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Taking Care of Our Own: A Multispecialty Study of Resident and Program Director Perspectives on Contributors to Burnout and Potential Interventions

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Abstract

Objective

Rates of resident physician burnout range from 60 to 76 % and are rising. Consequently, there is an urgent need for academic medical centers to develop system-wide initiatives to combat burnout in physicians. Academic psychiatrists who advocate for or treat residents should be familiar with the scope of the problem and the contributors to burnout and potential interventions to mitigate it. We aimed to measure burnout in residents across a range of specialties and to describe resident- and program director-identified contributors and interventions.

Methods

Residents across all specialties at a tertiary academic hospital completed surveys to assess symptoms of burnout and depression using the Maslach Burnout Inventory and the Patient Health Questionnaire-9, respectively. Residents and program directors identified contributors to burnout and interventions that might mitigate its risk. Residents were asked to identify barriers to treatment.

Results

There were 307 residents (response rate of 61 %) who completed at least one question on the survey; however, all residents did not respond to all questions, resulting in varying denominators across survey questions. In total, 190 of 276 residents (69 %) met criteria for burnout and 45 of 263 (17 %) screened positive for depression. Program directors underestimated rates of burnout, with only one program director estimating a rate of 50 % or higher. Overall residents and program directors agreed that lack of work-life balance and feeling unappreciated were major contributors. Forty-two percent of residents reported that inability to take time off from work was a significant barrier to seeking help, and 25 % incorrectly believed that burnout is a reportable condition to the medical board.

Conclusions

Resident distress is common and most likely due to work-life imbalance and feeling unappreciated. However, residents are reluctant to seek help. Interventions that address work-life balance and increase access to support are urgently needed in academic medical centers.

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References

  1. Chen PW. The widespread problem of doctor burnout. The New York Times. http://well.blogs.nytimes.com/2012/08/23/the-widespread-problem-of-doctor-burnout/?_r=0. Published 23 Aug 2012.

  2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general us working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–13.

    Article  PubMed  Google Scholar 

  3. Green DE, Walkey FH, Taylor AJ. The three-factor structure of the Maslach Burnout Inventory: a multicultural, multinational confirmatory study. J Soc Behav Personal. 1991;6(3):453.

    Google Scholar 

  4. Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443–51.

    Article  PubMed  Google Scholar 

  5. West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA. 2011;306(9):952–60.

    Article  CAS  PubMed  Google Scholar 

  6. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136(5):358–67.

    Article  PubMed  Google Scholar 

  7. Dyrbye LN, Shanafelt TD. Physician burnout: a potential threat to successful health care reform. JAMA. 2011;305(19):2009–10.

    Article  CAS  PubMed  Google Scholar 

  8. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21.

    Article  PubMed  Google Scholar 

  9. Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000.

    Article  PubMed  Google Scholar 

  10. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009;302(12):1294–300.

    Article  CAS  PubMed  Google Scholar 

  11. West CP, Tan AD, Shanafelt TD. Association of resident fatigue and distress with occupational blood and body fluid exposures and motor vehicle incidents. Mayo Clin Proc. 2012;87(12):1138–44.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet. 1996;347(9003):724–8.

    Article  CAS  PubMed  Google Scholar 

  13. Shanafelt TD, Balch CM, Dyrbye L, et al. Special report: suicidal ideation among American surgeons. Arch Surg. 2011;146(1):54–62.

    Article  PubMed  Google Scholar 

  14. Dyrbye LN, Massie FS, Eacker A, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010;304(11):1173–80.

    Article  CAS  PubMed  Google Scholar 

  15. Holmboe ES, Edgar L, Hamstra S. Milestones. 2015. http://www.acgme.org/acgmeweb/tabid/430/ProgramandInstitutionalAccreditation/NextAccreditationSystem/Milestones.aspx. Accessed 19 June 2015.

  16. Ospina-Kammerer V, Figley CR. An evaluation of the Respiratory One Method (ROM) in reducing emotional exhaustion among family physician residents. Int J Emerg Ment Health. 2003;5(1):29–32.

    PubMed  Google Scholar 

  17. Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med. 2005;165(22):2601–6.

    Article  PubMed  Google Scholar 

  18. Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165(22):2595–600.

    Article  PubMed  Google Scholar 

  19. Bragard I, Etienne A-M, Merckaert I, Libert Y, Razavi D. Efficacy of a communication and stress management training on medical residents’ self-efficacy, stress to communicate and burnout: a randomized controlled study. J Health Psychol. 2010;15(7):1075–81.

