Prevalence of Burnout among Internal Medicine and Primary Care Physicians before and during the COVID-19 Pandemic in Japan

Objective To evaluate the change in the prevalence of burnout during the COVID-19 pandemic among internists and primary care physicians in Japan, and to identify factors associated with the exacerbation of burnout among these populations during this period. Methods This was a cross-sectional study based on two web-based surveys conducted in January 2020 (before the declaration of the COVID-19 pandemic) and June 2020 (during the pandemic). The participants were internists and primary care physicians of the Japanese Chapter of the American College of Physicians. The main outcome was the change in the prevalence of burnout between before and during the “first wave” of the pandemic. We also examined factors associated with the exacerbation of burnout during this period. Results Among the 283 respondents in the first survey and 322 in the second survey, 98 (34.6%) and 111 (34.5%) reported symptoms of burnout, respectively. In June 2020, 82 respondents (25.5%) reported that their level of burnout exacerbated compared to January 2020. Only the experience of self-quarantine was associated with the exacerbation of burnout [odds ratio (OR) 3.12; 95% confidence interval (CI) 1.49-6.50; p=0.002], while being a woman, being a resident physician, and an experience of having worked in a prefecture under a state of emergency were not. Conclusions No marked change in the prevalence of burnout among internists and primary care physicians in Japan was observed during the COVID-19 pandemic as a whole. However, self-quarantine was associated with the exacerbation of the burnout level.     

Home Health Aides’ Increased Role in Supporting Older Veterans and Primary Healthcare Teams During COVID-19: a Qualitative Analysis

BackgroundHome health aides are important but often overlooked members of care teams, providing functional and emotional support to patients. These services became increasingly important during the COVID-19 pandemic as older adults faced disruptions in in-person medical services and family caregiving. Understanding how aides supported healthcare teams is important for informing emergency planning and better integrating home health services with primary care.ObjectiveTo describe aides’ roles in supporting veterans and working with primary care teams during COVID-19 and identify COVID-related changes in tasks.DesignSemi-structured interviews.ParticipantsEight home health aides, 6 home health agency administrators, and 9 primary care team members (3 RNs, 3 social workers, 3 MDs) serving veterans at a large, urban, Veterans Affairs medical center.ApproachCombined deductive and inductive analysis to identify a priori concepts (aide roles; changes in tasks and new tasks during COVID-19) and emergent ideas. Aide, administrator, and provider interviews were analyzed separately and compared and contrasted to highlight emergent themes and divergent perspectives.Key ResultsParticipants reported an increase in the volume and intensity of tasks that aides performed during the pandemic, as well as the shifting of some tasks from the medical care team and family caregivers to the aide. Four main themes emerged around aides’ roles in the care team during COVID-19: (1) aides as physically present “boots on the ground” during medical and caregiving disruptions, (2) aides as care coordination support, (3) aides as mental health support, and (4) intensification of aides’ work.ConclusionsHome health aides played a central role in coordinating care during the COVID-19 pandemic, providing hands-on functional, medical, and emotional support. Integrating aides more formally into healthcare teams and expanding their scope of practice in times of crisis and beyond may improve care coordination for older veterans.KEY WORDS: home health, home health aides, primary care, geriatrics, COVID-19     

Does Mental Health Care Integration Affect Primary Care Clinician Burnout? Results from a Longitudinal Veterans Affairs Survey

