Mark Linzer1,2, Sara Poplau3,4, Stewart Babbott5, Tracie Collins6, Laura Guzman-Corrales4, Jeremiah Menk7, Mary Lou Murphy8, Kay Ovington9. 1. Division of General Internal Medicine, Hennepin County Medical Center, 701 Park Avenue (P7), Minneapolis, MN, 55415, USA. Mark.Linzer@hcmed.org. 2. Department of Medicine, University of Minnesota, Minneapolis, MN, USA. Mark.Linzer@hcmed.org. 3. Division of General Internal Medicine, Hennepin County Medical Center, 701 Park Avenue (P7), Minneapolis, MN, 55415, USA. 4. Minneapolis Medical Research Foundation, Minneapolis, MN, USA. 5. Department of Medicine, University of Kansas, Kansas City, KS, USA. 6. Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita, KS, USA. 7. Biostatistical Design and Analysis Center, Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN, USA. 8. Center for Physician Wellness and Professional Fulfillment, Stanford Medicine, Palo Alto, CA, USA. 9. Society of General Internal Medicine and Association of Chiefs and Leaders in General Internal Medicine, Alexandria, VA, USA.
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.
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.
Entities:
Keywords:
burnout; clinician burnout; general internal medicine; physician satisfaction; stress
Authors: Tait D Shanafelt; Colin P West; Jeff A Sloan; Paul J Novotny; Greg A Poland; Ron Menaker; Teresa A Rummans; Lotte N Dyrbye Journal: Arch Intern Med Date: 2009-05-25
Authors: Stewart Babbott; Linda Baier Manwell; Roger Brown; Enid Montague; Eric Williams; Mark Schwartz; Erik Hess; Mark Linzer Journal: J Am Med Inform Assoc Date: 2013-09-04 Impact factor: 4.497
Authors: Mark Linzer; Sara Poplau; Ellie Grossman; Anita Varkey; Steven Yale; Eric Williams; Lanis Hicks; Roger L Brown; Jill Wallock; Diane Kohnhorst; Michael Barbouche Journal: J Gen Intern Med Date: 2015-02-28 Impact factor: 5.128
Authors: Tait D Shanafelt; Sonja Boone; Litjen Tan; Lotte N Dyrbye; Wayne Sotile; Daniel Satele; Colin P West; Jeff Sloan; Michael R Oreskovich Journal: Arch Intern Med Date: 2012-10-08
Authors: Tosha B Wetterneck; Mark Linzer; Julia E McMurray; Jeffrey Douglas; Mark D Schwartz; JudyAnn Bigby; Martha S Gerrity; Donald E Pathman; David Karlson; Elnora Rhodes Journal: Arch Intern Med Date: 2002-03-25
Authors: Karen E Hauer; Steven J Durning; Walter N Kernan; Mark J Fagan; Matthew Mintz; Patricia S O'Sullivan; Michael Battistone; Thomas DeFer; Michael Elnicki; Heather Harrell; Shalini Reddy; Christy K Boscardin; Mark D Schwartz Journal: JAMA Date: 2008-09-10 Impact factor: 56.272
Authors: Mark Linzer; Linda Baier Manwell; Eric S Williams; James A Bobula; Roger L Brown; Anita B Varkey; Bernice Man; Julia E McMurray; Ann Maguire; Barbara Horner-Ibler; Mark D Schwartz Journal: Ann Intern Med Date: 2009-07-07 Impact factor: 25.391
Authors: Rebekah L Gardner; Emily Cooper; Jacqueline Haskell; Daniel A Harris; Sara Poplau; Philip J Kroth; Mark Linzer Journal: J Am Med Inform Assoc Date: 2019-02-01 Impact factor: 4.497
Authors: Taiwo Adesoye; Christina Mangurian; Esther K Choo; Christina Girgis; Hala Sabry-Elnaggar; Eleni Linos Journal: JAMA Intern Med Date: 2017-07-01 Impact factor: 21.873
Authors: Monee Rassolian; Lars E Peterson; Bo Fang; H Clifton Knight; Michael R Peabody; Elizabeth G Baxley; Arch G Mainous Journal: JAMA Intern Med Date: 2017-07-01 Impact factor: 21.873
Authors: Kiran Gupta; Sarah Lisker; Natalie A Rivadeneira; Christina Mangurian; Eleni Linos; Urmimala Sarkar Journal: BMJ Qual Saf Date: 2019-02-04 Impact factor: 7.035