Giving physicians ‘a feeling of autonomy’ can minimize burnout, reduce turnover
Click Here to Manage Email Alerts
Approximately one-third of clinicians working in academic settings expressed intentions to leave their current institution within the next 2 years, survey results revealed.
The study — conducted by Healthcare Professional Well-being Academic Consortium and published in JAMA Network Open — included more than 18,000 physician respondents across specialties.
“We all recognize that there has been incredible strain on the medical workforce, not just through the pandemic, but even before that,” Jennifer A. Ligibel, MD, associate professor at Harvard Medical School and a senior physician in the breast oncology center at Dana-Farber Cancer Institute, told Healio.
“Recent years have imparted even more strain, first with the pandemic and then with staffing shortages,” she added. “As we think about ways to prevent physician turnover and the disruption this brings to patient care, it’s important to recognize the things that make physicians feel happy and supported in their jobs.”
Ligibel spoke with Healio about the varying degrees of professional fulfillment and burnout across specialties, and discussed how institutions can best support physicians in providing patient care.
Healio: What was the rationale for this study?
Ligibel: This is part of a larger effort around looking at the factors that cause physicians to be burned out and to leave medicine. The Healthcare Professional Well-being Consortium is a group of approximately 22 academic institutions, 15 of which participated in this survey during the period we evaluated. Consortium participants assess burnout and related factors in health care professionals working at their institutions on a regular basis and work together to develop programs to support well-being in their clinician workforce.
Healio: How did your study assess intention to leave?
Ligibel: Participants were asked about the likelihood that they would leave their institution within the next 2 years, responding on a scale that ranged from “not at all” to “definitely.” Respondents whose intention to leave on that scale was “moderate” or above were placed in the category of expressing at least moderate intention to leave. This definition has been used before and has been shown to be highly indicative in other surveys of people actually leaving their jobs. The survey also looked at burnout and professional fulfilment among respondents.
Healio: What did the survey find?
Ligibel: About one-third of physicians from participating institutions expressed at least a moderate intention to leave. The proportion of physicians expressing an intention to leave varied among the different specialties, with some reflecting almost 50% intention to leave and others demonstrating a much lower percentage. Anesthesiologists expressed a high rate of intention to leave, for example, at about 47% of surveyed physicians. Intention to leave was also high in some surgical specialties, as well as critical care. Notably, some of this information was collected during the pandemic, so that may have had an impact on the results.
Conversely, physicians in hospice and palliative care, physical medicine and rehabilitation, and pediatrics were less likely to express an intention to leave. We also found that — not surprisingly — those who expressed an intention to leave were more likely to be burned out and have lower rates of professional fulfillment. Many other factors were also related to intention to leave. This does give hospitals a starting point when thinking about how to support and retain physicians.
Healio: Where did oncologists fall in terms of intention to leave?
Ligibel: We were very interested in looking at oncology, in particular. Oncology is an interesting field in that there are inherent challenges in terms of the intensity of clinical care, given the seriousness of the illness and growing complexity of cancer treatments. Historically, oncology has also demonstrated higher rates of professional fulfillment and job satisfaction. This shows that physicians in some specialties can experience both higher rates of burnout, but also higher rates of professional fulfillment. In terms of intention to leave in the current survey, oncologists were right around the median point — not especially high or low.
Healio: The survey found some specialties had both high rates of burnout and professional fulfilment. What do you think this indicates?
Ligibel: We saw many different patterns. Some subspecialties had high rates of burnout and high rates of intention to leave with low professional fulfilment. Other specialties had low burnout and high fulfilment. Some physicians were burned out but still fulfilled, while others weren’t burned out but weren’t very fulfilled. We found that these factors aren’t necessarily inversely related. Overall, though, there was definitely an association between higher levels of burnout and higher levels of intention to leave, as well as a relationship between higher levels of fulfillment and lower likelihood of intending to leave.
Healio: What other factors are associated with professional fulfillment and intention to leave?
Ligibel: Not surprisingly, supportive leadership behaviors were associated with lower intention to leave, as was strong peer support, a feeling that physicians’ values were aligned with those of the institution, and feeling that people were grateful for the work they did. Conversely, depression and a negative impact of work on personal relationships were both related to a higher intention to leave.
Healio: Based on these findings, what can be done to improve professional fulfillment?
Ligibel: It’s not easy to work in medicine, so it’s important to ensure that physicians know that the work they do is important and valued. In terms of burnout, it’s important to give physicians a feeling of autonomy — having a say in decision-making and having control over their lives and schedules. This is an important piece of the puzzle as we try to support our physician workforce as well as other members of the health care team. We have arrived at a place over the past few years where there has been a tremendous number of departures from medical jobs, and I believe this is something we need to take seriously to ensure that we are able to care for the American population.
Healio: Do you plan to study this further now that the pandemic has subsided?
Ligibel: The institutions that are part of this consortium collect data from physicians and other members of their health care teams. Usually, each institution delivers a survey every 2 years. So, in a year or two, we will create another benchmark and look at trends over time. Specifically in terms of oncology, there is a group through ASCO that has been conducting a different survey that also looks at burnout and related factors in oncology professionals. I expect we will see some data from that soon. I’m also very interested in the work that seeks to pilot different solutions to issues like burnout and low professional fulfillment in physicians. The AMA has a great program called Joy at Work, which is focused on trying to combat burnout. Many institutions are now recognizing how important this is. We’re now considering how, on a system-wide basis, we can begin to turn the tide on burnout.
Healio: Is there anything else you’d like to mention?
Ligibel: One thing we couldn’t assess in this survey was where these physicians intended to go. They expressed an intention to leave, but where were they going? Were they leaving their current institution or leaving medicine altogether? This information will be critical to developing ways to prevent physician turnover and the disruption this causes to patient care.
Reference:
For more information:
Jennifer A. Ligibel, MD, can be reached at 450 Brookline Ave., Boston, MA 02215; email: jennifer_ligibel@dfci.harvard.edu.
Collapse
Healio Interviews
Read more about
Click Here to Manage Email Alerts