2017 HSC Section 2 - Practice Management

Fletcher et al

Table 4. Significant Predictors of Burnout

Predictor Regression Coefficient ( b ) Standard Error 95% Confidence Interval (of b ) R 2

P Value

Covariate

0.15 \ .0001 0.08 .0041 0.11 .0007 0.08 .0045 0.05 .0275 0.05 .0235 0.10 .0016 0.06 .0108

2 3.28 2 1.05 2 0.24 2 0.09

2 4.80 to –1.76 2 1.75 to –0.34 2 0.38 to –0.11 2 0.16 to –0.03

Age

EE

0.77 0.36

DP

No. of years married

EE

0.069 0.032

DP

Presence of children in the home

EE

1.93 0.88 0.15

0.86 0.38

0.22 to 3.64 0.12 to 1.64 0.06 to 2.24

DP

Hours worked/wk No. years on the job

EE EE

0.047

2 0.27

2 0.49 to –0.07

0.11

Abbreviations: EE, emotional exhaustion; DP, depersonalization.

to the immense underrecognition of burnout in physicians. The ability to quantify burnout using a validated instrument (MBI-HSS) has enhanced our capacity to detect burnout and to understand the factors associated with it. Studies that have used the MBI-HSS have shown lower levels of burnout in otolaryngologists when compared with other surgical special- ties. 1,13 Studies have also shown that burnout in otolaryngolo- gists varies based on level of training. In a 2007 study, Golub et al 5 found high levels of burnout in 10% of residents sur- veyed, whereas Hill and Smith 6 found that 31% of residents experienced high levels of burnout. This is in comparison to a survey of academic faculty demonstrating high levels of burnout in 4% and a separate study of department chairs that had high levels in only 3%. 7,8 Our investigation further bears this out, with burnout syndrome demonstrated in only 3.5% of practicing otolaryngologists surveyed. This difference is thought to be the result of the higher work hour demands placed on residents, who, despite the recent reduction in work hours mandated by the Accreditation Council for Graduate Medical Education, are still working more hours per week than their attending counterparts. Indeed, in many studies, the number of hours worked per week has consistently been shown to be one of the strongest predic- tors of physician burnout. 1,7,22,23 This was also the case in the present study, which demonstrated a significant corre- lation between the number of hours worked per week and one’s level of EE. Given the demanding nature of the med- ical field, this is not surprising; yet if a reduction in the level of burnout is to be expected with one’s career advancement, perhaps efforts to curb burnout are best tar- geted toward residents in training. These interventions may alleviate burnout stemming from overwork, but they would not obviate the search for modifiable risk factors to curb the incidence of burnout deriving from other sources. Our understanding of the risk factors that contribute to burnout is still emerging. In a recent survey of academic faculty in otolaryngology, Golub et al 7 found that dissatis- faction with the balance between personal and professional life was one of the strongest predictors of burnout. A similar survey of academic chairs in otolaryngology found that burnout was correlated with low spousal support, the loss of key faculty, and disputes with the medical school dean. 8

These findings shed light on one of the key elements of burnout: the sense of losing control of one’s professional life. In fact, a strong sense of control of one’s environment has been shown to be of paramount importance to attenuat- ing symptoms of burnout. 4,24,25 In the current study, younger age and fewer years in practice were significant predictors of burnout. This is in keeping with previously published data in otolaryngologists and other surgical specialties. 7,26 This may be explained by the perceived lack of control of one’s professional environ- ment at the early stages of one’s career when new and often unfamiliar stressors are brought to bear. Physicians who have been in practice longer have most likely adapted coping mechanisms that are protective against burnout. Experience also allows for maturity and increased confi- dence, both of which provide an improved sense of control over professional matters. It is also somewhat more difficult to determine the optimal professional/personal balance ear- lier in one’s career, thus increasing the strain of each. Interestingly, practice setting did not correlate with burnout, thus highlighting the importance of personal coping skills as a more important determinant of response to stress than work environment. We also found no significant correlation between religious beliefs and EE or DP. The quality of interpersonal relationships and personal sup- port systems has been highlighted as having a significant impact on the development of professional burnout. 15,18,23 The presence of work-home conflicts has also been shown to be a major contributing factor to surgeon burnout. 25 Our present analysis demonstrates an inverse relationship between the number of years married and both EE and DP. One explana- tion is that the experience and maturity acquired through years of marriage improve one’s adaptability to its demands and insulates against the development of EE and DP. Certainly, the personal stresses of a new marriage can be challenging, and when compounded with the constant emotional and psycholo- gical demands of patient care, this may significantly increase one’s risk of burnout. Our study also found that having more children in the home was significantly correlated with both EE and DP. Given the constant demands of childrearing, this is not surprising. Yet the complex interplay of these demands with one’s professional aspirations may also contribute to

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