BackgroundBurnout among primary care clinicians (PCPs) is associated with negative health and productivity consequences. The Veterans Health Administration (VA) embedded mental health specialists and care managers in primary care to manage common psychiatric diseases. While challenging to implement, mental health integration is a team-based care model thought to improve clinician well-being.ObjectiveTo examine the relationships between PCP-reported burnout (and secondarily, job satisfaction) and mental health integration at provider and clinic levelsDesignAnalysis of 286 cross-sectional surveys in 2012 (n = 171) and 2013 (n = 115)Participants210 PCPs in one VA regionMain MeasuresOutcomes were PCP-reported burnout (Maslach Burnout Inventory emotional exhaustion subscale), and secondarily, job satisfaction. Two independent variables represented mental health integration: (1) PCP-specialty communication rating and (2) proportion of clinic patients who saw integrated specialists. Using multilevel regression models, we examined PCP-reported burnout (and job satisfaction) and mental health integration, adjusting for PCP characteristics (e.g., gender), PCP ratings of team functioning (communication, knowledge/skills, satisfaction), and organizational factors.Key ResultsOn average, PCPs reported high burnout (29, range = 9–54) across all VA healthcare systems. In total, 46% of PCPs reported “very easy” communication with mental health; 9% of primary clinic patients had seen integrated specialists. Burnout was not significantly associated with mental health communication ratings (β coefficient = − 0.96, standard error [SE] = 1.29, p = 0.46), nor with proportion of clinic patients who saw integrated specialists (β = 0.02, SE = 0.11, p = 0.88). No associations were observed with job satisfaction either. Among study participants, PCPs with poor team functioning, as exhibited by low team communication ratings, reported high burnout (β = − 1.28, SE = 0.22, p < 0.001) and low job satisfaction (β = 0.12, SE = 0.02, p < 0.001).ConclusionsAs currently implemented, primary care and mental health integration did not appear to impact PCP-reported burnout, nor job satisfaction. More research is needed to explore care model variation among clinics in order to optimize implementation to enhance PCP well-being.KEY WORDS: burnout, primary care, mental health, communication, veterans     

The Influence of Face Gaze by Physicians on Patient Trust: an Observational Study

BackgroundPhysicians’ gaze towards their patients may affect patients’ trust in them. This is especially relevant considering recent developments, including the increasing use of Electronic Health Records, which affect physicians’ gaze behavior. Moreover, socially anxious patients’ trust in particular may be affected by the gaze of the physician.ObjectiveWe aimed to evaluate if physicians’ gaze towards the face of their patient influenced patient trust and to assess if this relation was stronger for socially anxious patients. We furthermore explored the relation between physicians’ gaze and patients’ perception of physician empathy and patients’ distress.DesignThis was an observational study using eye-tracking glasses and questionnaires.ParticipantsOne hundred patients and 16 residents, who had not met before, participated at an internal medicine out-patient clinic.MeasuresPhysicians wore eye-tracking glasses during medical consultations to assess their gaze towards patients’ faces. Questionnaires were used to assess patient outcomes. Multilevel analyses were conducted to assess the relation between physicians’ relative face gaze time and trust, while correcting for patient background characteristics, and including social anxiety as a moderator. Analyses were then repeated with perceived empathy and distress as outcomes.ResultsMore face gaze towards patients was associated with lower trust, after correction for gender, age, education level, presence of caregivers, and social anxiety (β=−0.17, P=0.048). There was no moderation effect of social anxiety nor a relation between face gaze and perceived empathy or distress.ConclusionsThese results challenge the notion that more physician gaze is by definition beneficial for the physician-patient relationship. For example, the extent of conversation about emotional issues might explain our findings, where more emotional talk could be associated with more intense gazing and feelings of discomfort in the patient. To better understand the relation between physician gaze and patient outcomes, future studies should assess bidirectional face gaze during consultations.KEY WORDS: face gaze, patient trust, physician empathy, eye-tracking, social anxiety     

Do Collaborative Care Managers and Technology Enhance Primary Care Satisfaction with Care from Embedded Mental Health Providers?

BackgroundTo improve mental health care access, the Veterans Health Administration (VA) implemented Primary Care-Mental Health Integration (PC-MHI) in clinics nationally. Primary care clinical leader satisfaction can inform model implementation and may be facilitated by collaborative care managers and technology supporting cross-specialty collaboration.Objective(1) To determine primary care clinical leaders’ overall satisfaction with care from embedded mental health providers for a range of conditions and (2) to examine the association between overall satisfaction and two program features (care managers, technology).DesignCross-sectional organizational survey in one VA region (Southern California, Arizona, and New Mexico), 2018.ParticipantsSixty-nine physicians or other designated clinical leaders in each VA primary care clinic (94% response rate).Main MeasuresWe assessed primary care clinical leader satisfaction with embedded mental health care on four groups of conditions: target, non-target mental health, behavioral health, suicide risk management. They additionally responded about the availability of mental health care managers and the sufficiency of information technology (telemental health, e-consult, instant messaging). We examined relationships between satisfaction and the two program features using χ² tests and multivariable regressions.Key ResultsMost primary care clinical leaders were “very satisfied” with care for targeted anxiety (71%) and depression (69%), but not for other common conditions (37% alcohol misuse, 19% pain). Care manager availability was significantly associated with “very satisfied” responses for depression (p = .02) and anxiety care by embedded mental health providers (p = .02). Highly rated sufficiency of communication technology (only 19%) was associated with “very satisfied” responses to suicide risk management (p = .002).ConclusionsCare from embedded mental health providers for depression and anxiety was highly satisfactory, which may guide improvement among less satisfactory conditions (alcohol misuse, pain). Observed associations between overall satisfaction and collaborative care features may inform clinics on how to optimize staffing and technology based on priority conditions.Electronic supplementary materialThe online version of this article (10.1007/s11606-020-05660-1) contains supplementary material, which is available to authorized users.KEY WORDS: primary care, mental health, care management, collaborative care, health information technology, health informatics, Veterans     

The efficacy of reduced-visit prenatal care model during the coronavirus disease 2019 pandemic: A protocol for systematic review and meta-analysis

Background:While this reduced-visit prenatal care model during the COVID-19 pandemic is well-intentioned, there is still a lack of relevant evidence to prove its effectiveness. Therefore, in order to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the efficacy of reduced-visit prenatal care model during the COVID-19 pandemic.Methods:The online literature will be searched using the following combination of medical subject heading terms: “prenatal care” OR “prenatal nursing” AND “reduced-visit” OR “reduce visit” OR “virtual visit.” MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science will be searched without any language restrictions. A standard data extraction form is used independently by 2 reviewers to retrieve the relevant data from the articles. The outcome measures are as following: pregnancy-related stress, satisfaction with care, quality of care. The present study will be performed by Review Manager Software (RevMan Version 5.3, The Cochrane Collaboration, Copenhagen, Denmark). P < .05 is set as the significance level.Results:It is hypothesized that reduced-visit prenatal care model will provide similar outcomes compared with traditional care model.Conclusions:The results of our review will be reported strictly following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and the review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.OSF registration number:10.17605/OSF.IO/WYMB7.     

Respiratory physicians’ awareness and referral of pulmonary rehabilitation in China: a cross-sectional study

BackgroundPulmonary rehabilitation (PR) has demonstrated physiological, symptom reducing, psychosocial, and health care savings benefits in multiple outcome areas for patients with chronic respiratory diseases. Physicians’ PR awareness and PR referral practices are key in PR promotion. However, PR awareness and referral among respiratory physicians in China have rarely been studied. This study aims to explore respiratory physicians’ perceptions towards PR and assess the referral of PR in China.MethodsA self-administered questionnaire was distributed via WeChat and emails to respiratory physicians in hospitals to assess their attitudes toward and knowledge of PR and identify treatment barriers. The study was conducted from June through October 2019.ResultsAs reported in the 520 questionnaires collected through October 2019 most respondents had heard about PR, and many had knowledge of PR practice, but relatively few had referred patients to PR before having responded to the survey. Education, region of practice, and duration of practice are significant factors that influenced the participating respiratory physicians’ awareness of PR. The percentage of referral was influenced by physicians’ education, region, and duration of practice. The absence of PR facilities was the main barrier to respiratory physicians’ referral of patients to PR.ConclusionsChinese respiratory physicians’ awareness of PR and referral to PR remain insufficient to support the delivery of PR to patients with chronic respiratory diseases. PR training for respiratory physicians and building PR centers are necessary to remedy these conditions.     

