Background: The COVID-19 pandemic introduced significant stressors on the healthcare workforce and psychological distress is on the rise. The objective of this study was to evaluate a Hospitalist Morale Index (HMI) as a measure of well-being during the pandemic in comparison to other measures of morale, quality of life, and burnout.
Methods: The HMI is a scale comprising 5 domains: (1) clinical, (2) workload, (3) leadership, (4) appreciation & acknowledgement, and (5) material rewards. Overall and domain scores are weighted means of items based on importance and satisfaction ratings, ranging from 0 (low) to 5 (high). In September 2020, we surveyed 183 hospitalists in 5 tertiary care and community hospitalist programs. We also measured self-reported quality of life, personal and group morale, emotional exhaustion, depersonalization, depression, and thoughts of leaving hospital medicine or the current group. Demographic factors collected included age, sex, race/ethnicity, and having children. Clinical factors included academic role, position/rank, years as a hospitalist and working for the current group, number of hospitalist groups worked for, and percent clinical time. We used ANOVA and logistic regression to determine the association of the HMI between groups and outcomes, accounting for site clustering.
Results: Of the 183 hospitalists, 141 (77%) responded. Fifty-four percent were women, 42% Caucasian, 39% Asian, 5% African-American and 1% Latino. The majority of physicians were 35-44 years old (44%), with an additional 28% under the age of 35. By position, median 90% clinical time [IQR: 65%, 100%], 46% were Clinical Associates, 42% Faculty Physicians, and 12% PA/NPs; 45% identified as academic. By experience, 51% had worked as a hospitalist for over 7 years, with 12% <1 year and 37% 1-7 years; for 62%, this was their first hospitalist group.The average HMI score was 3.00 (SD ±0.77). For the other outcomes, 78% reported good or better personal and group morale, with 71% good or better quality of life; however, 17% and 8% reported emotional exhaustion and depersonalization at least once a week respectively, and 15% felt depressed. Almost one fourth of providers had serious thoughts of leaving due to unhappiness, with 18% and 24% not seeing themselves as hospitalists or with the current group long-term, respectively. For the overall HMI and its domains, there was no statistically significant association between any of the measured demographic and clinical variables except for position, where NP/PAs had a lower overall HMI compared with Clinical Associates and Faculty Physicians (2.5, 3.1, 3.1, respectively; p=0.04) and those with children reported higher HMI, workload, and leadership scores (3.1, 3.2, 3.6, respectively, all p<0.02). An increase of 1 HMI point significantly increased good quality of life (OR 5.24; 95% CI 2.56, 10.74) and decreased emotional exhaustion (OR 0.51; CI 0.27, 0.98), depersonalization (OR 0.13; CI 0.04, 0.43), feeling depressed (OR 0.43; CI 0.21, 0.87), poor ratings of personal (OR 0.22; CI 0.10, 0.45) and group (OR 0.40; CI 0.21, 0.75) morale, and thoughts of leaving within 3 months (OR 0.27; CI 0.13, 0.53), from the group (OR 0.27; CI 0.14, 0.54) and hospital medicine (OR 0.34; CI 0.17, 0.69).
Conclusions: There was no significant association between HMI and most demographic and clinical variables, suggesting its robustness to be applied across groups. Higher HMI was associated with positive well-being measures and could be used to monitor hospitalist well-being during and after the pandemic.