Background: Mitigating physician burnout among health care professionals, especially among hospital providers, has become a national priority in the wake of COVID-19. While most studies focus on individual factors (e.g., exercise, psychosocial support), few studies have evaluated systemic factors (e.g., schedules, leadership). The objective of this study was to determine which systemic factors are associated with burnout, professional fulfillment, and resilience among hospitalists
Methods: A voluntary, anonymous survey was sent via email link to all hospitalists across a large health system in the New York metropolitan area between November 3, 2020 to November 24, 2020. The survey assessed the association between systemic factors (schedule predictability, leadership approachability, and electronic health record (EHR) efficiency and burnout (modified Maslach Burnout Inventory, mMBI), professional fulfillment (Professional Fulfillment Index, PFI), and resilience (Brief Resilience Scale, BRS). The mMBI consisted of three subscales, emotional exhaustion, depersonalization, and personal accomplishment. All variables were first summarized descriptively. Categorical variables were summarized using frequency and percent, and continuous variables were summarized using means and standard deviations. Separate multivariable linear regressions were performed to determine the association between exposures of interest (schedule predictability, leadership approachability, EMR efficiency) and the outcomes (burnout, professional fulfillment, and resilience).
Results: Of the 66 respondents, 66.7% were between the ages of 30-39 years old, 51.5% were female, and 66.7% were married or in a domestic partnership. 22.73% reported low satisfaction with schedule predictability, 12.12% reported low approachability of leadership, 46.97% reported low EHR efficiency, and 10.61% reported low job satisfaction.In multivariable analysis controlling for demographic variables (age, gender, race, marital status), satisfaction with schedule predictability was associated with higher personal accomplishment (β ̂=1.93, 95%CI=0.28, 3.59, p=0.0227), professional fulfillment (β ̂=0.68, 95%CI=0.20, 1.15, p=0.0059), and resilience (β ̂=0.61, 95%CI=0.22, 1.00, p=0.0027); satisfaction with leadership approachability was associated with lower emotional exhaustion (β ̂=-4.25, 95%CI=-5.58, -0.92, p=0.0133), depersonalization (β ̂=-4.16, 95%CI=-7.21, -1.12, p=0.0082), work exhaustion (β ̂=-1.25, 95%CI=-1.83, -0.68, p< 0.001), and higher personal accomplishment (β ̂=3.79, 95%CI=1.66, 5.39, p=0.0007) and professional fulfillment (β ̂=0.98, 95%CI=0.37, 1.59, p=0.0021). Satisfaction with EHR efficiency was only associated with increased resilience (β ̂=0.58, 95%CI=0.25, 0.91, p=0.0008.
Conclusions: Schedule flexibility and leadership approachability appear to have an important role in mitigating burnout and improving professional fulfillment. Future studies to improve moral distress should focus on interventions that target systemic health system factors.
