Abstract
Context: Burnout is a known problem among physicians in training but has not been extensively studied in osteopathic residents.
Objective: To evaluate the relationship of burnout to sex, age, marital status, and residency program type (surgical vs nonsurgical) and length (3, 4, 5, or 6 years) across 12 residency programs at Doctors Hospital in Columbus, Ohio.
Methods: An anonymous, voluntary questionnaire was given to residents in their 10th month of residency. Thirty questions were provided, including general background questions and the Maslach Burnout Inventory Human Services Survey to assess burnout.
Results: A total of 131 of 180 residents (72.8%) returned the questionnaire, and 129 provided complete responses in most categories. Of the 129 respondents, 89 (69.0%) reported emotional exhaustion and 96 (74.4%) reported depersonalization at a moderate or high level. In addition, 70 respondents (54.4%) experienced a moderate or high level of burnout in relation to personal accomplishment. No statistically significant association was found between the burnout factors (emotional exhaustion, depersonalization, and personal accomplishment) and sex, age, marital status, and residency program type and length.
Conclusions: The majority of the osteopathic residents surveyed reported experiencing burnout. More data on burnout among osteopathic residents and associated factors are needed.
Herbert Freudenberger first conceptualized burnout in the 1980s, associating work-related stress with job dissatisfaction.
1 Since this time, several studies have demonstrated burnout as a topic of public interest.
2-4 Burnout is higher among physicians when compared with the general US population, and it peaks during residency training.
2 Extended work hours, increased training demands, interference with personal life, and a sense of decreased control generate an environment in which burnout develops.
3
Christina Maslach created what is currently known as the criterion standard of burnout questionnaires, the Maslach Burnout Inventory (MBI), which recognizes 3 elements of burnout: emotional exhaustion, depersonalization, and personal accomplishment. Emotional exhaustion is defined as the overextension of one’s work emotionally. Depersonalization reflects indifference and impersonal responses toward patients. Personal accomplishment is how well one believes he or she has achieved success and competence through work.
4
Doctors Hospital is a 262-bed, general medical and surgical hospital located in Columbus, Ohio. Accredited by the American Osteopathic Association, Doctors Hospital is nationally recognized for quality care, safety, and efficiency. As a major teaching hospital, Doctors Hospital has the second largest osteopathic training program in the United States, training more than 160 residents each year in 12 different specialties (anesthesia, emergency medicine, family medicine, general surgery, internal medicine, neurological surgery, obstetrics/gynecology, ophthalmology, orthopedic surgery, otorhinolaryngology, pediatrics, and radiology).
Previous studies have shown high levels of burnout in residents in various specialties.
2,3,5,6 Using the MBI, Martini et al
7 found that 50% of the residents studied experienced burnout. Although not statistically significant, they found differences in burnout rates by specialty, with a rate of 75% in obstetrics and gynecology and 27% in family medicine.
7 Dyrbye et al
2 reported that burnout was more prevalent among medical students, residents, fellows, and early-career physicians than in the general US population.
Few studies have specifically addressed osteopathic resident specialties. As the number of trainees in osteopathic graduate medical education programs increases,
8 resident burnout in osteopathic programs has become a topic of controversial debate, with little known on the factors associated with burnout.
In the current study, we hoped to raise awareness of the stress and exhaustion experienced by residents in the osteopathic medical profession. The purpose of this study was to evaluate burnout in residents at Doctors Hospital and compare burnout rate with factors including sex, age, marital status, and residency program type (surgical vs nonsurgical) and length (3, 4, 5, or 6 years). Our hypothesis was that no association exists between these factors and burnout rate and that all residents experience burnout equally.
In April 2014, first-year residents in 12 residency programs (anesthesia, emergency medicine, family medicine, general surgery, internal medicine, neurological surgery, obstetrics/gynecology, ophthalmology, orthopedic surgery, otorhinolaryngology, pediatrics, radiology) were approached by the resident investigators during all-resident meetings and didactics throughout the month and asked to fill out a questionnaire. Participants did not receive any compensation. The investigators distributed the paper questionnaire to the residents, who were informed of the anonymous, voluntary nature of participation.
Burnout rates were measured by the MBI Human Services Survey.
4 The MBI, a 22-item valid and reproducible survey, evaluates 3 elements of burnout: emotional exhaustion, depersonalization, and personal accomplishment.
The internal reliability of the MBI was assessed using the Cronbach α coefficient. Study variables included age (continuous measure), sex (male vs female), marital status (unmarried vs married), residency program type (surgical vs nonsurgical), program length (3, 4, 5, or 6 years), and MBI score (emotional exhaustion, depersonalization, personal accomplishment).
Data collection ended 1 month after the initial request was made to the residents.
We tested the hypothesis that clinically high levels of burnout are seen in resident physicians. Descriptive statistics were produced, using means, medians, ranges, and SDs for continuous variables and percentages for categorical variables. Independent variables included sex, age, marital status, residency program, and survey responses. All statistical analyses were done using SPSS version 22.0 (IBM) and MedCalc version 15.8.
The current study had a small sample size at a single institution. Therefore, the findings may not be indicative of burnout in residencies across the osteopathic medical profession. In addition, although questionnaire results were kept confidential and anonymous, residents may have provided dishonest answers because of discriminating resident characteristics (eg, age, sex, specialty).
Imposed time constraints may have compelled residents to quickly finish the questionnaire without considering authentic answers. Questionnaires were provided during all resident meetings and didactic sessions, when the residents may have been preoccupied with other work.
The questionnaire was given during the 10th month of residency. A variable spectrum of burnout can be seen in different rotations, in the number of hours spent at work, and in different seasons. The time frame may have affected residents’ answers.
For future research, a longitudinal study with an adequate sample size and fewer questionnaire time constraints should be considered. In addition, different protective factors that affect burnout (culture, sleep, number of children, hours at work) should be investigated and compared.