2017 HSC Section 2 - Practice Management

Otolaryngology–Head and Neck Surgery 146(2)

relationship between practice setting (ie, academic or pri- vate, solo or group) and EE or DP. Discussion Physician burnout continues to be a widespread problem with many deleterious sequelae. The negative impacts of physician burnout on the health care landscape are well documented and include such effects as dissatisfied and less compliant patients, riskier prescribing profiles, lower produc- tivity, and increases in medical errors, to name a few. 14-18 Although several studies have recently begun to address this phenomenon in otolaryngologists, 7,8,19 we have yet to attain a thorough understanding of the risk factors leading to its occurrence. Herein we report a study of burnout in practicing otolaryngologists with correlation to potentially modifiable risk factors. Burnout was not very prevalent in our survey population. Of those surveyed, only 3.5% experienced the composite syndrome of burnout with high scores on all 3 indices, and 16% had burnout according to subscale measurements of EE and DP. In addition, analysis of the subscale results shows a more favorable picture of practicing otolaryngolo- gists’ health with respect to burnout. Both emotional exhaustion and depersonalization scores on average were in the low range. High levels of EE and DP were found in only 19% and 21% of respondents, respectively. These results are in contrast to other published surveys of burnout in academic otolaryngologists and department chairs, which showed moderate levels of burnout in the majority of respondents. 7,8 Prior studies 7 have also demonstrated lower levels of burnout among otolaryngologists when compared to other surgical specialties such as general surgery and OB/ GYN, and our results are in keeping with this. Our respon- dents also had lower mean burnout scores than were reported in the normative data for the medicine subscale of the MBI-HSS, which showed mean (SD) EE, DP, and PA levels of 22.19 (9.53), 7.12 (5.22), and 36.53 (7.34), respec- tively. 10 When compared to large surveys of burnout such as the one by Shanafelt et al 20 of 7905 members of the American College of Surgeons, our population also had a lower level and degree of burnout. This may reflect a sam- pling bias of our study in that those surgeons experiencing higher levels of burnout may have been less likely to com- plete and return our survey because of a lack of interest or time. Therefore, it is possible that the extent of burnout was underreported in our study population. The study population in Shanafelt et al also comprised 41% general surgeons compared to 4.7% otolaryngologists. This difference in study population may account for the observed difference in burnout reported, in light of the fact that the general surgery population tends to have higher degrees of burnout than otolaryngology. Both the prevention and treatment of burnout rely heav- ily on the recognition of its manifestations. Recognition can be difficult in professionals with high stress such as physi- cians, who frequently demonstrate poor insight into their own mental and professional health. 21 This has contributed

Table 2. Percentage of Participants Meeting Criteria for Burnout

Burnout

No. (%)

" EE/DP

19/115 (16) 4/115 (3.5)

" EE/DP, # PA

Abbreviations: EE, emotional exhaustion; DP, depersonalization; PA, per- sonal accomplishment, " , high level; # , low level.

Table 3. Mean Maslach Burnout Inventory Subscores for Survey Participants

Mean Standard Deviation Range

Emotional exhaustion Depersonalization

16.5

11.5

Low

6.2

5.4 5.8

Moderate

Personal accomplishment 41.2

Low

of EE were low in most participants (71%), with 15% and 19% indicating moderate and high levels, respectively. Levels of DP were also low in the majority (56%), with 17% exhibiting moderate and 21% with high levels. Results are listed in Table 2 for the number of respondents meeting criteria for the true syndrome of burnout characterized by high levels of EE and DP combined with low levels of PA, as well as those with high EE and DP alone, irrespective of PA. Both have been used in the literature to classify individ- uals as demonstrating high levels of burnout. 2,11,12 The use of the EE and DP indices to measure burnout independent of PA is based on findings from the development of the MBI-HSS showing strong correlation between levels of EE and DP regardless of PA. 10 On the basis of these 2 criteria, 3.5% exhibited burnout syndrome and 16% demonstrated high levels of burnout. Table 3 lists the mean MBI-HSS sub- scores for our survey participants. The mean (SD) EE score fell into the low range at 16.5 (11.5), the mean (SD) DP score was moderate at 6.2 (5.4), and the mean (SD) PA score was high at 41.2 (5.8) (scale: low EE 18, high EE 27; low DP 5, high DP 10; high PA 40, low PA 33). Correlation and linear regression modeling were per- formed to determine predictors of burnout. In keeping with similar studies of burnout, 3,13 our analysis concentrated on EE and DP, which had the strongest associations among the 3 burnout subscales. Table 4 summarizes significant results. Age showed an inverse relationship with EE ( r = –0.39, P \ .0001) and DP ( r = –0.28, P \ .0041). The length of time married also showed similar negative correlations with EE ( r = –0.33, P = .0007) and DP ( r = –0.33, P = .0045). The number of children in the home was correlated with EE ( r = 0.22, P = .0275) and DP ( r = 0.23, P = .0235). With regard to practice-related factors, the number of hours worked per week showed an association with EE ( r = 0.31, P = .0016). Likewise, the number of years on the job was also related with EE but showed an inverse relationship ( r = –0.25, P = .0108). There was no statistically significant

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