##common.pageHeaderLogo.altText##

Original article

Vol. 150 No. 2324 (2020)

The well-being of Swiss general internal medicine residents

Cite this as:
Swiss Med Wkly. 2020;150:w20255
Published
18.06.2020

Summary

BACKGROUND

Physician well-being has an impact on productivity and quality of care. Residency training is a particularly stressful period.

OBJECTIVE

To assess the well-being of general internal medicine (GIM) residents and its association with personal and work-related factors.

METHODS

We conducted an anonymous electronic survey among GIM residents from 13 Swiss teaching hospitals. We explored the association between a reduced well-being (≥5 points based on the Physician Well-Being Index [PWBI]) and personal and work-related factors using multivariable mixed-effects logistic regression.

RESULTS

The response rate was 54% (472/880). Overall, 19% of residents had a reduced well-being, 60% felt burned out (emotional exhaustion), 47% were worried that their work was hardening them emotionally (depersonalisation), and 21% had career choice regret. Age (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.05–1.34), working hours per week (OR 1.04 per hour, 95% CI 1.01–1.07) and <2.5 rewarding work hours per day (OR 3.73, 95% CI 2.01–6.92) were associated with reduced well-being. Administrative workload and satisfaction with the electronic medical record were not. We found significant correlations between PWBI score and job satisfaction (rs = -0.54, p<0.001), medical errors (rs = 0.18, p<0.001), suicidal ideation (rs = 0.12, p = 0.009) and the intention to leave clinical practice (rs = 0.38, p <0.001)

CONCLUSIONS

Approximately 20% of Swiss GIM residents appear to have a reduced well-being and many show signs of distress or have career choice regret. Having few hours of rewarding work and a high number of working hours were the most important modifiable predictors of reduced well-being. Healthcare organisations have an ethical responsibility to implement interventions to improve physician well-being.

