Overall Findings
Out of 8141 clinicians invited, 3176 (39.0%) responded to the survey and were included in the analysis. Respondents included 51.0% women, 7.5% <35 years old, 58.8% 35–54 years old, 33.2% 55+ years old, 88.8% physicians, and 11.2% non-physicians, mostly Nurse Practitioners and Physician Assistants (Table 1). The largest respondent specialty groups were Internal Medicine General 15.6%, Family Medicine 13.8%, Internal Medicine Sub-specialties 13.2%, Pediatrics 11.1%, and Surgical Specialties 9.3%. Survey respondents differed from non-respondents as well as from the overall population on most demographic characteristics including age, gender, and specialty (Table 1). Adjusting for response weights, the corrected estimates based on respondents were no longer statistically different from the overall population for all demographic variables. Response weights were applied in all analyses to adjust for response bias. Results reported below are based on weighted statistics.
Table 1 Characteristics of Population, Survey Non-respondents, Respondents, and Weighted Respondents Overall, 29.2% of clinicians reported burnout. Compared to men, more women reported burnout (39.0% vs 22.7%, p<0.0001). Rates of burnout also varied by age, with more clinicians under 35 years old (33.4%) and 35–54 years old (34.6%) reporting burnout compared to 55+ years olds (21.6%) (p<0.0001). More 35–54-year-olds reported severe burnout (i.e., selecting 4 or 5) compared to the other age groups (12% vs. 7.4% under 35 years old and 4.6% 55+ years olds) (Table 2). The largest variation in percent of clinicians reporting burnout by gender occurred among those under 35 years old (women 39.6% vs men 25.8%) and 55+ years old (women 42.3% vs men 13.3%) (Fig. 1).
Table 2 Responses to Survey Questions by Respondent Gender, Age, and Role (N=3176) Overall, 25.2% of clinicians reported caregiving responsibilities were impacting work. More women than men (32.9% vs. 19.0%, p<0.0001) and more middle-aged clinicians (37.5% 35–54 years old vs. 16.6% <35-year-olds and 7.4% 55+ years olds, p<0.0001) reported caregiving impacting work. Regarding other well-being measures, 46.3% reported “My overall well-being has been negatively affected,” 43.9% were worried about safety at work, and 45.6% indicated “I feel a great deal of stress because of my job.” Compared to men, more women reported job stress (51.1% vs. 41.3%, p<0.0001) and decreased overall well-being (51.1% vs 42.5%, p<0.01). More middle-aged clinicians reported decreased overall well-being (50.8% 35–54 years olds vs. 45.3% <35 years olds and 39.5% 55+ years olds, p<0.0001), and job stress (51.4% 35–54 years olds vs. 45.8% <35 years olds and 36.8% 55+ years olds, p<0.0001). Compared to non-physicians, more physicians reported decreased overall well-being (47.1% vs. 39.4%, p<0.05).
Compared to men, fewer women felt highly valued (63.7% vs. 71.5%, p<0.01), fewer were confident their concerns would be acted upon (51.0% vs. 57.6%, p<0.05), and more were worried about losing their job (27.2% vs. 18.3%, p<0.0001).
The most frequent requests for support were for more personal protective equipment (PPE) (36.0%), flexibility with schedules (25.0%), and support for mental health needs (12.4%). Compared to men, more women desired support for mental health (15.6% vs 9.9% male, p<0.01) as well as more flexible schedules (29.4% vs 21.6% male, p<0.0001). Younger clinicians desired more support for flexible schedules (35.8% <35-year-olds and 28.7% 35–54-year-olds vs 16.8% 55+-year-olds, p<0.0001).
Factors Associated with Burnout
Model 1
The first weighted multivariate logistic regression only included demographic variables (i.e., age, gender, job role, and primary specialty) to investigate their associations with reporting burnout (Table 3). Controlling for other covariates, age and gender were significantly associated with burnout, with women being more likely to report burnout than men (OR=2.19, 95% CI: 1.51–3.17), and clinicians 55+ years old less likely to report burnout (OR=0.54, 95% CI: 0.34–0.87). Moreover, clinicians whose primary specialty was emergency medicine had higher odds of reporting burnout (OR=1.58, 95% CI: 1.02–2.43) as did those in radiology (OR=1.87, 95% CI: 1.1–3.18).
Table 3 Weighted Logistic Regression Analysis for Demographics Associated with Overall Burnout (Model 1) Model 2
In Model 2, measures of well-being and work experience were included with demographic covariates from Model 1 to explore associations with burnout. Model 2 was also run separately for each age group and each gender group to identify any relationship variation (Table 4). After controlling for demographic covariates, Model 2 for all respondents showed that those reporting caregiving responsibilities impacting work (OR=2.19, 95% CI: 1.54–3.11), being concerned about loss of job (OR=2.19, 95% CI: 1.42–3.37), being worried about work safety (OR=1.67, 95% CI: 1.23–2.26), and being given additional tasks (OR=1.79, 95% CI: 1.33–2.42) were more likely to report burnout. On the other hand, clinicians who felt highly valued (OR=0.45, 95% CI: 0.3–0.68) and who felt their concerns would be acted upon (OR=0.57 95% CI: 0.4–0.81) had lower odds of reporting burnout.
Table 4 Weighted Logistic Regression Analyses for Factors Associated with Overall Burnout (Model 2) Subgroup analyses illustrated some differences across groups. Caregiving responsibilities impacting work and concern about losing jobs were significantly associated with burnout for 35–54- and 55+-year-old clinicians but not for clinicians under 35 years old. Feeling highly valued and being given additional tasks were significantly associated with burnout for younger and middle-age groups but not for 55+ years olds. Caregiving responsibilities impacting work and feeling highly valued were significantly associated with burnout for both female and male groups, but the relationships of burnout with concern about loss of jobs, given additional task, and increase of work hours were only significant for female clinicians.
Clinician Comments on Open-Ended Support Question
Clinicians wrote 1726 comments responding to “Please tell us more about what can be done to better support you right now.” The top three themes were (1)PPE or other equipment/facility needs (n=402, 23.3%): “We need more protective equipment, disinfecting wipes, masks that work, N95s, gowns/labcoat-style tops… This is a huge contributor to my unhappiness” and “We need to provide all physicians appropriate work from home equipment or we will be seeing a lot of work-related injuries”; (2)Improved communication with leadership (n=363, 21.0%): “I would like leadership to visit and talk to departments regularly. Once a week on a rotational visit, or something. Drive. Make it personal. Make it worth our connection”; and (3)Improved compensation, e.g., requests for hazard pay, increased primary care compensation (n=273, 15.8%): “It truly does not feel that there has been any effort to honor the frontline workers in this regard- words are one thing, but no clear additional financial compensation/hazard pay/etc.” (Table 5).
Table 5 Qualitative Analysis of Response to Question “Please Tell Us More About What Can Be Done to Better Support You Right Now”