Kate Johnson

November 06, 2012

MONTREAL, Canada — One hour of facilitated peer support every other week during working hours significantly improved certain measures of physicians' job satisfaction and burnout compared with the same amount of unsupervised time off, a randomized controlled trial shows.

"From this we conclude that a small amount of protected time during the workday did result in improved meaning from work and reduction in burnout. This was true in both arms of the study, but the effects were larger in the facilitated small group arm," said lead investigator Colin West, MD, Mayo Clinic, in Rochester, New York, who presented the findings here at the 2012 AMA/CMA/BMA International Conference on Physician Health (ICPH).

The time away from the clinic, added Dr. West, ended up costing departments the equivalent of about 1 clinical visit per week per participant.

The literature on physician burnout and prevention "tends to focus on personal responsibility for wellness as opposed to shared responsibility among institutions and organizations," said Dr West. "As a result, most interventions require participants sacrifice their own personal time...with the sort of perverse goal of being more effective at work."

The investigators set out to examine the effect of a facilitated peer group intervention that was held during working hours with the goal of improving the degree of meaning that physicians derived from their work.

"We chose meaning as a key driver of physician satisfaction and well-being, and also as a mechanism to hopefully reduce burnout," he said.

Increased Job Satisfaction

Volunteers within the department of internal medicine were randomly assigned to either the 90-minute intervention every second week over 9 months (n = 37) or to the same period of protected time but "with no strings attached" (n = 37), he said.

The intervention involved small groups of 6 to 8 physicians with trained facilitators who were colleagues and peers. Sessions were designed to identify and promote personal and professional satisfaction and foster a sense of community, exploring topics such as work-life balance, medical mistakes, and resiliency.

Participants completed surveys at baseline and then every 3 months, and responses from both the intervention and control groups were compared with annual well-being surveys from other department faculty (n = 476).

Preliminary results at the 3-month mark showed that compared with the nonstudy faculty, both study groups scored better on certain measures of burnout and meaning from work, with the most significant results among the intervention arm, said Dr. West.

Although the nonstudy faculty dropped 13.4 points from baseline on a meaning-from-work measure, the control group dropped 6.3 points, and the intervention group improved by 6.3 points.

Similarly, although nonstudy faculty increased by 4.3 points on scores of high emotional exhaustion and burnout, the control group dropped by 5.3 points, and the intervention group dropped by 20.4 points.

Scores for overall burnout increased by 4.9 points in the nonstudy faculty while decreasing by 13.8 points in the control group and 25.8 points in the intervention group.

Comparing just the intervention and control arms, the researchers found a statistically significant difference in scores on the Empowerment From Work scale, with an increase of 0.8 points in control participants vs an increase of 2.6 points in the intervention group (P = .001).

Similarly, on a measure of depersonalization ("I have become more callous toward people since I took this job"), the control group increased by 0.8 points, whereas the intervention group decreased by 15.5 points (P = .01).

"We had participants who came from very high levels of our institution — we didn't know that necessarily as they came in — and we do know that those individuals have been quite public among their own leadership groups about the need for this sort of work to continue."

Feasible in Other Settings?

"This is very, very important work," Andrew Clarke, MD, told Medscape Medical News in an interview following Dr. West's presentation. Dr. Clarke is executive director of the British Columbia Physician Health Program in Vancouver, Canada.

"The next question to answer is whether an intervention like that is feasible in another setting, for example, among physicians who are not on salary but in a pay-per-performance setting, who might be less willing to give up their time."

He noted the importance of institutions presenting such interventions in a way that is not stigmatizing for would-be participants.

"Physicians are required to maintain their competence through continuing professional development and education, so it's important to position something like this as continuing education or professional development," he said.

"Part of the strategy for doing that would be to obtain continuing professional development credits or have it accredited by the American Medical Association or something like that so that it's not seen as 'treatment.' "

Dr. West and Dr. Clarke have disclosed no relevant financial relationships.

2012 AMA-CMA-BMA International Conference on Physician Health (ICPH). Presented October 26, 2012.

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