References

  1. Bohman B, Dyrbye L, Sinsky Ch, Linzer M, Olson K, Babott S. Physician Well-Being: The Reciprocity of Practice Efficiency, Culture of Wellness, and Personal Resilience 2017 [updated 2017 April 26; cited 2019 June 30]. Available from: https://catalyst.nejm.org/physician-well-being-efficiency-wellness-resilience/
  2. Shanafelt TD, West CP, Sinsky C, Trockel M, Tutty M, Satele DV, et al. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017. Mayo Clin Proc. 2019;94(9):1681–94. doi:.https://doi.org/10.1016/j.mayocp.2018.10.023
  3. Goehring C, Bouvier Gallacchi M, Künzi B, Bovier P. Psychosocial and professional characteristics of burnout in Swiss primary care practitioners: a cross-sectional survey. Swiss Med Wkly. 2005;135(7-8):101–8.
  4. Shanafelt TD, West C, Zhao X, Novotny P, Kolars J, Habermann T, et al. Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med. 2005;20(7):559–64. doi:.https://doi.org/10.1007/s11606-005-0102-8
  5. Dyrbye LN, Satele D, Sloan J, Shanafelt TD. Ability of the physician well-being index to identify residents in distress. J Grad Med Educ. 2014;6(1):78–84. doi:.https://doi.org/10.4300/JGME-D-13-00117.1
  6. Dyrbye LN, Satele D, Sloan J, Shanafelt TD. Utility of a brief screening tool to identify physicians in distress. J Gen Intern Med. 2013;28(3):421–7. doi:.https://doi.org/10.1007/s11606-012-2252-9
  7. Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149(5):334–41. doi:.https://doi.org/10.7326/0003-4819-149-5-200809020-00008
  8. West CP, Tan AD, Shanafelt TD. Association of resident fatigue and distress with occupational blood and body fluid exposures and motor vehicle incidents. Mayo Clin Proc. 2012;87(12):1138–44. doi:.https://doi.org/10.1016/j.mayocp.2012.07.021
  9. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21. doi:.https://doi.org/10.1016/S0140-6736(09)61424-0
  10. Friedberg MW, Chen PG, Van Busum KR, Aunon F, Pham C, Caloyeras J, et al. Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy. Rand Health Q. 2014;3(4):1.
  11. Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med. 1997;44(7):1017–22. doi:.https://doi.org/10.1016/S0277-9536(96)00227-4
  12. DeVoe J, Fryer GE, Jr, Hargraves JL, Phillips RL, Green LA. Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care? J Fam Pract. 2002;51(3):223–8.
  13. Weng HC, Hung CM, Liu YT, Cheng YJ, Yen CY, Chang CC, et al. Associations between emotional intelligence and doctor burnout, job satisfaction and patient satisfaction. Med Educ. 2011;45(8):835–42. doi:.https://doi.org/10.1111/j.1365-2923.2011.03985.x
  14. Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000. doi:.https://doi.org/10.1097/SLA.0b013e3181bfdab3
  15. Wen J, Cheng Y, Hu X, Yuan P, Hao T, Shi Y. Workload, burnout, and medical mistakes among physicians in China: A cross-sectional study. Biosci Trends. 2016;10(1):27–33. doi:.https://doi.org/10.5582/bst.2015.01175
  16. Levinson DJ. A conception of adult development. Am Psychol. 1986;41(1):3–13. doi:.https://doi.org/10.1037/0003-066X.41.1.3
  17. Raj KS. Well-Being in Residency: A Systematic Review. J Grad Med Educ. 2016;8(5):674–84. doi:.https://doi.org/10.4300/JGME-D-15-00764.1
  18. Thomas NK. Resident burnout. JAMA. 2004;292(23):2880–9. doi:.https://doi.org/10.1001/jama.292.23.2880
  19. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377–85. doi:.https://doi.org/10.1001/archinternmed.2012.3199
  20. Faber DA, Joshi S, Ebell MH. US Residency Competitiveness, Future Salary, and Burnout in Primary Care vs Specialty Fields. JAMA Intern Med. 2016;176(10):1561–3. doi:.https://doi.org/10.1001/jamainternmed.2016.4642
  21. Freeborn DK. Satisfaction, commitment, and psychological well-being among HMO physicians. West J Med. 2001;174(1):13–8. doi:.https://doi.org/10.1136/ewjm.174.1.13
  22. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114(6):513–9. doi:.https://doi.org/10.1016/S0002-9343(03)00117-7
