Burnout High Among Hospitalists

Jim Kling

April 25, 2011

April 25, 2011 — Hospitalists in academic institutions experience high levels of stress and burnout, have relatively little opportunity for scholarly work, and are burdened with high workloads of nonteaching clinical work, according to a study published as a research letter in the April 25 issue of the Archives of Internal Medicine.

Hospitalists are becoming much more common in academic medical centers, but few have advanced into senior positions.

The researchers, led by Jeffrey J. Glasheen, MD, from the Section of Hospital Medicine, Division of General Internal Medicine, University of Colorado Denver, Aurora, conducted a cross-sectional email survey of hospitalists at 20 academic medical centers. The 61-question form included a previously validated question that covered burnout. Participants were asked to rank burnout from 1 to 5, with 1 indicating no symptoms of burnout and 5 indicating complete burnout and doubts about a willingness to continue as a hospitalist. Scores of 3 ("I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion") or higher were considered to be consistent with burnout.

The researchers measured stress and satisfaction with a 5-point Likert scale. Responses of 4 ("somewhat") and 5 ("high") were categorized as high stress and high satisfaction. A similar scale was used for working relationships, with 4 ("very good") and 5 ("excellent") considered to be good relationships. The researchers used self-reporting of teaching, publications, and presentations to assess academic output.

The form was sent to 420 hospitalists, of whom 266 (63%) responded. Of those respondents, 57% said that 20% or less of their work time was protected for scholarly activity, 20% reported that at least 80% of their time was spent on nonteaching duties, and 49% of respondents reported having been the first author on a peer-reviewed article. In addition, 26% had presented medical grand rounds at their own institution, and 24% had done it at another institution.

Seventy-five percent of the respondents were found to be satisfied with their job, 63% were satisfied with the support they received from their division report, and 54% were satisfied with how well they could control their schedules. Still, 67% were categorized as having high levels of stress, and 23% had some degree of burnout.

Limitations of the study noted by the authors include that the subset of hospitalists surveyed were from large academic institutions. In addition, the assessments used for burnout, satisfaction, and stress were subjective, the design was prone to response bias, and there was no measurement of actual, rather than reported, academic productivity.

The authors suggest that "at risk academic hospitalists” include those who have few peer-reviewed publications, have a lack of confidence in their teaching skills, and have presented fewer institutional grand rounds.

Comparatively few hospitalists have attained senior levels of promotion, possibly because of the youth of the field, having little time available for academic research, and high demands for nonteaching clinical work. "The resultant high levels of stress and burnout and low satisfaction may (present) a real threat to the vitality of a budding field. Targeted efforts and interventions are needed to stem this tide in order to create fulfilling, sustainable, and scholarly, robust academic hospitalist careers," the authors write.

One study author was supported by a grant from the National Heart Blood and Lung Institute. The data were originally presented at a research poster at the Hospital Medicine 2009. The authors have disclosed no relevant financial relationships.

Arch Intern Med. 2011;8:782-785.

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