Retaining VA Women’s Health Primary Care Providers: Work Setting Matters

BackgroundWhen an experienced provider opts to leave a healthcare workforce (attrition), there are significant costs, both direct and indirect. Turnover of healthcare providers is underreported and understudied, despite evidence that it negatively impacts care delivery and negatively impacts working conditions for remaining providers. In the Veterans Affairs (VA) healthcare system, attrition of women’s health primary care providers (WH-PCPs) threatens a specially trained workforce; it is unknown what factors contribute to, or protect against, their attrition.ObjectiveBased on evidence that clinic environment, adequate support resources, and workload affect provider burnout and intent to leave, we explored if such clinic characteristics predict attrition of WH-PCPs in the VA, to identify protective factors.DesignThis analysis drew on two waves of existing national VA survey data to examine predictors of WH-PCP attrition, via logistic regression.ParticipantsAll 2,259 providers from 140 facilities VA-wide who were WH-PCPs on September 30, 2016.Main MeasuresThe dependent variable was WH-PCP attrition in the following year. Candidate predictors were clinic environment (working in: a comprehensive women’s health center, a limited women’s health clinic, a general primary care clinic, or multiple clinic environments), availability of co-located specialty support resources (mental health, social work, clinical pharmacy), provider characteristics (gender, professional degree), and clinic workload (clinic sessions per week).Key ResultsWorking exclusively in a comprehensive women’s health center uniquely predicted significantly lower risk of WH-PCP attrition (adjusted odds ratio 0.40; CI 0.19–0.86).ConclusionsA comprehensive women’s health center clinical context may promote retention of this specially trained primary care workforce. Exploring potential mechanisms—e.g., shared mission, appropriate support to meet patients’ needs, or a cohesive team environment—may inform broader efforts to retain front-line providers.KEY WORDS: workforce turnover, Veterans Health Administration, organizational context, women’s health, burnout     

Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis

BackgroundHospital-at-home (HaH) provides acute healthcare in patients’ homes as an alternative to traditional hospital inpatient care. HaH has been shown to improve clinical outcomes, increase patient satisfaction, and reduce hospitalization costs. Despite its effectiveness, the uptake of HaH remains slow and little is known about factors that impact the quality and transferability of HaH. This review aimed to qualitatively synthesize existing literature to examine the perspectives of stakeholders to identify areas of improvement in this model of care.MethodologySix electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from inception date until 3 February 2021. The included studies were assessed for quality using the Critical Appraisal Skills Program tool. This review was registered on the International Prospective Register of Systematic Reviews. The meta-synthesis was completed according to Sandelowski and Barroso’s guidelines.ResultsSixteen articles met the inclusion criteria. The overarching synthesized theme was “the intricacies of developing HaH,” and the four main themes were (1) factors influencing patient selection, (2) advantages of HaH, (3) challenges of HaH, and (4) enablers for HaH development.ConclusionOverall, high levels of satisfaction were expressed by various stakeholders. Continuity of care remains an important factor for patient-centeredness in HaH. Caregivers should be involved in the decision-making process and supported throughout the HaH duration to prevent caregiver burnout. Collaboration and coordination among healthcare professionals are vital and can be strengthened through training and technological advancements of remote patient monitoring. Institutional and organizational support for stakeholders may make HaH a viable solution to modern healthcare challenges.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07065-0.KEY WORDS: hospital-at-home, healthcare professionals, healthcare administrators, patients, caregivers, perceptions, experience     

Electronic health record associated stress: A survey study of adult congenital heart disease specialists

