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Background Physician 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. Methods We 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. Results In 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. Conclusions Rates 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.

Background TheCOVID-19 pandemic profoundly affected female physicians, exacerbating existing gender disparities both at home and in the workplace. We aimed to understand how the effects of the pandemic continued to impact female physicians. Methods We conducted a qualitative study of 24 female physicians through focus groups consisting of 4 to 6 participants. Focus group transcripts were coded deductively. Results Key themes were identified, including lack of wellbeing, unsafe working conditions, increased work burden, lack of childcare, and the critical role of flexibility in scheduling. Lack of wellbeing, increased work burden, and the need for flexibility had persisted years after the pandemic. Conclusions The findings emphasize the need for institutional support to address these challenges and retain a robust, diverse workforce in medicine.

Background A concern before 2020, physician burnout worsened during the COVID-19 pandemic. Little empirical data are available on pandemic workplace support interventions or their influence on burnout. We surveyed a national sample of frontline physicians on burnout and workplace support during the pandemic. Methods We surveyed a stratified random sample of 12,833 US physicians most likely to care for adult COVID-19 patients from the comprehensive AMA Physician Professional Data ™ file. The sample included 6722 primary care physicians (3331 family physicians, 3391 internists), 880 hospitalists, 1783 critical care physicians (894 critical care physicians, 889 pulmonary intensivists), 2548 emergency medicine physicians, and 900 infectious disease physicians. The emailed survey elicited physicians’ perceptions of organizational interventions to provide workplace support and/or to address burnout. Burnout was assessed with the Professional Fulfillment Index Burnout Composite scale (PFI-BC). Proportional specialty representation and response bias were addressed by survey weighting. Logistic regression assessed the association of physician characteristics and workplace interventions with burnout. Results After weighting, respondents were representative of the total sample. Overall physician burnout was 45.4%, significantly higher than in our previous survey. Open-ended responses mentioned that staffing shortages (physician, nursing, and other staff) combined with the increased volume, complexity, and acuity of patients during the pandemic increased job demands. The most frequent workplace support interventions were direct pandemic control measures (increased access to personal protective equipment, 70.0%); improved telehealth functionality (43.4%); and individual resiliency tools (yoga, meditation, 30.7%). Respondents placed highest priority on workplace interventions to increase financial support and increase nursing and clinician staffing. Factors significantly associated with lower odds of burnout were practicing critical care (compared with emergency medicine) OR 0.33 (95% CI 0.12 – 0.93), improved telehealth functionality OR 0.47 (95% CI 0.23 – 0.97) and being in practice for 11 years or longer OR 0.44 (95% CI 0.19–0.99). Conclusions Burnout across frontline specialties increased during the pandemic. Physician respondents focused on inadequate staffing in the context of caring for more and sicker patients, combined with the lack of administrative efforts to mitigate problems. Burnout mitigation requires system-level interventions beyond individual-focused stress reduction programs to improve staffing, increase compensation, and build effective teams.

Background Physicians have complex and demanding jobs that may negatively affect their sustainable employability (SE) and quality of care. Despite its societal and occupational relevance, empirical research on physicians’ SE is scarce. To further advance our understanding of physicians’ SE, this study explores how physicians perceive their employment context to affect their SE, how physicians self-regulate with the intent to sustain their employability, and how self-regulations affect physicians’ SE and their employment context. Methods Twenty Dutch physicians from different specialisms were narratively interviewed between March and September 2021 by a researcher with a similar background (surgeon) to allow participants to speak in their own jargon. The interviews were analyzed collaboratively by the research team in accordance with theory-led thematic analysis. Results According to the interviewees, group dynamics, whether positive or negative, and (mis)matches between personal professional standards and group norms on professionalism, affect their SE in the long run. Interviewees self-regulate with the intent to sustain their employability by (I) influencing work; (II) influencing themselves; and (III) influencing others. Interviewees also reflect on long-term, unintended, and dysfunctional consequences of their self-regulations. Conclusions We conclude that physicians’ SE develops from the interplay between the employment context in which they function and their self-regulations intended to sustain employability. As self-regulations may unintentionally contribute to dysfunctional work practices in the employment context, there is a potential for a vicious cycle. Insights from this study can be used to understand and appraise how physicians self-regulate to face complex challenges at work and to prevent both dysfunctional work practices that incite self-regulation and dysfunctional consequences resulting from self-regulations.

