Workplace dysfunction, concern about patient care among top complaints

Mindfulness and confidence-building are not the solution to physician burnout — rather, an organizational shift to address workplace conditions is needed, according to a new study.

“The reviewed evidence suggests that trainee physicians reporting negative workplace conditions, such as dysfunctional work environment, excessive work demands, and concerns about patient care, were 2 times more likely to report burnout/stress,” wrote study author Anli Yue Zhou, MBChB, a health services and primary care researcher with the University of Manchester in the United Kingdom, and colleagues, in JAMA Network Open. “We also found evidence that some non-work-related factors may be associated with burnout/stress in trainee physicians, but most of these appear to be less important than workplace factors.”

It is well documented that residents, interns, and fellows face a higher-than-normal risk of burnout, a term Zhou and colleagues defined as “emotional exhaustion, reduced sense of personal accomplishment, and depersonalization.” Previous studies, they noted, have revealed that as many as half of all trainee physicians experienced burnout symptoms.

“Better understanding of factors that underpin feelings of stress and burnout in trainee physicians has important implications,” Zhou and colleagues wrote. “Thus, we have conducted the first systematic review and meta-analysis to identify workplace- and non-workplace-related factors that are associated with burnout/stress in trainee physicians and the relative importance of these factors.”

The study authors analyzed 48 studies encompassing 36,266 patients (median age, 29 years [range, 24.6-35.7 years]), of which 18,781 (52%) were men. Zhou and colleagues categorized potential factors for burnout into workplace- and non-workplace-related groupings. As part of their analysis, they used the I2 statistic “to assess heterogeneity between studies. An I2 value of 0% to 49% indicated low heterogeneity; 50% to 74%, moderate; and 75%to 100%, high.”

Under the category of workplace-related factors, work demands had the single strongest association with burnout among all factors, nearly tripling the odds among physicians included in the studies (OR 2.84; 95% CI 2.26-3.59; I2=88.8%; P<.001). Other workplace-related triggers included concerns related to patient care (OR 2.35; 95% CI 1.58-3.50; I2=83.2%; P<.001), work environment (OR 2.06; 95% CI 1.57-2.70; I2=82.8%; P<.010), work-life balance (OR 1.93; 95% CI 1.53-2.44; I2=85.7%; P<.001), and career development (OR 1.73; 95% CI 1.44-2.08; I2=71.4%; P<.001).

Several non-workplace-related stressors also were shown to increase the likelihood of burnout. Chief among these was poor mental or physical health, (OR 2.41; 95% CI 1.76-3.31), with other such factors including female sex (OR 1.34; 95% CI 1.20-1.50), financial worries (OR 1.35; 95% CI 1.07-1.72), and low self-efficacy (OR 2.13; 95% CI 1.31-3.46).

No connection emerged between burnout and seniority (OR 1.13; 95% CI 0.76-1.69; I2 = 87.7%; P<.001), with neither younger age nor a more junior trainee status significantly linked to burnout or stress.

Zhou and colleagues attempted to evaluate associations across specialties, though they wrote that a lack of robust data and inconsistency among studies made the prospect “challenging.” Still, they found that psychiatry was associated with higher levels of burnout than family medicine and surgery (OR 1.41; 95% CI 1.1-1.8; I2=22.8%; P=.27).

Based on their findings, study authors suggested that the work of addressing physician burnout should not fall solely to the physician.

“Previously evaluated interventions to reduce burnout have focused on physician-directed interventions, such as mindfulness and building self-confidence,” Zhou and colleagues wrote. “Studies that have tested organizational interventions tend to focus mostly on modifying shift patterns and workload, but few studies have incorporated interventions that try to address multiple organizational factors, including improved teamwork, workflow, and organizational restructuring, which may be more useful in reducing burnout. Our findings suggest a need to shift to research agendas that target the organizational environment, improving working relationships among physicians and other health care professionals, as well as promoting work-life balance to mitigate burnout in trainee physicians.”

Study limitations identified by the authors included challenges related to heterogeneity among studies and data. Zhou and colleagues suggested that “future empirical studies be conducted to examine the joint contribution of the core factors that we found to be associated with burnout.”

In an accompanying editorial, Dave Lu, MD, an emergency physician and health services researcher with University of Washington School of Medicine, and who was not affiliated with the study, observed that previous interventions geared toward reducing burnout have met with disappointing results. Strategies and studies that shift toward a broader view of the issue—and the responsibility for its improvement—could be an important step in seeking meaningful solutions.

“While there is a role for individual interventions, without concurrent systems- and organization-based actions, such interventions are not sufficient,” Lu wrote. “There remains a dearth of large-scale and rigorous studies of burnout interventions for trainees and other clinicians. As the landscape of medicine changes in the face of political, economic, and social challenges, issues surrounding burnout and occupational stress are not going away.”

  1. Work demands and other workplace-related concerns were the main cause of burnout among trainee physicians. Other workplace-related triggers included concerns related to patient care, work environment, work-life balance, and career development.

  2. Study finds that workplace conditions need to be addressed rather than implementing physician-directed interventions.

Scott Harris, Contributing Writer, BreakingMED™

No source appearing in this article disclosed any relevant financial relationships with industry.

Cat ID: 504

Topic ID: 498,504,504,791,730,192,925