Background: Physician burnout has many undesirable consequences, including nega‐ tive impact on patient care delivery and physician career satisfaction. Electronic health records (EHRs) may exacerbate burnout by increasing physician workload.
Objective: To determine burnout in adult congenital heart disease (ACHD) specialists by assessing stress associated with EHRs.
Design: Electronic survey study of ACHD providers.
Setting: Canada and United States.
Participants: Three hundred eighty‐three ACHD specialists listed on the Adult Congenital Heart Association directory between February and April 2017.
Outcome Measures: Burnout was measured using the Maslach Burnout Inventory (MBI) to understand factors contributing to work life and EHR satisfaction. Chi‐ square and Wilcoxon Rank Sum tests were used for statistical analysis.
Results: Of the 383 invited participants, 110 (28.7%) completed surveys with the majority (n = 88, 80.7%) reporting from an academic medical center. Burnout was defined as high scores on the emotional exhaustion and/or depersonalization MBI subscales. When comparing the 40% (n = 44) that met criteria for burnout with those that did not, there was strong disagreement that a reasonable amount of time is spent on clerical tasks related to direct (P = .0043) or indirect (P = .0004) patient care. There was strong disagreement that EHRs increased efficiency (P = .006) or the patient portal improved patient care (P = .0215). Finally, physicians who met criteria for burnout had lower personal accomplishment scores (P = .0355).
Conclusions: Our results suggest time spent on EHRs creates clerical burden exacer‐ bating ACHD physician burnout. The high levels of emotional exhaustion may de‐ crease quality of ACHD care by directing focus away from physician‐patient interaction. Health care systems must develop best practice for EHR design and im‐ plementation to optimize patient advocacy and care, and decrease physician burnout.     

Brazil’s Community Health Workers Practicing Narrative Medicine: Patients’ Perspectives

BackgroundNarrative medicine (NM) encourages health care providers to draw on their personal experiences to establish therapeutic alliances with patients of prevention and care services. NM medicine practiced by nurses and physicians has been well documented, yet there is little understanding of how community health workers (CHWs) apply NM concepts in their day-to-day practices from patient perspectives.ObjectiveTo document how CHWs apply specific NM concepts in Brazil’s Family Health Strategy (FHS), the key component of Brazil’s Unified Health System.DesignWe used a semi-structured interview, grounded in Charon’s (2001) framework, including four types of NM relationships: provider–patient, provider–colleague, provider–society, and provider–self. A hybrid approach of thematic analysis was used to analyze data from 27 patients.Key ResultsSample: 18 females; 13 White, 12 “Pardo” (mixed races), 12 Black. We found: (1) provider–patient relationship—CHWs offered health education through compassion, empathy, trustworthiness, patience, attentiveness, jargon-free communication, and altruism; (2) provider–colleague relationship—CHWs lacked credibility as perceived by physicians, impacting their effectiveness negatively; (3) provider–society relationship—CHWs mobilized patients civically and politically to advocate for and address emerging health care and prevention needs; (4) provider–self relationship—patients identified possible low self-esteem among CHWs and a need to engage in self-care practices to abate exhaustion from intense labor and lack of resources.ConclusionThis study adds to patient perspectives on how CHWs apply NM concepts to build and sustain four types of relationships. Findings suggest the need to improve provider–colleague relationships by ongoing training to foster cooperation among FHS team members. More generous organizational supports (wellness initiatives and supervision) may facilitate the provider–self relationship. Public education on CHWs’ roles is needed to enhance the professional and societal credibility of their roles and responsibilities. Future research should investigate how CHWs’ personality traits may influence their ability to apply NM.KEY WORDS: community health workers, Brazil, narrative medicine, Unified Health System     

A study of mechanical ventilation in the ICU after cardiac surgery: a bibliometric analysis

BackgroundAfter cardiac surgery, patients are often admitted to the intensive care unit (ICU) due to various preoperative factors and continue to receive mechanical ventilation. This study sought to conduct a bibliometric analysis to summarize studies on mechanical ventilation among postoperative ICU patients who had undergone cardiac surgery.MethodsWe searched the Science Citation Index Expanded (SCI-E) database using the following terms: “cardiac surgery (Topic)”, “intensive care (Topic)” and “ventilation (Topic)”. The search results were analyzed using R software. The analysis examined the number of publications of relevant articles and the annual change trend, the number of times an article was cited and the annual change trend, the distribution of countries conducting the research, the cooperation between countries and the citation frequency, the distribution of institutions conducting research, the cooperation between institutions, and the citation frequency, the number of published articles, the cooperation among researchers, and the citations frequency of researchers, the journals in which the articles were published, and the use of keywords.ResultsA total of 1,969 relevant research papers were included in this study. The main countries that conducted the relevant research included the United States (US), China, Germany, and Canada. The research institutions were mainly located in the US and Canada, and the main researchers were from research institutions in these countries. The most cited authors were Zappitelli, Hichey, and Wypij. According to Bradford''s law, 9 core journals in this field were identified. The results of the keyword analysis showed that in the past 10 years, research has focused on the mortality of patients, but only a few related random controlled trials have been conducted.ConclusionsMore randomized controlled trials need to be conducted in this field to provide higher evidence-based medical evidence.     