Background Physician burnout is rising, especially among academic physicians facing pressures to increase their clinical workload, lead administrative tasks and committees, and be active in research. There is a concern this could have downstream effects on learners’ experiences and academic physician’s ability to teach learners on the team. Methods A 29-question RedCap survey was electronically distributed to 54 attending physicians within an academic learning health system who oversaw the General Medicine inpatient teaching services during the 2022–2023 academic year. The aims were to assess this cohort of attending physicians’ experiences, attitudes, and perceptions on their ability to effectively teach learners on the team, feeling valued, contributors to work-life balance and symptoms of burnout, Fisher’s Exact Tests were used for data analysis. Results Response rate was 56%. Attendings splitting time 50% inpatient / 50% outpatient felt that team size and type of admissions model affected their ability to effectively teach learners ( p  = 0.022 and p  = 0.049). Attendings with protected administrative time felt that non-patient care obligations affected their ability to effectively teach the learners ( p  = 0.019). Male attendings and attendings with ≤ 5 years of General Medicine inpatient teaching experience felt less valued by residency leadership ( p  = 0.019 and p  = 0.026). 80% of attendings experienced emotional exhaustion, and those with > 10 weeks on a General Medicine inpatient teaching service were more likely to experience emotional exhaustion ( p  = 0.041). Attendings with > 10 weeks on a General Medicine inpatient teaching service and those who were a primary caregiver were more likely to experience depersonalization ( p  = 0.012 and p  = 0.031). 57% of attendings had reduced personal achievement. Conclusions Institutions should seek an individual and organizational approach to professional fulfillment. Special attention to these certain groups is warranted to understand how they can be better supported. Further research, such as with focus groups, is needed to address these challenges.

Objective We sought to determine whether average cumulated time to chart closure (CTCC), a novel construct to measure clinician workload burden, and electronic health record (EHR) measures were associated with a validated measure of burnout. Materials and methods Physicians at a large academic institution participated in a well-being survey that was linked to their EHR use data. CTCC was defined as the average time from the start of patient encounters to chart closure over a set of encounters. Established EHR use measures including daily total time in the EHR (EHR-Time8), time in the EHR outside scheduled hours, work outside of work (WOW8), and time spent on inbox (IB-Time8) were calculated. We examined the relationship between CTCC, EHR use metrics, and burnout using descriptive statistics and adjusted logistic regression models. Results We included data from 305 attendings, encompassing 242 432 ambulatory encounters (2021). Among them, 42% (128 physicians) experienced burnout. The median CTCC for all clinicians was 32.5 h. Unadjusted analyses revealed significant associations between CTCC, WOW8, IB-Time8, and burnout. In a final adjusted model, only CTCC remained statistically significant with an odds ratio estimate of 1.42 (95% CI, 1.00-2.01). Discussion These results suggest that CTCC is predictive of burnout and that purely measuring duration of interaction with the EHR itself is not sufficient to capture burnout. Conclusion Workload burden as manifested by average CTCC has the potential to be a practical, quantifiable measure that will allow for identification of clinicians at risk of burnout and to assess the success of interventions designed to address burnout. Lay Summary Electronic health records (EHRs) have been adopted widely to improve quality, safety, and efficiency. However, EHR use has also demonstrably contributed to clinician stress and burnout—which in turn may jeopardize patient safety and other outcomes the EHR proposes to improve. Effectively measuring burnout and understanding the drivers of burnout are critical to implementing programs to reduce burnout. Existing burnout assessment tools are burdensome to implement, and EHR use measures have limitations in predicting burnout. This study proposes a new metric, cumulated time to chart closure (CTCC), to address these gaps. CTCC measures the time elapsed from the start of a clinical visit to the completion of all required documentation, considering both EHR-based work and other demands on clinicians’ time—clinical, non-clinical work, and non-work responsibilities. The mismatch of these demands with the individual’s resources to address them is posited to result in burnout. In this study, 42% of 305 physicians from a large academic multi-specialty health system reported burnout. CTCC is significantly associated with burnout, while traditional EHR use measures are not. CTCC could serve as a valuable tool for more easily identifying physicians at risk of burnout and evaluating the impact of interventions to reduce burnout.

