Resident worklife and wellness through the late phase of the pandemic: a mixed methods national survey study.

BACKGROUND: System contributors to resident burnout and well-being have been under-studied. We sought to determine factors associated with resident burnout and identify at risk groups. METHODS: We performed a US national survey between July 15 2022 and April 21, 2023 of residents in 36 specialties in 14 institutions, using the validated Mini ReZ survey with three 5 item subscales: 1) supportive workplace, 2) work pace/electronic medical record (EMR) stress, and 3) residency-specific factors (sleep, peer support, recognition by program, interruptions and staff relationships). Multilevel regressions and thematic analysis of 497 comments determined factors related to burnout. RESULTS: Of 1118 respondents (approximate median response rate 32%), 48% were female, 57% White, 21% Asian, 6% LatinX and 4% Black, with 25% PGY 1 s, 25% PGY 2 s, and 22% PGY 3 s. Programs included internal medicine (15.1%) and family medicine (11.3%) among 36 specialties. Burnout (found in 42%) was higher in females (51% vs 30% in males, p = 0.001) and PGY 2's (48% vs 35% in PGY-1 s, p = 0.029). Challenges included chaotic environments (41%) and sleep impairment (32%); favorable aspects included teamwork (94%), peer support (93%), staff support (87%) and program recognition (68%). Worklife subscales were consistently lower in females while PGY-2's reported the least supportive work environments. Worklife challenges relating to burnout included sleep impairment (adjusted Odds Ratio (aOR) 2.82 (95% CIs 1.94, 4.19), absolute risk difference (ARD) in burnout 15.9%), poor work control (aOR 2.25 (1.42, 3.58), ARD 12.2%) and chaos (aOR 1.73 (1.22, 2.47), ARD 7.9%); program recognition was related to lower burnout (aOR 0.520 (0.356, 0.760), ARD 9.3%). These variables explained 55% of burnout variance. Qualitative data confirmed sleep impairment, lack of schedule control, excess EMR and patient volume as stressors. CONCLUSIONS: These data provide a nomenclature and systematic method for addressing well-being during residency. Work conditions for females and PGY 2's may merit attention first.

Childcare Stress, Burnout, and Intent to Reduce Hours or Leave the Job During the COVID-19 Pandemic Among US Health Care Workers.

Importance: Childcare stress (CCS) is high during the COVID-19 pandemic because of remote learning and fear of illness transmission in health care workers (HCWs). Associations between CCS and burnout, intent to reduce (ITR) hours, and intent to leave (ITL) are not known. Objective: To determine associations between CCS, anxiety and depression, burnout, ITR in 1 year, and ITL in 2 years. Design, Setting, and Participants: This survey study, Coping with COVID, a brief work-life and wellness survey of US HCWs, was conducted between April and December 2020, assessing CCS, burnout, anxiety, depression, workload, and work intentions. The survey was distributed to clinicians and staff in participating health care organizations with more than 100 physicians. Data were analyzed from October 2021 to May 2022. Main Outcomes and Measures: The survey asked, "due to…COVID-19, I am experiencing concerns about childcare," and the presence of CCS was considered as a score of 3 or 4 on a scale from 1, not at all, to 4, a great extent. The survey also asked about fear of exposure or transmission, anxiety, depression, workload, and single-item measures of burnout, ITR, and ITL. Results: In 208 organizations, 58 408 HCWs (15 766 physicians [26.9%], 11 409 nurses [19.5%], 39 218 women [67.1%], and 33 817 White participants [57.9%]) responded with a median organizational response rate of 32%. CCS was present in 21% (12 197 respondents) of HCWs. CCS was more frequent among racial and ethnic minority individuals and those not identifying race or ethnicity vs White respondents (5028 respondents [25.2%] vs 6356 respondents [18.8%]; P < .001; proportional difference, -7.1; 95% CI, -7.8 to -6.3) and among women vs men (8281 respondents [21.1%] vs 2573 respondents [17.9%]; odds ratio [OR], 1.22; 95% CI, 1.17 to 1.29). Those with CCS had 115% greater odds of anxiety or depression (OR, 2.15; 95% CI, 2.04-2.26; P < .001), and 80% greater odds of burnout (OR, 1.80; 95% CI, 1.70-1.90; P < .001) vs indidivuals without CCS. High CCS was associated with 91% greater odds of ITR (OR, 1.91; 95% CI, 1.76 to 2.08; P < .001) and 28% greater odds of ITL (OR, 1.28; 95% CI, 1.17 to 1.40; P < .001). Conclusions and Relevance: In this survey study, CCS was disproportionately described across different subgroups of HCWs and was associated with anxiety, depression, burnout, ITR, and ITL. Addressing CCS may improve HCWs' quality of life and HCW retention and work participation.

