Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey

• Published in: Journal of general internal medicine : JGIM Vol. 31; no. 9; pp. 1004 - 1010
• Main Authors: Linzer, Mark, Poplau, Sara, Babbott, Stewart, Collins, Tracie, Guzman-Corrales, Laura, Menk, Jeremiah, Murphy, Mary Lou, Ovington, Kay
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2016; Springer Nature B.V
• Subjects: Academic Medical Centers - statistics & numerical data; Alignment; Burnout; Burnout, Professional - epidemiology; Burnout, Professional - psychology; Content analysis; Documentation; Electronic medical records; Female; Health Personnel - psychology; Health Personnel - statistics & numerical data; Hospitalists; Humans; Internal Medicine; Internal Medicine - statistics & numerical data; Job Satisfaction; Male; Medical electronics; Medical personnel; Medicine; Medicine & Public Health; Nurse Practitioners - psychology; Nurse Practitioners - statistics & numerical data; Occupational health; Original Research; Physician Assistants - psychology; Physician Assistants - statistics & numerical data; Physicians; Physicians - psychology; Physicians - statistics & numerical data; Pressure; Qualitative analysis; Stress; Stress, Psychological - epidemiology; Stress, Psychological - psychology; Stresses; Surveys and Questionnaires; Sustainability; Teamwork; United States - epidemiology; Workplace - psychology; Workplace - statistics & numerical data; Workplaces; stress; physician satisfaction; general internal medicine; burnout; clinician burnout
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-016-3720-4

ABSTRACT BACKGROUND General internal medicine (GIM) careers are increasingly viewed as challenging and unsustainable. OBJECTIVE We aimed to assess academic GIM worklife and determine remediable predictors of stress and burnout. DESIGN We conducted an email survey. PARTICIPANTS Physicians, nurse practitioners, and physician assistants in 15 GIM divisions participated. MAIN MEASURES A ten-item survey queried stress, burnout, and work conditions such as electronic medical record (EMR) challenges. An open-ended question assessed stressors and solutions. Results were categorized into burnout, high stress, high control, chaos, good teamwork, high values alignment, documentation time pressure, and excessive home EMR use. Frequencies were determined for national data, Veterans Affairs (VA) versus civilian populations, and hospitalist versus ambulatory roles. A General Linear Mixed Model (GLMM) evaluated associations with burnout. A formal content analysis was performed for open-ended question responses. KEY RESULTS Of 1235 clinicians sampled, 579 responded (47 %). High stress was present in 67 %, with 38 % burned out (burnout range 10–56 % by division). Half of respondents had low work control, 60 % reported high documentation time pressure, half described too much home EMR time, and most reported very busy or chaotic workplaces. Two-thirds felt aligned with departmental leaders’ values, and three-quarters were satisfied with teamwork. Burnout was associated with high stress, low work control, and low values alignment with leaders (all p  < 0.001). The 45 VA faculty had less burnout than civilian counterparts (17 % vs. 40 %, p  < 0.05). Hospitalists described better teamwork than ambulatory clinicians and fewer hospitalists noted documentation time pressure (both p  < 0.001). Key themes from the qualitative analysis were short visits, insufficient support staff, a Relative Value Unit mentality, documentation time pressure, and undervaluing education. CONCLUSIONS While GIM divisions overall demonstrate high stress and burnout, division rates vary widely. Sustainability efforts within GIM could focus on visit length, staff support, schedule control, clinic chaos, and EMR stress.