. Findings from quantile regression were consistent with those from random effects.ConclusionsRates of physician burnout during the first year of the pandemic increased over time among four of five frontline specialties, with greatest increases among hospitalist and primary care respondents. Our findings, while not statistically significant, were consistent with worsening burnout; both the random effects and quantile regressions produced similar point estimates. Impacts of the ongoing pandemic on physician burnout warrant further research.

Burnout, Professional Fulfillment, Intention to Leave, and Sleep-Related Impairment among Radiology Trainees across the United States (US): A Multisite Epidemiologic Study

To examine the prevalence of burnout among radiology trainees in the United States, and to study the relationships between burnout and professional fulfillment (PF), intent-to-leave (ITL), sleep-related impairment and self-compassion by gender. This cross-sectional study was conducted via an anonymous electronic survey sent to 11 large academic medical centers (Physician Wellness Academic Consortium) between January 2017 and September 2018. The survey included the Professional Fulfillment Index (PFI) and an abbreviated form of the PROMIS Sleep-related impairment (SRI) scale. Two-sample t-tests and chi-square exact tests were used for analysis (p < 0.05). Two hundred forty-seven radiology residents responded to the survey. Out of these, 36.2% reported burnout, 37.4% endorsed PF, 64.8% reported sleep-related impairment, 7.6% expressed ITL. There were no significant differences between genders. Burnout was associated with reduced PF, increased sleep-impairment (p < 0.001 for both) and increased ITL (p=0.02). Lower PF, peer support, perceived appreciation for and meaningfulness in work, alignment of organizational and personal values, self-compassion, and higher sleep impairment were associated with burnout (p < 0.001 for all). Burnout was associated with perceptions of less support from department leaders (p=0.003), control over schedules (p=0.001) and helpfulness of electronic health record systems (p=0.01). ITL was associated with reduced PF, perceived work appreciation, and leadership support (p=0.03, p=0.04, and p=0.007, respectively). Burnout is prevalent among radiology residents. Many demonstrate sleep-impairment and reduced professional fulfillment, with a lesser fraction desiring to leave their institution. Key factors to burnout included peer and organizational support, electronic health record systems helpfulness, and personal factors like self-compassion and work appreciation.

An Assessment of Physician Well-Being and Burnout Among Army Obstetricians and Gynecologists.

Physician burnout is associated with unsafe patient care and poor patient satisfaction. Civilian studies show burnout rates of 46% among obstetricians/gynecologists (OB/GYNs). Army Active Duty (A-AD) physician burnout rates range from 7.7% to 26% across specialties, but no studies have assessed A-AD OB/GYN burnout. The objective of this study was to quantify well-being of A-AD OB/GYNs by determining rates of professional fulfillment (wellness) and burnout and detect factors of potential protective or risk for wellness and burnout. A cross-sectional survey-based study was designed to determine well-being of A-AD OB/GYNs. This Institutional Review Board-approved study used the validated Professional Fulfillment Index. The survey was shared anonymously via email to 197 A-AD OB/GYNs. Additional questions asked as possible risk factors for burnout include location, training status, fellowship training, and remaining active duty service obligation (ADSO). Wellness and burnout rates were determined using published scales. Mean rates of wellness and burnout were reported, and chi-square tests detected associations between wellness/burnout and other variables. Eighty-three A-AD OB/GYNs responded to the survey (42%), with 73 available for full analysis. 26.5% had positive wellness, and 50% reported burnout. Completing fellowship training and shorter ADSO (of 0-2 years compared to >5 years) had higher rates of wellness. There were no differences in burnout among groups. Burnout rates in A-AD OB/GYNs appear higher than A-AD physicians of other specialties but are similar to civilian OB/GYNs. Fellowship training may confer higher rates of wellness. Further research is needed regarding improvements in A-AD OB/GYN well-being and burnout.

Assessment of Burnout, Professional Fulfillment, and Strategies for Improvement in Veterinary Faculty at a Large Academic Department.

Retention and recruitment of clinical faculty is crucial for the success of quality veterinary education. Clinical faculty in busy teaching hospital environments have the potential to experience significant burnout, though few studies have focused on identifying stressors in this group. The objective of this study was to measure burnout and professional fulfillment in clinical faculty using a recently validated instrument, the Stanford Professional Fulfillment Index (PFI). The survey was distributed to faculty in July 2020, a time that coincided with the COVID-19 pandemic. The survey was completed by 80% (52/65) of survey recipients. Scores for Overall Burnout were significantly higher (p = .027) and Professional Fulfillment scores significantly lower (p < .001) for veterinary faculty when compared with a reference group of academic physicians; 61.7% (29/47) of the faculty met the criteria for burnout, and 20.4% (10/49) met the criteria for professional fulfillment. Overall Burnout and Professional Fulfillment scores were not affected by faculty rank or gender, although interpersonal disengagement was greater in faculty who had worked > 6 years at the institution (p = .032). Responses indicated that faculty valued their work and their patients but faced an excessive workload and lacked autonomy to make changes. Faculty proposed improving efficiency, increasing staffing, and distributing work to technical staff. The PFI is a brief, no-cost instrument validated for measuring burnout and fulfillment in health care workers that can be used to assess well-being among veterinary faculty. Involving faculty in suggesting interventions may yield a variety of creative and actionable options.

