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Early trainee level, younger age linked to burnout, fatigue in rheumatology fellows
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ATLANTA — A national survey of rheumatology fellows found that early trainee level and young age are associated with worsening degrees of fatigue, quality of life and burnout, according to a speaker at the ACR/ARP Annual Meeting.
“According to previous research, 41% of rheumatologists are self-reporting burnout,” Jenna McGoldrick, MD, of Oregon Health & Science University, told attendees. “This is thought to be especially relevant given the anticipated rheumatologist workforce shortage. Hence, the retention of rheumatologists and trainees is critical. The demand for rheumatologists in 2030 is expected to exceed the supply by about 4,000 clinical fulltime equivalent practitioners — and this demand is rising. In 2015, there was an estimated baseline shortage of 700 FTE.”
“There also is a rapid gender shift,” she added. “Currently, the rheumatologist workforce is 59% male. However, by 2030, male physicians will be the minority and female physicians will be predominant in the workforce. One previous study reported that women physicians self-report burnout at a rate 1.6-times that of men. In addition, a 2019 Medscape survey found that 50% of women physicians self-reported burnout, compared with 39% of men.”
To analyze burnout among rheumatology fellows in the United States, McGoldrick and colleagues conducted a cross-sectional study using an anonymous electronic survey. Open from January to February 2019, the survey was distributed through the ACR program directors’ listserv and the ACR Fellows-In-Training Google group, to fellows at ACGME-accredited adult and pediatric rheumatology programs. As an incentive, participants were entered into a raffle to win an Amazon gift card. Among the 567 fellows who received the survey, 105 responded.
The survey used the Maslach Burnout Inventory (MBI) and the Patient Health Questionnaire 2 (PHQ2) to measure depression. Other burnout measures included assessments of emotional exhaustion and depersonalization adapted from the full MBI. Questions measuring fatigue, quality of life, demographics and training year were also included. Open-ended questions assessed participants’ perceptions regarding ways to promote resiliency and reduce burnout, as well as factors that contribute to or worsen burnout. The researchers used bivariate and multivariate regression analyses to evaluate correlates of burnout.
According to McGoldrick and colleagues, 28.2% of rheumatology fellows in postgraduate year four, and 10.6% of those in postgraduate year five or six, demonstrated at least one symptom of burnout (P = .021). In addition, 12.8% of those in postgraduate year four met the criteria for depression, compared with 2.4% of those in year five or six. Fellows in postgraduate year four also reported worse fatigue and poorer quality of life compared with their fifth- or sixth-year peers.
In multivariable models that controlled for training year and gender, higher age was associated with a decreased risk for burnout. Although unadjusted models suggested that fellows in their fifth or sixth postgraduate year demonstrated reduced odds of experiencing burnout, this effect was not present in adjusted models.
In the researchers’ thematic analysis of the open-ended responses, exercise, family and friends, sleep, support at work and hobbies were found to promote resilience and reduce burnout. Participant-reported factors that contribute to burnout included pagers, documentation, presentations and expectations, long hours and the demands of patient care.
“Early training level and younger age are associated with worsened levels of fatigue, quality of life and burnout,” McGoldrick said. “Although awareness and strategies to prevent burnout are needed for all fellows and physicians, targeted interventions for younger fellow, and those in their first year of training, may be provide the highest yield.” – by Jason Laday
Reference:
McGoldrick J. Abstract #1794. An evaluation of burnout among U.S. rheumatology fellows: A national survey. Presented at: American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting; Nov. 9-13, 2019; Atlanta.
Disclosure: McGoldrick reports no relevant financial disclosures.