For
the last several years, there has been an increasing focus at the national
level on physician burnout and its effect on our healthcare system. (1) A
recent survey (2) of a community graduate medical education program in Wichita KS
adds to the worry. The authors surveyed
all of the residents and core faculty in thirteen programs that are associated
with the KUSOM in Wichita. The response rate was about 50 percent (281/439)
with higher response from the faculty (55%) than the residents (47%55%) than
the residents (47%). The surveyed used
the Abbreviated version of the Maslach Burnout Inventory (MBI-9). The authors found that 32 percent of the
residents and faculty had emotional exhaustion and 31 percent
depersonalization. Overall, 94/281 (43%)
were considered burned out, with 51 percent of the residents meeting burnout
criteria. There were three themes that emerged as activities that promote
wellness among physicians: promotion of healthy and mindfulness activities;
enhanced program leadership; and administration, program, and system
modification to make the practice of medicine better for physicians.
Another
survey of family medicine residents and faculty in Texas explored burnout. (3) Participants
included 295 family medicine residents and faculty members across eleven FM programs
within the Residency Research Network of Texas. The residents and faculty
completed several measures that assessed resilience, burnout, flexibility, and stress.
The primary outcome variables were burnout (depersonalization, emotional
exhaustion, and personal achievement) and resilience. Depersonalization
accounted for 27.1% of the variance (P<.001), with a moderate effect size
(f²=.371). Risk factors included younger age, non-Hispanic white ethnicity, and
lower resilience predicted. Resilience was the only variable that predicted
depersonalization among program faculty while younger age and non-Hispanic
white ethnicity along with resilience were significant predictors of
depersonalization among residents. Emotional exhaustion accounted for 39% of
the variance in the model (F [11,286] = 16.609, P<.001). Resiliency was
significantly associated with younger age and greater psychological
flexibility. Younger age, identifying as an ethnic minority, and psychological
flexibility predicted resiliency among faculty, but there were no statistically
significant predictors of resilience among the resident physicians.
And finally, a survey from the Association of Family
Medicine Residency Directors (AFMRD) Physician Wellness Task Force (4) was done
to help programs create a “culture of wellness.” Of the 16 elements presented, 14 were rated
as essential by at least 80% of the program directors. The five areas that were
ranked as the most important after three rounds of questioning included: make
wellness part of the residency vocabulary and culture by beginning wellness
conversations in orientation and regularly thereafter; create a culture of
safe, confidential disclosure for burnout, depression, suicidal ideation, and
impairment; provide (directly or referral) accessible, confidential, affordable
mental health services; develop and
maintain a regular recurring or longitudinal wellness curriculum (eg, building
skills such as mindfulness, resilience, empathy); identify one or more wellness
champions (faculty or resident) with explicit leadership support.
I am very excited that Family Medicine has given so
much thought to this important issue.
Three studies in the journal that really add to the discourse! Thanks.
References
(2)
Ofei-Dodoo S,
Callaway P, Engels K. Prevalence and Etiology of Burnout in a Community-Based
Graduate Medical Education System: A Mixed-Methods Study. Fam Med 2019; 51(9):
766-71.
(3)
Buck K, Williamson
M, Ogbeide S, Norberg B. Family Physician Burnout and Resilience: A Cross-sectional
Analysis. Fam Med 2019; 51(8): 657-663.
(4)
Penwell-Waines
L, Runyan C, Kolobova I, et al. Making
Sense of Family Medicine Resident Wellness Curricula: A Delphi Study of Content
Experts. Fam Med 2019; 51(8): 670-6.