  23. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81. doi:.https://doi.org/10.1016/j.jbi.2008.08.010
  24. Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463–71. doi:.https://doi.org/10.1097/SLA.0b013e3181ac4dfd
  25. Soler JK, Yaman H, Esteva M, Dobbs F, Asenova RS, Katic M, et al.; European General Practice Research Network Burnout Study Group. Burnout in European family doctors: the EGPRN study. Fam Pract. 2008;25(4):245–65. doi:.https://doi.org/10.1093/fampra/cmn038
  26. Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Sloan J, Freischlag J. Relationship between work-home conflicts and burnout among American surgeons: a comparison by sex. Arch Surg. 2011;146(2):211–7. doi:.https://doi.org/10.1001/archsurg.2010.310
  27. Arigoni F, Bovier PA, Sappino AP. Trend of burnout among Swiss doctors. Swiss Med Wkly. 2010;140:w13070.
  28. Castelo-Branco C, Figueras F, Eixarch E, Quereda F, Cancelo MJ, González S, et al. Stress symptoms and burnout in obstetric and gynaecology residents. BJOG. 2007;114(1):94–8. doi:.https://doi.org/10.1111/j.1471-0528.2006.01155.x
  29. Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Freischlag J. Physicians married or partnered to physicians: a comparative study in the American College of Surgeons. J Am Coll Surg. 2010;211(5):663–71. doi:.https://doi.org/10.1016/j.jamcollsurg.2010.03.032
  30. Buddeberg-Fischer B, Klaghofer R, Stamm M, Siegrist J, Buddeberg C. Work stress and reduced health in young physicians: prospective evidence from Swiss residents. Int Arch Occup Environ Health. 2008;82(1):31–8. doi:.https://doi.org/10.1007/s00420-008-0303-7
  31. Marchalik D, Brems J, Rodriguez A, Lynch JH, Padmore J, Stamatakis L, et al. The Impact of Institutional Factors on Physician Burnout: A National Study of Urology Trainees. Urology. 2019;131:27–35. doi:.https://doi.org/10.1016/j.urology.2019.04.042
  32. Embriaco N, Azoulay E, Barrau K, Kentish N, Pochard F, Loundou A, et al. High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med. 2007;175(7):686–92. doi:.https://doi.org/10.1164/rccm.200608-1184OC
  33. Cheng WJ, Cheng Y. Night shift and rotating shift in association with sleep problems, burnout and minor mental disorder in male and female employees. Occup Environ Med. 2017;74(7):483–8. doi:.https://doi.org/10.1136/oemed-2016-103898
  34. Rao SK, Kimball AB, Lehrhoff SR, Hidrue MK, Colton DG, Ferris TG, et al. The Impact of Administrative Burden on Academic Physicians: Results of a Hospital-Wide Physician Survey. Acad Med. 2017;92(2):237–43. doi:.https://doi.org/10.1097/ACM.0000000000001461
  35. Tak HJ, Curlin FA, Yoon JD. Association of Intrinsic Motivating Factors and Markers of Physician Well-Being: A National Physician Survey. J Gen Intern Med. 2017;32(7):739–46. doi:.https://doi.org/10.1007/s11606-017-3997-y
  36. Yoon JD, Daley BM, Curlin FA. The Association Between a Sense of Calling and Physician Well-Being: A National Study of Primary Care Physicians and Psychiatrists. Acad Psychiatry. 2017;41(2):167–73. doi:.https://doi.org/10.1007/s40596-016-0487-1
  37. Pantenburg B, Luppa M, König HH, Riedel-Heller SG. Burnout among young physicians and its association with physicians’ wishes to leave: results of a survey in Saxony, Germany. J Occup Med Toxicol. 2016;11(1):2. doi:.https://doi.org/10.1186/s12995-016-0091-z
  38. Msaouel P, Keramaris NC, Tasoulis A, Kolokythas D, Syrmos N, Pararas N, et al. Burnout and training satisfaction of medical residents in Greece: will the European Work Time Directive make a difference? Hum Resour Health. 2010;8(1):16. doi:.https://doi.org/10.1186/1478-4491-8-16
  39. Shanafelt TD, Dyrbye LN, Sinsky C, Hasan O, Satele D, Sloan J, et al. Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction. Mayo Clin Proc. 2016;91(7):836–48. doi:.https://doi.org/10.1016/j.mayocp.2016.05.007
  40. Grembowski D, Ulrich CM, Paschane D, Diehr P, Katon W, Martin D, et al. Managed care and primary physician satisfaction. J Am Board Fam Pract. 2003;16(5):383–93. doi:.https://doi.org/10.3122/jabfm.16.5.383
