Longitudinal Analyses of Pediatrician Burnout

doi:10.1016/j.acap.2018.11.006

Academic Pediatrics

Volume 19, Issue 3, April 2019, Pages 256-262

https://doi.org/10.1016/j.acap.2018.11.006 Get rights and content

Abstract

Objective

Utilize the unique capabilities of a longitudinal design to 1) examine whether burnout is increasing over time among 2 cohorts of pediatricians, and 2) identify factors associated with decreased burnout.

Methods

Data from a national longitudinal study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine self-reported burnout over a 5-year period (2012 to 2016) among 2002 to 2004 and 2009 to 2011 residency graduates (N = 1804). Study participation rates ranged from 94% in 2012 to 85% in 2016. Mixed-effects logistic regression for longitudinal analysis was used to examine burnout over time.

Results

In any given year, between 20% and 35% of study pediatricians reported that they were currently experiencing burnout. Significant increases in burnout over time were found for all participants combined and for each subgroup examined. Several factors were associated with reduced burnout. The largest associations with reduced burnout were found for increased flexibility in work schedule (adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.22–0.35), decreased work busyness (aOR, 0.28; 95% CI, 0.22–0.36), or a job change (aOR, 0.48; 95% CI, 0.36–0.65).

Conclusions

Following 5 years of participation in a longitudinal study, more than 1 in 3 early- to mid-career pediatricians reported experiencing burnout. This represents a 75% relative increase in burnout from the start of the study. Specific characteristics of pediatricians’ jobs, such as flexible work schedules and busyness of work settings, were most strongly associated with reduced burnout.

Section snippets

Methods

The American Academy of Pediatrics (AAP) Pediatrician Life and Career Experience Study (PLACES) was launched in 2012 to track the work and life experiences of pediatricians early in their careers using a national longitudinal design with 2 study cohorts (2002–2004 and 2009–2011 residency graduates).¹⁸ PLACES participants are surveyed twice each year; a primary, longer survey covers several domains measured each year (eg, work characteristics, satisfaction, work-life balance, life experiences),

Results

Data from all 1804 PLACES participants were included in the analyses. Participants were equally divided by cohort, with 50% in the 2002–2004 graduate cohort (n = 901) and 50% in the 2009–2011 graduate cohort (n = 903). The majority of participants were female (1316/1804, 73%). Nearly 9 in 10 (1567/1801, 87%) graduated from US medical schools, and 41% (745/1803) had received subspecialty training.

Discussion

In a national longitudinal study, 35% of pediatricians reported experiencing burnout in 2016, and 58% experienced burnout at 1 or more time points over 5 years. Although the current study is generally consistent with other studies,6, 7 comparisons across studies are difficult due to the heterogeneity of burnout measures that have been used and inconsistent definitions.11, 26 Our results also demonstrated a relative increase in self-reported burnout of 75% over time for the sample overall, with

Conclusions

In summary, our study documented an increase in the percentage of early- to mid-career pediatricians experiencing burnout, with 35% reporting it in 2016 and 58% in any year. The increase was apparent in all subgroups examined and largest among women. Most pediatricians who reported burnout did not also report being dissatisfied with their career or being sad or depressed. Many structural work changes, such as more flexible work schedules and decreased busyness, were most strongly associated

Acknowledgments

The authors thank the pediatricians participating in the Pediatrician Life and Career Experience Study (PLACES), who all are giving generously of their time to make this project possible. Members of the PLACES Project Advisory Committee include Bobbi J. Byrne, MD, FAAP, chair; Gary L. Freed, MD, MPH, FAAP; Shesha Kalyan Katakam, MD, MPH, FAAP; Laurel K. Leslie, MD, MPH, FAAP; Ashley A. Miller, MD, FAAP; and Amy J. Starmer, MD, MPH, FAAP.