The impact of faculty and student pharmacist relationships on burnout

BackgroundStudents in health professions, including student pharmacist, are at an increased risk of psychological distress. Unfortunately, effective efforts to combat burnout for student pharmacists are still lacking in the literature and create a void in schools and colleges of pharmacy that seek to assist their students. ObjectivesThe objective of this study was to explore how increasing positive out-of-class interactions between the student pharmacists and faculty members affect burnout, especially in work exhaustion and interpersonal disengagement. Professional fulfillment was also assessed as a primary outcome. MethodsThe institutional review board approved this study consisting of 4 faculty members and 12 students. After providing informed consent, the participants were assigned to one of 4 groups. Each group included 1 faculty member and 3 students. At the start of the study, each participant completed a modified Stanford Professional Fulfillment Index questionnaire to measure baseline burnout characteristics and initial level of professional fulfillment. For 8 weeks, the groups met weekly to discuss a topic related to burnout and professional fulfillment. After 8 weeks, each participant completed the postquestionnaire. Wilcoxon signed-rank tests were performed to the mean scores (pre vs. post) in each of the 3 constructs. The statistical significance was set at P < 0.05. ResultsThe results of the Wilcoxon signed-rank analysis showed a statistically significant difference in the burnout constructs, work exhaustion and interpersonal disengagement. There was not a statistically significant change in professional fulfillment. ConclusionsImproving relationships between student pharmacist and faculty through increasing out-of-class interactions benefits individuals who are at risk of experiencing burnout. Future initiatives can focus on effective strategies that target work exhaustion and interpersonal disengagement and build on the social networks that develop in pharmacy school.

Physician wellness in orthopaedic surgery : a multinational survey study.

AimsPhysician burnout and its consequences have been recognized as increasingly prevalent and important issues for both organizations and individuals involved in healthcare delivery. The purpose of this study was to describe and compare the patterns of self-reported wellness in orthopaedic surgeons and trainees from multiple nations with varying health systems.MethodsA cross-sectional survey of 774 orthopaedic surgeons and trainees in five countries (Australia, Canada, New Zealand, UK, and USA) was conducted in 2019. Respondents were asked to complete the Mayo Clinic Well-Being Index and the Stanford Professional Fulfillment Index in addition to 31 personal/demographic questions and 27 employment-related questions via an anonymous online survey.ResultsA total of 684 participants from five countries (Australia (n = 74), Canada (n = 90), New Zealand (n = 69), UK (n = 105), and USA (n = 346)) completed both of the risk assessment questionnaires (Mayo and Stanford). Of these, 42.8% (n = 293) were trainees and 57.2% (n = 391) were attending surgeons. On the Mayo Clinic Well-Being Index, 58.6% of the overall sample reported feeling burned out (n = 401). Significant differences were found between nations with regards to the proportion categorized as being at risk for poor outcomes (27.5% for New Zealand (19/69) vs 54.4% for Canada (49/90) ; p = 0.001). On the Stanford Professional Fulfillment Index, 38.9% of the respondents were classified as being burned out (266/684). Prevalence of burnout ranged from 27% for Australia (20/74 up to 47.8% for Canadian respondents (43/90; p = 0.010). Younger age groups (20 to 29: RR 2.52 (95% confidence interval (CI) 1.39 to 4.58; p = 0.002); 30 to 39: RR 2.40 (95% CI 1.36 to 4.24; p = 0.003); 40 to 49: RR 2.30 (95% CI 1.35 to 3.9; p = 0.002)) and trainee status (RR 1.53 (95% CI 1.15 to 2.03 p = 0.004)) were independently associated with increased relative risk of having a ‘at-risk’ or ‘burnout’ score.ConclusionsThe rate of self-reported burnout and risk for poor outcomes among orthopaedic surgeons and trainees varies between countries but remains unacceptably high throughout. Both individual and health system characteristics contribute to physician wellness and should be considered in the development of strategies to improve surgeon wellbeing.Level of Evidence: IIICite this article: Bone Jt Open 2021;2(11):932–939.