Stress and Burnout in Stress and Burnout in Department ChairsDepartment Chairs

F. Bruder Stapleton, MDF. Bruder Stapleton, MD

President, AMSPDCPresident, AMSPDC

AMSPDC Annual MeetingAMSPDC Annual Meeting

March 12, 2007March 12, 2007

San Antonio, TexasSan Antonio, Texas

Study of Stress and Burnout in Study of Stress and Burnout in Pediatric Department ChairsPediatric Department Chairs

McPhillips H, Stanton B, Zuckerman B, McPhillips H, Stanton B, Zuckerman B,

Stapleton FB. J Pediatr 2007, In PressStapleton FB. J Pediatr 2007, In Press

Pediatric Chairs have a high degree of Pediatric Chairs have a high degree of job satisfaction. 65% are highly job satisfaction. 65% are highly

satisfied and 30% somewhat satisfiedsatisfied and 30% somewhat satisfied

Pediatric Chairs Compared to OthersPediatric Chairs Compared to Others

Satisfaction scoresSatisfaction scores Emotional ExhaustionEmotional Exhaustion DepersonalizationDepersonalization Personal AchievementPersonal Achievement

Pediatric ChairsPediatric Chairs 17.1 17.1 4.74.7 4040

OB/GYN ChairsOB/GYN Chairs 29.9 29.9 9.19.1 41.541.5

Otolaryngology ChairsOtolaryngology Chairs 17.5 17.5 3.93.9 32.832.8

Medicine ResidentsMedicine Residents 26.4 26.4 12.712.7 36.236.2

All PhysiciansAll Physicians 22.2 22.2 7.17.1 36.536.5

EE, DP scores- lower is better. PA scores- higher is betterEE, DP scores- lower is better. PA scores- higher is better

Selected Data from SurveySelected Data from Survey

1. No gender differences found1. No gender differences found

2. No relationship to children’s hospitals2. No relationship to children’s hospitals

3. 19/148 worked > 60hrs; 75/148 > 50 hrs3. 19/148 worked > 60hrs; 75/148 > 50 hrs

4. 90/148 were away 4. 90/148 were away ≥ 2 nights/week≥ 2 nights/week

5. 67/148 took ≤ 2 weeks vacation/year5. 67/148 took ≤ 2 weeks vacation/year

6. 37/148 did no hospital clinical work6. 37/148 did no hospital clinical work

What do Pediatric Chairs find What do Pediatric Chairs find mostmost satisfying? satisfying?

1. Teaching1. Teaching 65% very65% very

2. Mentoring Students2. Mentoring Students 65% very65% very

3.3. Mentoring Faculty Mentoring Faculty 65% very65% very

4. Improving Child Health4. Improving Child Health 52% very52% very

What are areas of What are areas of leastleast satisfaction? satisfaction?

1. Fund Raising1. Fund Raising 33% not 33% not

2. Research and writing2. Research and writing 31% not 31% not

3. Work-life balance 3. Work-life balance 19% not 19% not

High Burnout was found in High Burnout was found in 30% of Pediatric Chairs 30% of Pediatric Chairs

Burnout in Pediatric Chairs Burnout in Pediatric Chairs is associated with:is associated with:

1. Being Chair < 5 years1. Being Chair < 5 years

2. More hours worked/week2. More hours worked/week

3. High work load3. High work load

4. Lack of supportive work environment4. Lack of supportive work environment

5. Failing to meet expectations of Dean and/or 5. Failing to meet expectations of Dean and/or

Hospital Administration Hospital Administration

Burnout in Pediatric ChairsBurnout in Pediatric Chairs

years as chairyears as chair wks attending/yearwks attending/year

<5 <5 >5>5 0 0 1-81-8 9+ 9+

BurnoutBurnout 29% 29% 15%15% 32%32% 13%13% 21%21%

No BurnoutNo Burnout 71% 71% 85%85% 68%68% 87%87% 79%79%

Work Hours and BurnoutWork Hours and Burnout

hours/weekhours/week evening events/weekevening events/week vacation weeksvacation weeks