Innovative Wellness Models to Support Advancement and Retention Among Women Physicians.

Despite improvements in representation of women in academic medicine, the rate of promotion and career advancement remains unequal. Compared with their male colleagues, women report lower rates of personal-organizational value alignment and higher rates of burnout. Particular challenges further exist for Black women, Indigenous women, women of color, and third gender or gender nonbinary faculty. Promoting the well-being of women physicians requires innovative approaches beyond the traditional scope of physician well-being efforts and careful attention to the unique barriers women face. Three wellness-oriented models are presented to promote the professional fulfillment and well-being of women physicians: (1) redefine productivity and create innovative work models, (2) promote equity through workplace redesign and burnout reduction, and (3) promote, measure, and improve diversity, equity, and inclusion. By engaging in innovative models for equitable advancement and retention, it is anticipated that diverse groups of women faculty will be better represented at higher levels of leadership and thus contribute to the creation of more equitable work climates, fostering well-being for women physicians.

Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study.

BACKGROUND: COVID-19 has put extraordinary stress on healthcare workers. Few studies have evaluated stress by worker role, or focused on experiences of women and people of color. METHODS: The "Coping with COVID" survey assessed US healthcare worker stress. A stress summary score (SSS) incorporated stress, fear of exposure, anxiety/depression and workload (Omega 0.78). Differences from mean were expressed as Cohen's d Effect Sizes (ESs). Regression analyses tested associations with stress and burnout. FINDINGS: Between May 28 and October 1, 2020, 20,947 healthcare workers responded from 42 organizations (median response rate 20%, Interquartile range 7% to 35%). Sixty one percent reported fear of exposure or transmission, 38% reported anxiety/depression, 43% suffered work overload, and 49% had burnout. Stress scores were highest among nursing assistants, medical assistants, and social workers (small to moderate ESs, p < 0.001), inpatient vs outpatient workers (small ES, p < 0.001), women vs men (small ES, p < 0.001), and in Black and Latinx workers vs Whites (small ESs, p < 0.001). Fear of exposure was prevalent among nursing assistants and Black and Latinx workers, while housekeepers and Black and Latinx workers most often experienced enhanced meaning and purpose. In multilevel models, odds of burnout were 40% lower in those feeling valued by their organizations (odds ratio 0.60, 95% CIs [0.58, 0.63], p< 0.001). INTERPRETATION: Stress is higher among nursing assistants, medical assistants, social workers, inpatient workers, women and persons of color, is related to workload and mental health, and is lower when feeling valued.

Preliminary Report: US Physician Stress During the Early Days of the COVID-19 Pandemic.

OBJECTIVE: To assess the impact of the COVID-19 crisis on physician stress and mental health. METHODS: The 10-item Coping With COVID survey assessed stress among 2373 physicians from April 4 to May 27, 2020. A stress summary score with 4 items (a single-item [overall] stress measure, fear of exposure, perceived anxiety/depression due to COVID, and work overload, each scored 1-4) ranged from 4 to 16. