0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Research Letters |

Career Satisfaction and Burnout in Academic Hospital Medicine FREE

Jeffrey J. Glasheen, MD; Gregory J. Misky, MD; Mark B. Reid, MD; Rebecca A. Harrison, MD; Brad Sharpe, MD; Andrew Auerbach, MD, MPH
[+] Author Affiliations

Author Affiliations: Section of Hospital Medicine, Division of General Internal Medicine, University of Colorado Denver, Aurora (Drs Glasheen and Misky); Division of Hospital Medicine, Denver Health Medical Center, Denver, Colorado (Dr Reid); Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland (Dr Harrison); and Division of Hospital Medicine, University of California, San Francisco (Drs Sharpe and Auerbach).


Arch Intern Med. 2011;171(8):782-790. doi:10.1001/archinternmed.2011.153.
Text Size: A A A
Published online

The number of hospitalists in academic medical centers has grown rapidly, producing a field with few senior members, potentially impeding the academic success and career sustainability of academic hospitalists, not to mention contributing to burnout.1 However, little is known about career promotion, job satisfaction, stress, and rates of burnout in academic hospital medicine or how these factors affect scholarly success and productivity.

We performed a cross-sectional 61-question e-mail survey of hospitalists at 20 academic medical centers in the United States. Hospital medicine faculty at each site were identified via their group leader; members of each group then received an e-mail survey up to 5 times.

Burnout was assessed using the previously validated question:

Using your own definition of “burnout,” select one of the following: 1 = “I have no symptoms of burnout,” 2 = “I don't always have as much energy as I once did, but I don't feel burned out,” 3 = “I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion,” 4 = “The symptoms of burnout that I am experiencing won't go away,” 5 = “I feel completely burned out and wonder if I can go on.”

A score of 3 or higher was consistent with burnout.2

Levels of stress and satisfaction were assessed using a 5-point Likert scale with responses of 4 (“somewhat”) and 5 (“high”) interpreted as high stress and satisfaction. Working relationships were assessed using a similar Likert scale with 4 (“very good”) and 5 (“excellent”) interpreted as good relationships. Academic output was assessed using self-report of teaching, publications, and presentations.

Of 420 hospitalists, 266 (63%) completed the survey (Table 1). Of the respondents, 57% reported having 20% or less protected time for scholarly activity, while 1 in 5 spent more than 80% of their time on nonteaching services. Most (86%) were at the instructor or assistant professor rank. Most respondents had no first-author peer-reviewed publications or presentations at a grand rounds or national meeting.

Table Graphic Jump LocationTable 1. Characteristics of 266 Respondents

Although most were satisfied with their job (75%), their division chief support (63%), and their ability to control their schedule (54%), the majority reported high levels of stress (67%). Approximately 1 in 4 (23%) reported some degree of burnout (Table 2).

Table Graphic Jump LocationTable 2. Hospitalist Satisfaction, Stress, Work Life, and Burnout Among 266 Respondents

Predictors of low overall job satisfaction (Table 3) included the following: training in a medical subspecialty; practicing at a nonuniversity hospital; and low satisfaction with the amount of personal/family time, amount of control over work schedule, and level of support from their division chief. Predictors of burnout (Table 3) included low satisfaction with the amount of personal/family time and low satisfaction with control over their work schedule.

Table Graphic Jump LocationTable 3. Factors Associated With Low Satisfaction and With Reports of Burnout

Low job satisfaction was associated with nonstatistically significant trends toward fewer peer-reviewed first-author publications, lower teaching skills confidence, and lack of institutional grand rounds presentation. Burnout was associated with a nonstatistically significant trend toward lack of institutional grand rounds presentation (Table 4).

Table Graphic Jump LocationTable 4. Association Between Burnout or Low Satisfaction and Academic Productivity in 154 Academic Hospitalists Practicing Less Than 5 Years

Although academic hospitalists are generally satisfied with their career choice, rates of low career satisfaction, stress, and burnout appear higher than those that have been reported elsewhere.3,4 The only prior evaluation of hospitalist burnout, surveying both community and academic hospitalists, reported that 12.9% of hospitalists were burned out, while an additional 25% were at risk for burnout.4

Our data confirm known causes of burnout (eg, lack of control over work schedule) but suggest additional potential associations, such as lack of division chief support. While we observed that low satisfaction and burnout were associated with lower academic productivity, we cannot discern the causal link between these factors. However, we are able to develop a picture of an “at risk academic hospitalist,” as one who has fewer peer-reviewed publications, lower confidence in their teaching skills, and a lower likelihood of having presented institutional grand rounds.

Previous research suggests that “career fit” appears to be a driver of physician burnout,5 providing another potential way to interpret our results. Hospitalists in our study likely chose to work in an academic environment to partake in scholarly activity. While most described their roles as ones generally considered “academic” (eg, clinician educators), many had large nonteaching clinical roles. This discordance between self-identified job goals and actual work reported represents a clear lack of career fit, and one that may also partially explain the high rate of burnout we observed.