We aim to incorporate physician insights into the development of a performance dashboard based on a novel patient experience survey system at a large academic health system. A multidisciplinary team of physicians, researchers, and designers met regularly to develop the dashboard informed by Clinical Performance Feedback Intervention Theory. Semistructured qualitative interviews with frontline physicians underwent combined inductive-deductive thematic analysis to inform dashboard improvements. A total of 20 interviews were conducted April-July 2023 with 9 neurologists and 6 primary care physicians in 2 phases. Physician preferences converged along design, content, and administration features, which were incorporated into the dashboard and accepted by physicians during phase 2. Important themes included establishment of survey credibility, preference for qualitative over quantitative data, and associated incentive structure. Dashboard design required an intuitive data overview with features such as hover-over insights that allowed deeper exploration. Physicians valued patient comments over quantitative data, prompting further redesign of the dashboard to prioritize qualitative insights, contrasting with the national emphasis on quantitative benchmarks.

In the practice of medicine, resilience has gained attention as on of the ways to address burnout. Qualitative studies have explored the concept of physician resilience in several contexts. However, individual qualitative studies have limited generalizability, making it difficult to understand the resilience concept in a wider context. This study aims to develop a concept of resilience in the context of physicians’ experience through a meta-synthesis of relevant qualitative studies. Using a predetermined search strategy, we identified nine qualitative studies among 450 participants that reported themes of resilience in developed and developing countries, various specialties, and stages of training. We utilized the meta-ethnography method to generate themes and a line-of-argument synthesis. We identified six key themes of resilience: tenacity, resources, reflective ability, coping skills, control, and growth. The line-of-argument synthesis identified resilient physicians as individuals who are determined in their undertakings, have control in their professional lives, reflect on adversity, utilize adaptive coping strategies, and believe that adversity provides an opportunity for growth. Resilient physicians are supported by individual and organizational resources that include nurturing work culture, teamwork, and support from the medical community and at home. Our findings suggest that resilience in physicians is dynamic and must be supported not only by physician-directed interventions but also by organization-directed interventions.

Background/Objectives: Menopause is a significant, universal hormonal transition, with symptoms impacting ~80% of women. Research shows that menopause can be professionally disruptive, contributing to decreased productivity, absenteeism, and early exit from the workplace. The objective of this study was to describe the landscape of menopause among Canadian women physicians and explore its potential impact on work performance, job satisfaction, and absenteeism. Methods: In this exploratory cross-sectional study, Canadian physicians self-identifying as women and peri-menopausal or menopausal were invited to participate in an online survey between May–September 2023. Demographic and practice characteristics data were collected. A modified Menopause Rating Scale (MRS) was used to quantify symptom burden. Qualitative data describing the menopausal experience were collected as well. Primary outcome was self-reported work performance. Secondary outcomes included perceived impact of menopause on promotional opportunities, absenteeism, and job satisfaction. Multivariable regression was used to examine associations between MRS scores and outcomes of interest. Results: Among 217 respondents, 47.7% reported a severe menopausal symptom burden; 40% felt menopause negatively impacted work performance, and 16.1% expressed job dissatisfaction. However, fewer than 10 respondents (4.6%) ever took time off for menopausal symptoms. Increasing MRS scores were significantly associated with negative perceived work performance (p < 0.001), fewer promotional opportunities (p < 0.001), and lower job satisfaction (p = 0.006) when controlling for confounders. Qualitative responses were provided by 43 participants, 6 of whom reported positive aspects of the menopausal transition, whereas 20 elaborated on the challenges. Conclusions: Canadian women physicians can experience severe menopausal symptoms, often without support. This needs assessment highlights an important occupational health issue and suggests that opportunities remain for medical institutions and employers to formally recognize and study this life stage of women physicians to improve well-being for this valuable workforce.

Background Almost half of trainees experience burnout during their career. Despite the Accreditation Council on Graduate Medical Education (ACGME) recommendation that training programs enact well-being curricula, there is no proven method of addressing this difficult topic. Methods We created a curriculum addressing physician resiliency and well-being, designed for an Internal Medicine Residency Program. This curriculum utilized episodes from a medical television series, Scrubs , to facilitate a monthly, 1-h faculty guided discussion group. We collected informal feedback and abbreviated Maslach Burnout Inventories (aMBI) monthly and conducted a formal focus group after 6 months to gauge its effectiveness. Results The curriculum was successfully conducted for 12 months with each session averaging 18–20 residents. Residents reported high satisfaction, stating it was more enjoyable and helpful than traditional resiliency training. 19 of 24 residents (79 %) completed a baseline aMBI, and 17 of 20 residents (85 %) who attended the most recent session completed the 6-month follow-up, showing a non-significant 1-point improvement in all subsets of the aMBI. Conclusions This novel, low-cost, easily implemented curriculum addressed resiliency and burn-out in an Internal Medicine Residency. It was extremely well received and can easily be expanded to other training programs or to providers outside of training.