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The Burden of Burnout


 

SHM’s Career Satisfaction Task Force is no longer active, but its mission—to help hospitalists and groups improve job and career satisfaction—continues with a small group of former members. Working behind the scenes, the group surveyed hospitalists across the nation and began analyzing the data, all with the goal of finding maximal approaches to preventing burnout among their peers and colleagues.

“It’s one thing to describe burnout as a problem, and it’s a second thing to say, ‘How do we minimize the risk of burnout for the individual and for the program?’ ” says Chad Whelan, MD, FHM, director of the division of hospital medicine at Loyola University Health System in Maywood, Ill.

Dr. Whelan is one of three people working on the Hospital Medicine Physician Worklife Survey project. The others are Keiki Hinami, MD, assistant professor in the division of hospital medicine at Northwestern Memorial Hospital in Chicago, and Tosha Wetterneck, MD, FACP, associate professor of medicine at the University of Wisconsin School of Medicine and Public Health in Madison.

They surveyed nearly 3,800 potential hospitalists, ultimately analyzing more than 800 responses, and Dr. Wetterneck presented results and analysis through two research abstracts at HM11. The first abstract was translated into a paper and published online in July by the Journal of General Internal Medicine.1

What they found was while 62.6% of respondents reported high satisfaction with their job and 69% with the HM specialty, there were certain satisfaction domains—such as organizational climate and personal time availability—that rated low. The authors suspect those low ratings could lead to burnout, but they also note the results provide a roadmap for HM groups looking to address the issue.

“Now we have a lot more needs and demands put upon us as a profession,” Dr. Wetterneck says. “We wanted to know what people were doing nowadays, what kind of work were they doing, and were they happy with it.”

One revealing result, she notes, is that some hospitalists are “not happy” with some of the reasons they initially chose a career in HM. For example, many physicians turn to HM because of the flexibility in scheduling and team approach to patient care and QI. Yet, survey results suggest hospitalists are unhappy with the amount of personal time they have and don’t feel like they are part of a team, she says.

It’s very important for [hospitalists] to be able to feel like they’re part of a team, that they’re part of an organization, and that the work they do really matters within that organization.

—Tosha Wetterneck, MD, FACP, associate professor of medicine, University of Wisconsin School of Medicine and Public Health, Madison

Workload Worries

The JGIM article, which assessed hospitalists’ satisfaction with such aspects as workload, compensation, patient-care quality, organizational fairness, autonomy, availability of personal time, and work relationships, showed that while hospitalists rated care quality and relationships with staff and colleagues high, they ranked compensation, organizational climate, autonomy, and availability of personal time low.

“To have such low satisfaction scores with their climate and their organization is concerning,” Dr. Wetterneck says. “It’s very important for [hospitalists] to be able to feel like they’re part of a team, that they’re part of an organization, and that the work they do really matters within that organization.”

Dr. Wetterneck acknowledges schedule flexibility is a key factor in hospitalist career choice, and it worries her that a majority of hospitalists surveyed are unhappy with the amount of personal time they had.

“When I presented these findings at the meeting, I had a lot of people telling me that the field has grown so quickly and the demands on the hospitalist group have grown so much that they haven’t been able to keep pace with hiring hospitalists to meet the demands in the workplace,” she says. “So people have to work more than they thought they would in the beginning, and that’s impinging on their personal time. … The flexibility piece is lost.”

Most hospitalists asked to work more are resilient and adapt. But over time, Dr. Wetterneck says, they begin to lose the ability to balance the demands and rewards of the job, and burnout develops.

Listen to Dr. Wetterneck discuss hospitalist burnout and career satisfaction.

“The study that we’ve been conducting suggests that the rate of burnout among practicing hospitalists is about 30 percent, which is a significant proportion of us,” Dr. Hinami says. “[It appears] that the rate of burnout symptoms of practicing hospitalists has remained stable, or may have increased, since the last time the publication of a nationwide survey was done.”