Funding disclosure: This research was funded by the

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Our results have high clinical relevance to challenge psychological burnout among early medical residents, offering some possible clues for prevention such as reduced burden, more flexibility during the first year and strengthening coworker support. Insomnia exerted moderate to strong effects on depression and monitoring of sleep appears indispensable in this specific population.
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Most ECPs believe their sacrifices to become a pediatrician were worth it. Female pediatricians were less likely to feel personal sacrifices were worth it and reported more sacrifices related to having children.
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And, finally, like all of society, health care providers were concerned and grappling with their family's health and their children's education while coping with the isolation imposed by social distancing (Randell et al., 2021; Brooks et al., 2020; Brubaker, 2020; Shanafelt et al., 2020). Literature has shown that physician wellness was already an issue before the pandemic (AAMC, 2021; Hartzband and Groopman, 2020; Shanafelt et al., 2020; Cull et al., 2019; Kalmoe et al., 2019; Friedberg et al., 2014), but several studies have shown that the wellness of health care professionals has suffered even more during this time (Rosenberg et al., 2021; Bansal et al., 2020; Cabarkapa et al., 2020; Conti et al., 2020; Dewey et al., 2020; Sanghavi et al., 2020; Friedberg et al., 2014). Increasing rates of anxiety, depression, and stress have been documented (Conti et al., 2020; Sanghavi et al., 2020; Shanafelt et al., 2020; Temsah et al., 2020).
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Different Measures and Ways to Categorize Pediatrician Burnout and the Association with Satisfaction
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Citation Excerpt :
Millennial and Gen X physicians reported bureaucratic tasks, too many hours at work, and lack of respect from administrators, employers, colleagues, and staff as top contributors to burnout.28 Another study using PLACES data found that pediatrician participants who experienced burnout at 1 or more time points across the study years reported processes that decrease administrative tasks for physicians, processes to improve workflow efficiency, and lighter or flexible work schedules as strategies to help decrease burnout.12 Our study found strong relationships between burnout profiles and EHR documentation stress.
Compare pediatrician burnout when measured and categorized in different ways to better understand burnout and the association with satisfaction.
We analyzed national survey data from a cohort study of early to midcareer pediatricians. In 2017, participants randomly received 1 of 3 question sets measuring burnout components (emotional exhaustion, depersonalization, and personal accomplishment): group A received the Maslach Burnout Inventory, group B received a previously used measure, and group C received a new severe measure. Repeated measures ANOVA tested differences across burnout categorizations: high emotional exhaustion and high depersonalization and low personal accomplishment; high emotional exhaustion and high depersonalization; and high emotional exhaustion or high depersonalization. Logistic regression tested relationships between burnout profiles (engaged, intermediate, and burnout) and satisfaction. Seventy-one percent of participants completed the survey (1279/1800).
Burnout varied depending on measurement (groups A, B, and C) and categorization. For example, for group A, when categorized as high emotional exhaustion, high depersonalization, and low personal accomplishment, burnout was lower (4.8%) than categorized as high emotional exhaustion and depersonalization (15.2%) (P < .001) or categorized as high emotional exhaustion or depersonalization (44.6%) (P < .001). Most participants were satisfied with their career (83.6%). Using burnout profiles, 38.4%-85.1% fell in the engaged profile. For each group, burnout profiles were associated with satisfaction. For example, group A participants in the burnout or intermediate profile were less likely than those engaged to be satisfied with their careers (aOR, 0.08 [95% CI, 0.03-0.24]; and aOR, 0.23 [95% CI, 0.10-0.56], respectively).
The way burnout is measured and categorized affects burnout prevalence and its association with satisfaction. Transparency in methodology used is critical to interpreting results.

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: The authors have no conflicts of interest to disclose.

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Original ArticleLongitudinal Analyses of Pediatrician Burnout

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgments

Mayo Clin Proc

Mayo Clin Proc

Compassion, compassion fatigue, and burnout: key insights for oncology professionals

Am Soc Clin Oncol Educ Book

Compassion fatigue, burnout and compassion satisfaction in neonatologists in the US

J Perinatol

Compassion fatigue is similar in emergency medicine residents compared to other medical and surgical specialties

West J Emerg Med

Understanding compassion fatigue in healthcare providers: a review of current literature

J Nurs Scholarsh

Reframing physician burnout as an organizational problem: a novel pragmatic approach to physician burnout

Acad Psychiatry

Burnout and satisfaction with work-life balance among US physicians relative to the general US population

Arch Intern Med

Mid-career burnout in generalist and specialist physicians

JAMA

Predictors of physician career satisfaction, work-life balance, and burnout

Obstet Gynecol

Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals

J Gen Intern Med

Prevalence of burnout among physicians: a systematic review

JAMA

Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians

JAMA

Original Article
Longitudinal Analyses of Pediatrician Burnout