  41. Amiri M, Khosravi A, Eghtesadi AR, Sadeghi Z, Abedi G, Ranjbar M, et al. Burnout and its Influencing Factors among Primary Health Care Providers in the North East of Iran. PLoS One. 2016;11(12):e0167648. doi:.https://doi.org/10.1371/journal.pone.0167648
  42. Dyrbye LN, Schwartz A, Downing SM, Szydlo DW, Sloan JA, Shanafelt TD. Efficacy of a brief screening tool to identify medical students in distress. Acad Med. 2011;86(7):907–14. doi:.https://doi.org/10.1097/ACM.0b013e31821da615
  43. Dyrbye LN, Szydlo DW, Downing SM, Sloan JA, Shanafelt TD. Development and preliminary psychometric properties of a well-being index for medical students. BMC Med Educ. 2010;10(1):8. doi:.https://doi.org/10.1186/1472-6920-10-8
  44. West CP, Dyrbye LN, Satele DV, Sloan JA, Shanafelt TD. Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment. J Gen Intern Med. 2012;27(11):1445–52. doi:.https://doi.org/10.1007/s11606-012-2015-7
  45. West CP, Dyrbye LN, Sloan JA, Shanafelt TD. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med. 2009;24(12):1318–21. doi:.https://doi.org/10.1007/s11606-009-1129-z
  46. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186–91. doi:.https://doi.org/10.1097/00007632-200012150-00014
  47. Wada K, Arimatsu M, Higashi T, Yoshikawa T, Oda S, Taniguchi H, et al. Physician job satisfaction and working conditions in Japan. J Occup Health. 2009;51(3):261–6. doi:.https://doi.org/10.1539/joh.O8023
  48. Steger MF, Dik BJ, Shim Y. Assessing meaning and satisfaction at work. In: Lopez SJ, Snyder CR (eds). The Oxford Handbook of Positive Psychology Assessment. 2nd edition. Oxford: Oxford University Press. 2009.
  49. Wanous JP, Reichers AE, Hudy MJ. Overall job satisfaction: how good are single-item measures? J Appl Psychol. 1997;82(2):247–52. doi:.https://doi.org/10.1037/0021-9010.82.2.247
  50. Shanafelt TD, Balch CM, Dyrbye L, Bechamps G, Russell T, Satele D, et al. Special report: suicidal ideation among American surgeons. Arch Surg. 2011;146(1):54–62. doi:.https://doi.org/10.1001/archsurg.2010.292
  51. Faller N, Stalder O, Limacher A, Bassetti S, Beer JH, Genné D, et al. Frequency of use and acceptability of clinical prediction rules for pulmonary embolism among Swiss general internal medicine residents. Thromb Res. 2017;160:9–13. doi:.https://doi.org/10.1016/j.thromres.2017.09.028
  52. Schober P, Boer C, Schwarte LA. Correlation Coefficients: Appropriate Use and Interpretation. Anesth Analg. 2018;126(5):1763–8. doi:.https://doi.org/10.1213/ANE.0000000000002864
  53. StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.
  54. West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA. 2011;306(9):952–60. doi:.https://doi.org/10.1001/jama.2011.1247
  55. Dyrbye LN, Burke SE, Hardeman RR, Herrin J, Wittlin NM, Yeazel M, et al. Association of Clinical Specialty With Symptoms of Burnout and Career Choice Regret Among US Resident Physicians. JAMA. 2018;320(11):1114–30. doi:.https://doi.org/10.1001/jama.2018.12615
  56. Wayne DB, Arora VM. Duty hour reform and internal medicine residency training: no time to lose. J Gen Intern Med. 2009;24(10):1169–70. doi:.https://doi.org/10.1007/s11606-009-1093-7
  57. Bolster L, Rourke L. The Effect of Restricting Residents’ Duty Hours on Patient Safety, Resident Well-Being, and Resident Education: An Updated Systematic Review. J Grad Med Educ. 2015;7(3):349–63. doi:.https://doi.org/10.4300/JGME-D-14-00612.1
  58. Sen S, Kranzler HR, Didwania AK, Schwartz AC, Amarnath S, Kolars JC, et al. Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study. JAMA Intern Med. 2013;173(8):657–62, discussion 663. doi:.https://doi.org/10.1001/jamainternmed.2013.351
  59. Shanafelt TD, West CP, Sloan JA, Novotny PJ, Poland GA, Menaker R, et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009;169(10):990–5. doi:.https://doi.org/10.1001/archinternmed.2009.70