The last time a large survey measuring satisfaction among hospitalists was published was in 2001.2 It found that about 13% of hospitalists were burned out and about 25% were at risk of burnout, says Winthrop Whitcomb, MD, MHM, medical director of healthcare quality at Baystate Medical Center in Springfield, Mass., and one of the authors of the 2001 study. Without question, burnout continues to be a major challenge for the entire field of HM, he says.

“Growth has always and will continue to fuel burnout,” says Dr. Whitcomb, cofounder and past president of SHM. “It’s a hard job, and as long as you’re growing, you’re not really getting your feet underneath you.”

The task force study found that hospitalists with burnout symptoms were much more likely to reduce work effort, leave their clinical situation, leave HM, and abandon direct patient care altogether than those without burnout symptoms.

Whereas the task force survey used a single-item question to ask hospitalists their level of burnout on a scale of 1 to 5, the 2001 study used a different scale and asked multiple questions to determine if respondents were burned out or at risk of burnout, Dr. Wetterneck explains.

“Even though it’s not a fair comparison, could it be that more hospitalists are burned out now than they were 10 years ago? I happen to think it probably is real … because of some of the satisfaction data we’re looking at,” she says.

Dr. Wetterneck’s group hasn’t analyzed if the reasons for burnout among hospitalists have changed over the years, but, anecdotally, Dr. Whelan has noticed a difference. Early hospitalists often burned out because they had to work day shifts and take night call. Today, far fewer hospitalists are always on. However, there are more hospitalists than ever before working in the hospital at off hours, which comes with different stressors, he says.

Greater Responsibility, Greater Dissatisfaction

As hospitalists’ roles expand, unpredictable interruptions are more frequent, says Sylvia McKean, MD, SFHM, FACP, a senior hospitalist at Brigham and Women’s Hospital in Boston, associate professor of medicine at Harvard Medical School, and former co-chair of the Career Satisfaction Task Force.

“For example, if you’re [scheduled] to admit patients to the hospital and you’re also on the rapid-response team and someone happens to need a rapid assessment, you can be interrupted,” she says. “If you’re a hospitalist taking care of someone who has had a subarachnoid hemorrhage and the neurosurgeon is going to come in the next morning but you’re uncertain about what to do or even to recognize a problem in that patient, those are the kinds of things that cause people to get anxious and feel more fatigued.”

As more subspecialists focus on consultations in the hospital, hospitalists are tending to see more specialty patients and, as a result, could feel overwhelmed, Dr. McKean says.

Listen to Dr. Hinami discuss hospitalist burnout and career satisfaction.

The new survey group is not yet in a position to be prescriptive about burnout, Dr. Hinami says. However, he and his colleagues hope to shed some light on possible solutions in the near future.

“What we understand about burnout is that it depends on both individual characteristics and characteristics of the work environment,” Dr. Hinami says. “We’re exploring the kind of ways in which job designs can be altered to help hospitalists—whatever their personal endowments are—to cope better with the stresses of the work.”

According to the research group, one thing is clear: Compensation is not a cure-all. One of the HM11 abstracts showed that satisfaction with compensation was correlated the least with both. “There’s only so much you can be paid more to do before it’s not enough anymore,” Dr. Wetterneck says. “There are some people who take money over a happy job, and that’s what they want to do for a couple of years. That’s not really going to grow our profession in the long run.”

Lisa Ryan is a freelance writer based in New Jersey.

Reference

  1. Hinami K, Whelan CT, Wolosin RJ, Miller JA, Wetterneck TB. Worklife and satisfaction of hospitalists: toward flourishing careers. J Gen Intern Med. July 2011 [epub ahead of print].
  2. Hoff TH, Whitcomb WF, Williams K, Nelson JR, Cheesman RA. Characteristics and work experiences of hospitalists in the United States. Arch Intern Med. 2001;161(6):851-858.

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