Integrating Interprofessional Trainees into a Complex Care Program for Veterans Experiencing Homelessness: Effects on Health Services Utilization

AbstractPURPOSEHigh-quality, comprehensive care of vulnerable populations requires interprofessional ambulatory care teams skilled in addressing complex social, medical, and psychological needs. Training health professionals in interprofessional settings is crucial for building a competent future workforce. The impacts on care utilization of adding continuity trainees to ambulatory teams serving vulnerable populations have not been described. We aim to understand how the addition of interprofessional trainees to an ambulatory clinic caring for Veterans experiencing homelessness impacts medical and mental health services utilization.METHODSTrainees from five professions were incorporated into an interprofessional ambulatory clinic for Veterans experiencing homelessness starting in July 2016. We performed clinic-level interrupted time series (ITS) analyses of pre- and post-intervention utilization measures among patients enrolled in this training continuity clinic, compared to three similar VA homeless clinics without training programs from October 2015 to September 2018.RESULTSOur sample consisted of 37,671 patient- months. There was no significant difference between the intervention and comparison groups’ post-intervention slopes for numbers of primary care visits (difference in slopes =−0.16 visits/100 patients/month; 95% CI −0.40, 0.08; p=0.19), emergency department visits (difference in slopes = 0.08 visits/100 patients/month; 95% CI −0.16, 0.32; p=0.50), mental health visits (difference in slopes = −1.37 visits/month; 95% CI −2.95, 0.20; p= 0.09), and psychiatric hospitalizations (−0.005 admissions/100 patients/month; 95% CI −0.02, 0.01; p= 0.62). We found a clinically insignificant change in medical hospitalizations.CONCLUSIONSAdding continuity trainees from five health professions to an interprofessional ambulatory clinic caring for Veterans experiencing homelessness did not adversely impact inpatient and outpatient care utilization. An organized team-based care approach is beneficial for vulnerable patients and provides a meaningful educational experience for interprofessional trainees by building health professionals’ capabilities to care for vulnerable populations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06856-9.KEYWORDS: interprofessional, homeless, Veteran, ambulatory care, hospitalization     

The Role of Gender in Careers in Medicine: a Systematic Review and Thematic Synthesis of Qualitative Literature

AbstractBackgroundGender disparities exist in the careers of women in medicine. This review explores the qualitative literature to understand how gender influences professional trajectories, and identify opportunities for intervention.MethodsA systematic review and thematic synthesis included articles obtained from PubMed, Cochrane Central Register of Controlled Trials (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), and GenderWatch (ProQuest) on June 26 2020, updated on September 10, 2020. Included studies explored specialty choice, leadership roles, practice setting, burnout, promotion, stigma, mentoring, and organizational culture. Studies taking place outside of the USA, using only quantitative data, conducted prior to 2000, or focused on other health professions were excluded. Data were extracted using a standardized extraction tool and assessed for rigor and quality using a 9-item appraisal tool. A three-step process for thematic synthesis was used to generate analytic themes and construct a conceptual model. The study is registered with PROSPERO (CRD42020199999).FindingsAmong 1524 studies identified, 64 were eligible for analysis. Five themes contributed to a conceptual model for the influence of gender on women’s careers in medicine that resembles a developmental socio-ecological model. Gender influences career development externally through culture which valorizes masculine stereotypes and internally shapes women’s integration of personal and professional values.ConclusionMedical culture and structures are implicitly biased against women. Equitable environments in education, mentoring, hiring, promotion, compensation, and support for work-life integration are needed to address gender disparities in medicine. Explicit efforts to create inclusive institutional cultures and policies are essential to support a diverse workforce.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06836-z.KEY WORDS: physician careers, gender, careers in medicine     