  60. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018;283(6):516–29. doi:.https://doi.org/10.1111/joim.12752
  61. Wenger N, Méan M, Castioni J, Marques-Vidal P, Waeber G, Garnier A. Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts. Ann Intern Med. 2017;166(8):579–86. doi:.https://doi.org/10.7326/M16-2238
  62. Linzer M, Poplau S, Babbott S, Collins T, Guzman-Corrales L, Menk J, et al. Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey. J Gen Intern Med. 2016;31(9):1004–10. doi:.https://doi.org/10.1007/s11606-016-3720-4
  63. Sinsky CA, Dyrbye LN, West CP, Satele D, Tutty M, Shanafelt TD. Professional Satisfaction and the Career Plans of US Physicians. Mayo Clin Proc. 2017;92(11):1625–35. doi:.https://doi.org/10.1016/j.mayocp.2017.08.017
  64. Gardner RL, Cooper E, Haskell J, Harris DA, Poplau S, Kroth PJ, et al. Physician stress and burnout: the impact of health information technology. J Am Med Inform Assoc. 2019;26(2):106–14. doi:.https://doi.org/10.1097/SLA.0b013e3181ac4dfd
  65. Linzer M, Poplau S, Grossman E, Varkey A, Yale S, Williams E, et al. A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study. J Gen Intern Med. 2015;30(8):1105–11. doi:.https://doi.org/10.1007/s11606-015-3235-4
  66. Olson K, Marchalik D, Farley H, Dean SM, Lawrence EC, Hamidi MS, et al. Organizational strategies to reduce physician burnout and improve professional fulfillment. Curr Probl Pediatr Adolesc Health Care. 2019;49(12):100664. doi:.https://doi.org/10.1016/j.cppeds.2019.100664
  67. Desai SV, Asch DA, Bellini LM, Chaiyachati KH, Liu M, Sternberg AL, et al.; iCOMPARE Research Group. Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine. N Engl J Med. 2018;378(16):1494–508. doi:.https://doi.org/10.1056/NEJMoa1800965
  68. Bilimoria KY, Chung JW, Hedges LV, Dahlke AR, Love R, Cohen ME, et al. National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training. N Engl J Med. 2016;374(8):713–27. doi:.https://doi.org/10.1056/NEJMoa1515724
  69. Levey RE. Sources of stress for residents and recommendations for programs to assist them. Acad Med. 2001;76(2):142–50. doi:.https://doi.org/10.1097/00001888-200102000-00010
  70. Naylor RA, Reisch JS, Valentine RJ. Factors related to attrition in surgery residency based on application data. Arch Surg. 2008;143(7):647–51, discussion 651–2. doi:.https://doi.org/10.1001/archsurg.143.7.647
  71. Gregory S, Demartini C. Satisfaction of doctors with their training: evidence from UK. BMC Health Serv Res. 2017;17(1):851. doi:.https://doi.org/10.1186/s12913-017-2792-0
  72. Lases SS, Slootweg IA, Pierik EGJM, Heineman E, Lombarts MJMH. Efforts, rewards and professional autonomy determine residents’ experienced well-being. Adv Health Sci Educ Theory Pract. 2018;23(5):977–93. doi:.https://doi.org/10.1007/s10459-018-9843-0
  73. Taylor DR, Park YS, Smith CA, Karpinski J, Coke W, Tekian A. Creating Entrustable Professional Activities to Assess Internal Medicine Residents in Training: A Mixed-Methods Approach. Ann Intern Med. 2018;168(10):724–9. doi:.https://doi.org/10.7326/M17-1680
  74. ten Cate O, Chen HC, Hoff RG, Peters H, Bok H, van der Schaaf M. Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99. Med Teach. 2015;37(11):983–1002. doi:.https://doi.org/10.3109/0142159X.2015.1060308
  75. Klein J, Grosse Frie K, Blum K, von dem Knesebeck O. Burnout and perceived quality of care among German clinicians in surgery. Int J Qual Health Care. 2010;22(6):525–30. doi:.https://doi.org/10.1093/intqhc/mzq056
  76. Han S, Shanafelt TD, Sinsky CA, Awad KM, Dyrbye LN, Fiscus LC, et al. Estimating the Attributable Cost of Physician Burnout in the United States. Ann Intern Med. 2019;170(11):784–90. doi:.https://doi.org/10.7326/M18-1422
  77. Cribari M, Holzer BM, Battegay E, Minder CE, Zimmerli LU. What makes internal medicine attractive for the millennial generation? A survey of residents in internal medicine in Switzerland. Swiss Med Wkly. 2018;148:w14696. doi:.https://doi.org/10.4414/smw.2018.14696