<50<50 >60>60 0-10-1 2+2+ <2<2 3+3+

BurnoutBurnout 12%12% 42%42% 7% 7% 26%26% 25% 25% 14%14%

No BurnoutNo Burnout 88%88% 58%58% 93% 93% 74%74% 75% 75% 86%86%

Burnout and Work Place Climate for Burnout and Work Place Climate for Pediatric ChairsPediatric Chairs

Supportive ReceptiveSupportive Receptive lowlow 38%38% medmed 19%19% highhigh 11%11%

Choice IndependenceChoice Independence lowlow 43%43% medmed 19%19% highhigh 8%8%

Burnout in Chairs of OB/GYN Burnout in Chairs of OB/GYN

Gabbe et al. AJOG 2002: 186; 601-612Gabbe et al. AJOG 2002: 186; 601-612

Burnout in OB/GYN ChairsBurnout in OB/GYN Chairs

1. Younger chairs worked longer hours1. Younger chairs worked longer hours

2. Women worked longer hours than men2. Women worked longer hours than men

3. The most significant stressors were budgeting, 3. The most significant stressors were budgeting,

Medicaid audits, loss of key faculty and Medicaid audits, loss of key faculty and

dismissing facultydismissing faculty

Burnout in OB/GYN ChairsBurnout in OB/GYN Chairs

4. 22% were somewhat or very dissatisfied4. 22% were somewhat or very dissatisfied

5. High emotional exhaustion was more common 5. High emotional exhaustion was more common

in younger chairsin younger chairs

6. Burnout was more common in new chairs6. Burnout was more common in new chairs

Internal Medicine Department Internal Medicine Department Chairs: Where they come from, Chairs: Where they come from, Why they leave, Where they go.Why they leave, Where they go.

Nettleman M, Schuester BL.Nettleman M, Schuester BL.Am J Med 2007: 120; 186-190Am J Med 2007: 120; 186-190

Internal Medicine ChairsInternal Medicine Chairs

18% annual turnover18% annual turnover

Were usually division chiefsWere usually division chiefs

Left being chair becauseLeft being chair because Wanted new challengesWanted new challenges Disagreed with Dean/UniversityDisagreed with Dean/University Were burned outWere burned out

Advice from former IM ChairsAdvice from former IM Chairs

Maintain skillsMaintain skills

Stay clinically activeStay clinically active

Obtain leadership trainingObtain leadership training

Remain active nationally Remain active nationally

What can be done about What can be done about burnout in Pediatric Chairs?burnout in Pediatric Chairs?

Burnout in Pediatric Chairs Burnout in Pediatric Chairs in office in office ≤ 5years≤ 5years

1. Higher burnout 29% vs. 15%1. Higher burnout 29% vs. 15%

2. Worked longer hours:2. Worked longer hours:

80% worked >70 hours 80% worked >70 hours

compared to 56% in more experienced chairscompared to 56% in more experienced chairs

Burnout in Pediatric Department ChairsBurnout in Pediatric Department Chairs

0% of chairs with high work-life balance 0% of chairs with high work-life balance

satisfaction had high burnoutsatisfaction had high burnout

50% of chairs with high burnout plan to step 50% of chairs with high burnout plan to step

down in next yeardown in next year

Opportunities to reduce burnout in Opportunities to reduce burnout in Pediatric ChairsPediatric Chairs

1. Encourage more balanced workload (Improve 1. Encourage more balanced workload (Improve efficiency)efficiency)2. Improve recruiting and fund-raising skills2. Improve recruiting and fund-raising skills3. Develop better work-life balance3. Develop better work-life balance4. Build in more escape time4. Build in more escape time5. Enhance ability to work with Dean5. Enhance ability to work with Dean6. Enhance ability to cope with non-supportive 6. Enhance ability to cope with non-supportive

work environmentswork environments