Establishing Crosswalks Between Common Measures of Burnout in US Physicians

BackgroundPhysician burnout is often assessed by healthcare organizations. Yet, scores from different burnout measures cannot currently be directly compared, limiting the interpretation of results across organizations or studies.ObjectiveTo link common measures of burnout to a single metric in psychometric analyses such that group-level scores from different assessments can be compared.DesignCross-sectional survey.SettingUS practices.ParticipantsA total of 1355 physicians sampled from the American Medical Association Physician Masterfile.Main MeasuresWe linked the Stanford Professional Fulfillment Index (PFI) and Mini-Z Single-Item Burnout (MZSIB) scale to the Maslach Burnout Inventory (MBI) in item response theory (IRT) fixed-calibration and equipercentile analyses and created crosswalks mapping PFI and MZSIB scores to corresponding MBI scores. We evaluated the accuracy of the results by comparing physicians’ actual MBI scores to those predicted by linking and described the closest cut-point equivalencies across scales linked to the same MBI subscale using the resulting crosswalks.Key ResultsIRT linking produced the most accurate results and was used to create crosswalks mapping (1) PFI Work Exhaustion (PFI-WE) and MZSIB scores to MBI Emotional Exhaustion (MBI-EE) scores and (2) PFI Interpersonal Disengagement (PFI-ID) scores to MBI Depersonalization (MBI-DP) scores. The commonly used MBI-EE raw score cut-point of ≥27 corresponded most closely with respective PFI-WE and MZSIB raw score cut-points of ≥7 and ≥3. The commonly used MBI-DP raw score cut-point of ≥10 corresponded most closely with a PFI-ID raw score cut-point of ≥9.ConclusionsOur findings allow healthcare organizations using the PFI or MZSIB to compare group-level scores to historical, regional, or national MBI scores (and vice-versa).Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06661-4.Key words: physician burnout, physician well-being, burnout measurement     

Feasibility of Spotlight Consultations Tool in Routine Care: Real-World Evidence

Background:Burnout in people with diabetes and healthcare professionals (HCPs) is at an all-time high. Spotlight AQ, a novel “smart” adaptive patient questionnaire, is designed to improve consultations by rapidly identifying patient priorities and presenting these in the context of best-practice care pathways to aid consultations. We aimed to determine Spotlight AQ’s feasibility in routine care.Materials and Methods:The Spotlight prototype tool was trialed at three centers: two UK primary care centers and one US specialist center (June-September 2020). Participants with type 1 (T1D) or type 2 diabetes (T2D) completed the questionnaire prior to their routine consultations. Results were immediately available and formed the basis of the clinical discussion and decision-making within the clinic visit.Results:A convenience sample of 49 adults took part, n=31 T1D, (n=18 female); and n=18 T2D (n=10 male, n=4 female, n=4 gender unreported). Each identified two priority concerns. “Psychological burden of diabetes” was the most common priority concern (T1D n = 27, 87.1%) followed by “gaining more skills about particular aspects of diabetes” (T1D n=19, 61.3%), “improving support around me” (n=8, 25.8%) and “diabetes-related treatment issues” (n=8, 25.8%). Burden of diabetes was widespread as was lack of confidence around self-management. Similarly, psychological burden of diabetes was the primary concern for participants with T2D (n=18,100%) followed by “gaining more skills about aspects of diabetes” (n=7, 38.9%), “improving support around me” (n=7, 38.9%) and “diabetes-related treatment issues” (n=4; 22.2%).Conclusions:Spotlight AQ is acceptable and feasible for use in routine care. Gaining more skills and addressing the psychological burden of diabetes are high-priority areas that must be addressed to reduce high levels of distress.     

