Background: Healthcare provider burnout is highly prevalent, has been increasing during the COVID pandemic, and affects both physician and advanced practice providers (APP) wellbeing in hospital medicine (HM). The purpose of this study is to characterize and understand HM physician and APP stressors in their work environment, including workload.

Methods: We distributed anonymous, online surveys September – November 2020 through email invitations to 118 HM physicians and 25 APPs at one academic HM division in the Midwest. The surveys assessed stressful aspects of work environment (communication, inclusivity, mentorship) and factors (workload, shift times, patient complexity, electronic health record) that negatively impact well-being, with the latter adapted from the validated burnout measure Mini-Z. We used the Mini-Z open-ended question “Tell us about your stressors and what we can do to minimize them.” We performed univariate statistics to describe work stressors measured quantitatively. We performed qualitative content analysis of open-ended question using an iterative coding process to apply codes, create a codebook, review codes until agreement by consensus, and identify key themes. The study received institutional review board approval.

Results: Of 118 physicians, those completing questions were 53 (45%) for quantitative and 40 (34%) for qualitative. Of 25 APPs, those completing questions were 12 (48%) for quantitative and 10 (40%) for qualitative. For quantitative analyses, the most frequent physician work stressors were amount of work during each shift (64%), variability of work shifts (62%), and poor interactions with nursing (64%) and consulting services (58%). The most frequent APP work stressors were amount of work during each shift (75%), variability of work shifts (67%), lack of sense of belonging in division (67%), and patient complexity (58%). See Table 1 for complete list of stressors. For qualitative analyses, the most frequent physician work stressors were scheduling control, workload, and communication with consulting services and nursing. The most frequent APP work stressors were workload, job anxiety (including COVID-19 impacts on staffing and adjusting to new roles), and communication with leadership. See Table 2 for complete list of stressors.

Conclusions: HM physicians and APPs described similar workload and work factor stressors, though they differed in work environment, job anxiety, and communication stressors. These findings may reflect differences in job roles and leadership structures both in and outside an HM division, with varying impact on inclusivity. Remarkably, COVID-19 was not a common stressor described by HM physicians and APPs, and this finding may reflect resilience and adaptability among HM providers. The results are limited by response rate < 50% and small sample size for APPs, both of which can limit HM physician and APP comparisons and affect generalizability of quantitative findings to other HM programs. Further work should continue to combine quantitative and qualitative approaches to better understand reasons and help create solutions for differences in HM provider well-being, stressors, and burnout.

IMAGE 1: Table 1: HM physician and APP work stressors

IMAGE 2: Table 2: HM physician and APP stressor themes, descriptions, and representative quotations (n=50)