Journal of General Internal Medicine

, Volume 31, Issue 9, pp 1004–1010

Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey

  • Mark Linzer
  • Sara Poplau
  • Stewart Babbott
  • Tracie Collins
  • Laura Guzman-Corrales
  • Jeremiah Menk
  • Mary Lou Murphy
  • Kay Ovington
Original Research

DOI: 10.1007/s11606-016-3720-4

Cite this article as:
Linzer, M., Poplau, S., Babbott, S. et al. J GEN INTERN MED (2016) 31: 1004. doi:10.1007/s11606-016-3720-4

ABSTRACT

BACKGROUND

General internal medicine (GIM) careers are increasingly viewed as challenging and unsustainable.

OBJECTIVE

We aimed to assess academic GIM worklife and determine remediable predictors of stress and burnout.

DESIGN

We conducted an email survey.

PARTICIPANTS

Physicians, nurse practitioners, and physician assistants in 15 GIM divisions participated.

MAIN MEASURES

A ten-item survey queried stress, burnout, and work conditions such as electronic medical record (EMR) challenges. An open-ended question assessed stressors and solutions. Results were categorized into burnout, high stress, high control, chaos, good teamwork, high values alignment, documentation time pressure, and excessive home EMR use. Frequencies were determined for national data, Veterans Affairs (VA) versus civilian populations, and hospitalist versus ambulatory roles. A General Linear Mixed Model (GLMM) evaluated associations with burnout. A formal content analysis was performed for open-ended question responses.

KEY RESULTS

Of 1235 clinicians sampled, 579 responded (47 %). High stress was present in 67 %, with 38 % burned out (burnout range 10–56 % by division). Half of respondents had low work control, 60 % reported high documentation time pressure, half described too much home EMR time, and most reported very busy or chaotic workplaces. Two-thirds felt aligned with departmental leaders’ values, and three-quarters were satisfied with teamwork. Burnout was associated with high stress, low work control, and low values alignment with leaders (all p < 0.001). The 45 VA faculty had less burnout than civilian counterparts (17 % vs. 40 %, p < 0.05). Hospitalists described better teamwork than ambulatory clinicians and fewer hospitalists noted documentation time pressure (both p < 0.001). Key themes from the qualitative analysis were short visits, insufficient support staff, a Relative Value Unit mentality, documentation time pressure, and undervaluing education.

CONCLUSIONS

While GIM divisions overall demonstrate high stress and burnout, division rates vary widely. Sustainability efforts within GIM could focus on visit length, staff support, schedule control, clinic chaos, and EMR stress.

KEY WORDS

general internal medicine stress burnout clinician burnout physician satisfaction 

Supplementary material

11606_2016_3720_MOESM1_ESM.docx (18 kb)
ESM 1(DOCX 17 kb)

Copyright information

© Society of General Internal Medicine 2016

Authors and Affiliations

  • Mark Linzer
    • 1
    • 2
  • Sara Poplau
    • 1
    • 3
  • Stewart Babbott
    • 4
  • Tracie Collins
    • 5
  • Laura Guzman-Corrales
    • 3
  • Jeremiah Menk
    • 6
  • Mary Lou Murphy
    • 7
  • Kay Ovington
    • 8
  1. 1.Division of General Internal MedicineHennepin County Medical CenterMinneapolisUSA
  2. 2.Department of MedicineUniversity of MinnesotaMinneapolisUSA
  3. 3.Minneapolis Medical Research FoundationMinneapolisUSA
  4. 4.Department of MedicineUniversity of KansasKansas CityUSA
  5. 5.Department of Preventive Medicine and Public HealthUniversity of Kansas School of MedicineWichitaUSA
  6. 6.Biostatistical Design and Analysis Center, Clinical and Translational Sciences InstituteUniversity of MinnesotaMinneapolisUSA
  7. 7.Center for Physician Wellness and Professional FulfillmentStanford MedicinePalo AltoUSA
  8. 8.Society of General Internal Medicine and Association of Chiefs and Leaders in General Internal MedicineAlexandriaUSA