physician burnout - residents in EM

In March 2017, our ALiEM Wellness Think Tank launched an ambitious initiative to try to identify the prevalence rate of U.S. emergency medicine (EM) resident burnout across the country. No study to date had been done to assess this. Amazingly we got a response from over 1,500 confirmed U.S. EM residents from 193 residency programs purely through our social media, email listservs, and Wellness Think Tank outreach efforts. We measured burnout using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). This 22-item MBI-HSS is the most common, validated tool used to measure burnout in healthcare professionals. It assesses 3 subscale domains:

  • Emotional exhaustion (EE), which means being emotionally depleted at work
  • Depersonalization (DP), which means a lack of feelings or negative, cynical feelings towards others
  • Personal accomplishment (PA), which is a positive sense of self-evaluation and success at work.

A combination of high EE, high DP, and/or low PA scores are correlated with burnout.1,2 This post reviews some of the highlights from our study, High Prevalence of Burnout among Emergency Medicine Residents across the US, which was recently accepted by Annals of Emergency Medicine and published online.3

STUDY OBJECTIVE: Previous work shows that emergency medicine attending physicians have higher-than-average rates of burnout. Preliminary data suggest that emergency medicine residents are also at risk for burnout. The objective of this study was to conduct the first national survey assessment of US emergency medicine residents to determine the prevalence of burnout.

METHODS: This prospective 2017 National Emergency Medicine Resident Wellness Survey study was conducted through the Wellness Think Tank whereby EM residents from 247 residencies across the United States were invited to participate in a national survey. The primary measure of burnout was the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). As per others’ work, “burnout” was defined as a dichotomous variable represented by high levels of emotional exhaustion or depersonalization. Due to interpretative variability with the MBI-HSS tool, we also calculated burnout rates using a more restrictive definition and more inclusive definition that have been reported in the literature.

RESULTS: Surveys were completed by 1,522 residents (21.1% of all US EM residents), representing 193 of 247 (78.1%) US EM residency programs. Within this sample, the prevalence of burnout residents was 76.1% [95% CI 74.0-78.3%]. Applying alternative definitions, burnout prevalence rates for this same sample was 18.2% [16.3-20.1%] using the more restrictive definition and 80.9% [78.9-82.9%] using the more inclusive definition.

CONCLUSIONS: The majority of U.S. EM residents responding to this survey reported symptoms consistent with burnout, highlighting that physician burnout in the EM profession seems to begin as early as residency training. These findings may provide a baseline against which future work can be compared.

Results

Demographics

1,522 residents (21.1% of all U.S. EM residents) responded to the survey, representing 193 of 247 (78.1%) U.S. EM residency programs.

Figure 1: Geographic distribution of survey respondents.
Figure 2: Breakdown of Survey Respondents

 

Result: 76% of residents are burned out

We applied the most accepted definition of burnout, which is defined as showing high levels of emotional exhaustion or depersonalization.

Figure 3: Primary study findings about resident burnout rates

 

Result: EM resident physician burnout may be different from general physician burnout

The causes of burnout may not be the same for residents and practicing physicians. 72.5% of residents in our study reported a high degree of depersonalization versus lower depersonalization scores reported in other studies of attending emergency physicians (38.9%)4 and in other specialties (34.6%).5 We hypothesize that this more negative and cynical attitude towards patients results from working more clinical hours in the Emergency Department as a resident; having a greater clerical burden; and interacting more with consultants, admitting services, and ancillary staff as a trainee.4,6

Result: Intern burnout rates are lower than those of more senior residents

Uniquely, PGY-1 residents had the lowest levels of burnout at 75%, followed by PGY-3+ (83%) and PGY-2 (85%). These first-year residents are typically less often working in the ED and instead are on off-service rotations. They presumably have less clinical responsibilities, are not as responsible for ED throughput in the face of overcrowding, and typically do not manage high-acuity patients.

Bottom line and next steps

  • We now know that physician burnout in EM often begins during residency training, although it may be slightly less during intern year. We report that 76% of U.S. EM residents are burned out. This ranks among the highest rates of resident burnout across specialties.
  • This national survey provides baseline prevalence data on U.S. EM residents that has not been available before. As more and more programs are focusing on wellness and burnout, we hope to repeat this survey periodically to track national burnout rate trends. This data can be used to inform future individual, programmatic, and systems-level interventions.
  • This study and publication would not be possible without the help of:
    • US Acute Care Solutions as the exclusive sponsor of the Wellness Think Tank
    • Hippo Education and Emergent Medical Associates for helping to fund gift cards and prizes to incentivize survey completion
    • CORD and EMRA for allowing us to post the announcement of this survey on their listservs.
    • William Briggs and Newton Addo-Otoo for their statistical help
    • The tireless work of the entire 2017-18 Wellness Think Tank members

Are you a resident interested in resident wellness and burnout? Come join us at Essentials of Emergency Medicine’s Resident Wellness Event featuring Dr. James Dahle (White Coat Investor).

May 13, 2019 in Las Vegas

 

References

  1. 1.
    Schaufeli WB, Bakker AB, Hoogduin K, Schaap C, Kladler A. on the clinical validity of the maslach burnout inventory and the burnout measure. Psychology & Health. September 2001:565-582. doi:10.1080/08870440108405527
  2. 2.
    Manual – Maslach Burnout Inventory. Mind Garden. https://www.mindgarden.com/maslach-burnout-inventory/685-mbi-manual.html. Accessed February 20, 2019.
  3. 3.
    Lin M, Battaglioli N, Melamed M, Mott SE, Chung AS, Robinson DW. High Prevalence of Burnout Among US Emergency Medicine Residents: Results From the 2017 National Emergency Medicine Wellness Survey. Ann Emerg Med. 2019. doi:https://doi.org/10.1016/j.annemergmed.2019.01.037
  4. 4.
    Lu D, Dresden S, McCloskey C, Branzetti J, Gisondi M. Impact of Burnout on Self-Reported Patient Care Among Emergency Physicians. WestJEM. December 2015:996-1001. doi:10.5811/westjem.2015.9.27945
  5. 5.
    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 Clinic Proceedings. December 2015:1600-1613. doi:10.1016/j.mayocp.2015.08.023
  6. 6.
    Physician Burnout: Stop Blaming the Individual. NEJM Catalyst. https://catalyst.nejm.org/videos/physician-burnout-stop-blaming-the-individual/. Accessed February 20, 2019.

 

Michelle Lin, MD
ALiEM Editor-in-Chief
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls https://t.co/7v7cgJqNEn
Michelle Lin, MD
Nicole Battaglioli, MD

Nicole Battaglioli, MD

Champion, 2016-17 ALiEM Chief Resident Incubator Chief Operating Officer, 2016-19 ALiEM Wellness Think Tank Assistant Professor of EM University of Kentucky
Nicole Battaglioli, MD

@batt_doc

EM Doc- Wellness Think Tank- Wilderness Medicine Lover- Cupcake Connoisseur. Views and opinions are my own. #WellnessTT