Effect of Resident Gender and Surname Origin on Clinical Load: Observational Cohort Study in an Internal Medicine Continuity Clinic

BackgroundStudies show patients may have gender or racial preferences for physicians.ObjectiveTo determine the degree to which physicians’ gender and name characteristics influenced physician clinical load in medical practice, including patient panel size and percent of slots filled.DesignObservational cohort study of a continuity clinic site in Rochester, MN, from July 1, 2015 to June 30, 2017 (“historical” period) and July 1, 2018 to January 30, 2020 (“contemporary” period).ParticipantsInternal medicine resident physicians.Main MeasuresResident gender, name, and race came from residency management system data. Panel size, percent of appointment slots filled (“slot fill”), panel percent female, and panel percent non-White came from the electronic health record. Multivariable linear regression models calculated beta estimates with 95% confidence intervals and R² for the impact of physician gender, surname origin, name character length, and name consonant-to-vowel ratio on each outcome, adjusting for race and year of residency.Key ResultsOf the 307 internal medicine residents, 122 (40%) were female and 197 (64%) were White. Their patient panels were 51% female (SD 16) and 74% White (SD 6). Female gender was associated with a 5.3 (95% CI 2.7–7.9) patient increase in panel size and a 1.5% (95% CI −0.6 to 3.7) increase in slot fill. European, non-Hispanic surname was associated with a 5.3 (95% CI 2.6–7.9) patient increase in panel size and a 4.3 percent (95% CI 2.1–6.4) increase in slot fill. Race and other name characteristics were not associated with physician clinical load. From the historical to contemporary period, the influence of name characteristics decreased from 9 to 4% for panel size and from 15 to 5% for slot fill.ConclusionsFemale gender and European, non-Hispanic surname origin are associated with increased physician clinical load—even more than race. While these disparities may have serious consequences, they are also addressable.Electronic supplementary materialThe online version of this article (10.1007/s11606-020-06296-x) contains supplementary material, which is available to authorized users.KEY WORDS: gender, surname, race, physician, patient     

Burnout among Primary Care Providers and Staff: Evaluating the Association with Practice Adaptive Reserve and Individual Behaviors

BackgroundWorkplace burnout among healthcare professionals is a critical public health concern. Few studies have examined organizational and individual factors associated with burnout across healthcare professional groups.ObjectiveThe purpose of this study was to examine the association between practice adaptive reserve (PAR) and individual behavioural response to change and burnout among healthcare professionals in primary care.DesignThis cross-sectional study used survey data from 154 primary care practices participating in the EvidenceNOW Heart of Virginia Healthcare initiative.ParticipantsWe analysed data from 1279 healthcare professionals in Virginia. Our sample included physicians, advanced practice clinicians, clinical support staff and administrative staff.Main MeasuresWe used the PAR instrument to measure organizational capacity for change and the Change Diagnostic Index© (CDI) to measure individual behavioural response, which achieved a 76% response rate. Logistic regression analysis was used to estimate the effects of PAR and CDI on burnout.Key ResultsAs organizational capacity for change increased, burnout in healthcare professionals decreased by 51% (OR: 0.49; 95% CI, 0.33, 0.73). As healthcare professionals showed improved response toward change, burnout decreased by 84% (OR: 0.16; 95% CI, 0.11, 0.23). Analysis by healthcare professional type revealed a significant association between high organizational capacity for change, positive response to change and low burnout among administrative staff (OR: 2.92; 95% CI, 1.37, 6.24). Increased hours of work per week was associated with higher odds of burnout (OR: 1.07; 95% CI, 1.05, 1.10) across healthcare professional groups.ConclusionAs transformation efforts in primary care continue, it is critical to understand the influence of these initiatives on healthcare professionals’ well-being. Efforts to reduce burnout among healthcare professionals are needed at both a system and organizational level. Building organizational capacity for change, supporting providers and staff during major change and consideration of individual workload may reduce levels of burnout.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06367-z.KEY WORDS: adaptive reserve, burnout, practice transformation, primary care, well-being