    Article  PubMed  Google Scholar 

  20. Ghetti C, Chang J, Gosman G. Burnout, psychological skills, and empathy: Balint training in obstetrics and gynecology residents. J Grad Med Educ. 2009;1(2):231–5.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sikora R, Mongold B, Sedgeman J, Davis SM. Burnout in emergency medicine residents and faculty: an attempt to modify stress response by journaling. Poster presentation presented at the International Conference on Emergency Medicine, San Francisco, CA. April, 2008.

  22. Lieberman III J, The SM. BATHE method: incorporating counseling and psychotherapy into the everyday management of patients. Prim Care Companion J Clin Psychiatry. 1999;1(2):35–8.

  23. Williams D, Tricomi G, Gupta J, Janise A. Efficacy of burnout interventions in the medical education pipeline. Acad Psychiatry. 2015;39(1):47–54.

    Article  PubMed  Google Scholar 

  24. Moutier C, Norcross W, Jong P, et al. The suicide prevention and depression awareness program at the University of California, San Diego School of Medicine. Acad Med. 2012;87(3):320–6.

    Article  PubMed  Google Scholar 

  25. UNC. The taking care of our own program. 2016. https://www.med.unc.edu/psych/education/taking-care-of-our-own.

  26. Stanford. Resident well being. 2016. http://med.stanford.edu/gme/current_residents/resident_wellness.html.

  27. Maslach C, Jackson SE, Leither MP, Schaufeli WB, Schwab RL. Maslach burnout inventory manual. 3rd ed. Palo Alto: Consulting Psychologists Pr; 1996.

    Google Scholar 

  28. Rafferty JP, Lemkau JP, Purdy RR, Rudisill JR. Validity of the Maslach Burnout Inventory for family practice physicians. J Clin Psychol. 1986;42(3):488–92.

    Article  CAS  PubMed  Google Scholar 

  29. Martin A, Rief W, Klaiberg A, Braehler E. Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. Gen Hosp Psychiatry. 2006;28(1):71–7.

    Article  PubMed  Google Scholar 

  30. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. The Journal of Extension—JOE. http://www.joe.org.libproxy.lib.unc.edu/joe/2012april/tt2.php. Accessed 14 April 2016.

  32. Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health; 2015. http://www.samhsa.gov/data/.

  33. Cepoiu M, McCusker J, Cole MG, Sewitch M, Belzile E, Ciampi A. Recognition of depression by non-psychiatric physicians—a systematic literature review and meta-analysis. J Gen Intern Med. 2008;23(1):25–36.

    Article  PubMed  Google Scholar 

  34. Jackson J, Passamonti M, Kroenke K. Outcome and impact of mental disorders in primary care at 5 years. Psychosom Med. 2007;69(3):270–6.

  35. Adams E, Lee A, Pritchard C, White R. What stops us from healing the healers: a survey of help-seeking behaviour, stigmatisation and depression within the medical profession. Int J Soc Psychiatry. 2010;56(4):359–70.

  36. Accreditation Council for Graduate Medical Education. Duty hours. 2016. http://www.acgme.org/What-We-Do/Accreditation/Duty-Hours/GraduateMedicalEducation/DutyHours.

  37. Ahmed N, Devitt KS, Keshet I, et al. A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg. 2014;259(6):1041–53.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Drolet BC, Christopher DA, Fischer SA. Residents’ response to duty-hour regulations—a follow-up national survey. N Engl J Med. 2012;366(24):e35.

    Article  PubMed  Google Scholar 

  39. Desai SV, Feldman L, Brown L, et al. Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial. JAMA Intern Med. 2013;173(8):649–55.

    Article  PubMed  Google Scholar 

  40. Bilimoria KY, Chung JW, Hedges LV, et al. National cluster-randomized trial of duty-hour flexibility in surgical training. N Engl J Med. 2016;374(8):713–27.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The UNC Sanders Clinician Scholars Award provides funds to Dr. Meltzer-Brody that were used for this project.

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Correspondence to Emily G. Holmes.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Holmes, E.G., Connolly, A., Putnam, K.T. et al. Taking Care of Our Own: A Multispecialty Study of Resident and Program Director Perspectives on Contributors to Burnout and Potential Interventions. Acad Psychiatry 41, 159–166 (2017). https://doi.org/10.1007/s40596-016-0590-3

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  • DOI: https://doi.org/10.1007/s40596-016-0590-3

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