Background: Physician burnout is associated with negative outcomes for physicians, patients, and organizations. In our urban, academic medical center, 32% of hospitalist faculty report experiencing burnout at least once weekly. Clinical practice as a hospitalist involves dealing with medical acuity, diagnostic and therapeutic uncertainty, and complex interpersonal interactions, all of which may contribute to emotional distress and burnout. However, specific drivers of burnout among hospitalists and areas for intervention are poorly understood. In this project, we aim to describe stressors related to clinical work and coping strategies used among hospitalists in our division.
Methods: In this mixed methods study, we conducted individual interviews of 12 faculty (58% men and 42% women), with a range of 1 to 30 years of experience. Interviews were semi-structured and included 18 questions. Responses were coded by our study team to identify themes and sub-themes. Based on these findings, a 10-question survey, including multiple choice and free text prompts, was developed. The survey was distributed to all 160 faculty in our division, with a response rate of 39% (62 respondents), representing all levels of career experience.
Results: Coding of faculty interviews identified 9 themes for sources of distress and 6 themes for coping strategies, with multiple subthemes within each category (Table 1). The single most frequently cited source of stress among both interviewees (67%) and survey respondents (74%) was inadequate support with systems issues. When survey responses were stratified by years of experience, clinical volume was a common stressor among faculty with 0-1 years of experience (88%) and competing priorities were common among those with 6-10 years of experience (78%) (Table 2). Faculty most frequently cited self-care activities (81%) and debriefing with colleagues (76%) as coping strategies. Among desired interventions to mitigate stress, most faculty preferred communal workspaces (51%) and accessible, free food (51%). Many with 0-1 years of experience (50%) also expressed interest in longitudinal small groups for debriefing.
Conclusions: Through this mixed methods study, we identified a wide range of stressors that hospitalists in our group face related to clinical work, as well as strategies they currently employ and interventions they feel would be beneficial. Improving communal workspaces and providing food are desired by a majority, and longitudinal groups for debriefing may be helpful for early-career faculty. However, the most prominent sources of distress at all levels of experience remain rooted in systems issues, including care coordination, disposition challenges, and administrative tasks. Interventions in these areas, rather than a focus on individual wellness strategies, may most effectively reduce emotional distress and burnout among hospitalists.