Academic leaders should develop faculty plans to ensure academic career fit. This should include mentorship, faculty development, and balance between academic activities and rising clinical needs. Since hospitalist groups are generally funded by hospitals, we were surprised that perceptions of hospital support were not associated with risks for burnout and low satisfaction. This suggests that even though relationships with their hospital are critical for financial and strategic success,1 direct support from divisions appears to be more critical for hospitalists' career satisfaction and burnout. Nearly 90% of respondents reported to a general internal medicine chief, which suggests a need for general internal medicine division chief support to balance work demands, schedules, and protected time in a manner consistent with academic success.

Our study had several important limitations. First, we studied only a subset of hospitalists from primarily larger academic institutions known to the study authors. It is likely that scholarly infrastructure, support, and expectations are different in these institutions than other types of teaching hospitals, reducing the generalizability of our data. Next, our study design was prone to response bias and we did not assess the actual vs reported academic productivity of respondents. Finally, low satisfaction, stress, and burnout were assessed through subjective assessment tools.

In conclusion, few academic hospitalists have succeeded in achieving senior levels of promotion. This is likely owing, in part, to the youth of the field and inadequate amounts of protected scholarly time fueled by high demands for nonteaching clinical work. However, the resultant high levels of stress and burnout and low satisfaction may also 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.

Correspondence: Dr Glasheen, Section of Hospital Medicine, Division of General Internal Medicine, University of Colorado Denver, Mail Stop F782, 12401 E 17th Ave, Ninth Floor, Aurora, CO 80045 (jeffrey.glasheen@ucdenver.edu).

Author Contributions:Study concept and design: Glasheen, Misky, Reid, Harrison, Sharpe, and Auerbach. Acquisition of data: Glasheen, Misky, Reid, Sharpe, and Auerbach. Analysis and interpretation of data: Glasheen, Misky, Sharpe, and Auerbach. Drafting of the manuscript: Glasheen, Misky, Harrison, Sharpe, and Auerbach. Critical revision of the manuscript for important intellectual content: Glasheen, Misky, Reid, Harrison, Sharpe, and Auerbach. Statistical analysis: Misky and Auerbach. Administrative, technical, and material support: Misky and Auerbach. Study supervision: Glasheen, Misky, and Reid.

Financial Disclosure: None reported.

Funding/Support: Dr Auerbach was supported by a Mid-Career Research Development Award (K24HL09837) from the National Heart, Blood, Lung Institute during the period of this study.

Previous Presentation: This information was presented as a research poster at the Society of Hospital Medicine Annual Meeting; May 15, 2009; Chicago, Illinois.

Flanders  SACentor  BWeber  VMcGinn  TDeSalvo  KAuerbach  A Challenges and opportunities in academic hospital medicine: report from the Academic Hospital Medicine Summit. J Hosp Med 2009;4 (4) 240- 246
PubMed Link to Article
Linzer  MVisser  MROort  FJSmets  EMMcMurray  JEde Haes  HCSociety of General Internal Medicine (SGIM) Career Satisfaction Study Group (CSSG), Predicting and preventing physician burnout: results from the United States and the Netherlands. Am J Med 2001;111 (2) 170- 175
PubMed Link to Article
Landon  BEReschovsky  JBlumenthal  D Changes in career satisfaction among primary care and specialist physicians, 1997-2001. JAMA 2003;289 (4) 442- 449
PubMed Link to Article
Hoff  THWhitcomb  WFWilliams  KNelson  JRCheesman  RA Characteristics and work experiences of hospitalists in the United States. Arch Intern Med 2001;161 (6) 851- 858
PubMed Link to Article
Shanafelt  TDWest  CPSloan  JA  et al.  Career fit and burnout among academic faculty. Arch Intern Med 2009;169 (10) 990- 995
PubMed Link to Article

Figures

Tables

Table Graphic Jump LocationTable 1. Characteristics of 266 Respondents
Table Graphic Jump LocationTable 2. Hospitalist Satisfaction, Stress, Work Life, and Burnout Among 266 Respondents
Table Graphic Jump LocationTable 3. Factors Associated With Low Satisfaction and With Reports of Burnout
Table Graphic Jump LocationTable 4. Association Between Burnout or Low Satisfaction and Academic Productivity in 154 Academic Hospitalists Practicing Less Than 5 Years

References

Flanders  SACentor  BWeber  VMcGinn  TDeSalvo  KAuerbach  A Challenges and opportunities in academic hospital medicine: report from the Academic Hospital Medicine Summit. J Hosp Med 2009;4 (4) 240- 246
PubMed Link to Article
Linzer  MVisser  MROort  FJSmets  EMMcMurray  JEde Haes  HCSociety of General Internal Medicine (SGIM) Career Satisfaction Study Group (CSSG), Predicting and preventing physician burnout: results from the United States and the Netherlands. Am J Med 2001;111 (2) 170- 175
PubMed Link to Article
Landon  BEReschovsky  JBlumenthal  D Changes in career satisfaction among primary care and specialist physicians, 1997-2001. JAMA 2003;289 (4) 442- 449
PubMed Link to Article
Hoff  THWhitcomb  WFWilliams  KNelson  JRCheesman  RA Characteristics and work experiences of hospitalists in the United States. Arch Intern Med 2001;161 (6) 851- 858
PubMed Link to Article
Shanafelt  TDWest  CPSloan  JA  et al.  Career fit and burnout among academic faculty. Arch Intern Med 2009;169 (10) 990- 995
PubMed Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 12

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections