Background: Burnout is a syndrome characterized by three dimensions: emotional exhaustion, depersonalization, and low sense of accomplishment from work. Long work hours, sleep deprivation and loss of autonomy all contribute to higher prevalence of burnout in medical providers1. Organizations are increasingly being encouraged to routinely measure burnout in their providers and implement strategies to mitigate the effects of stress. Additionally, the ACGME has added Professionalism 4: Knowledge of Systemic and Individual Factors of Well Being to residents’ milestones. Despite these calls to address well-being in health care teams, few organizations and training programs routinely measure burnout and incorporate such metrics into organizational quality dashboards.
Methods: The Well-being Index (WBI), developed at the Mayo Clinic is a well-validated self-assessment screening tool that measures six dimensions of distress. “At risk,” individuals who score above a given threshold are at greater risk for adverse outcomes, including but not limited to burnout, severe fatigue, and suicidal ideation. In November 2021, the survey was administered to providers at our hospital that we believed were most susceptible to burnout secondary to the COVID pandemic: providers in the emergency department, intensive care unit, hospitalists, and internal medicine (IM) residents. The WBI was also administered prior to implementation of a Wellness curriculum for the IM residents.
Results: Surprisingly, the pre-intervention survey demonstrated that all physician and physician assistants scored well below the national average with only 25% of responders “at risk” compared to over 40% found to be at risk in the national data2. In contrast, the IM residents scored well above the national average3, with women and PGY2/3s found to be at highest risk. Given these results, our QI team focused efforts on the residents. In collaboration with clinical social workers, we conducted a series of focus groups to identify factors contributing to those questions on the survey that were answered positively, indicating higher measure of distress, and then created qualitative reports that were shared with program leadership. During this time, the piloted wellness curriculum was delivered to all residents. Our residents continued to take part in events organized by the resident-lead wellness committee including, birthday celebrations and holiday parties. The WBI was administered again to just the residents in April 2022. The post-intervention survey found that the WBI score improved from 3.80 to 2.85, with a statistically significant p-value of 0.03 (p ≤ 0.05). Additionally, the number of residents “at risk” decreased by 50% from 40% at baseline to 20%.
Conclusions: Burnout is a major problem facing healthcare systems with negative consequences not only for healthcare providers but also their patients. Residency programs should routinely screen for distress among their trainees and implement strategies to mitigate the effects of work-place stress.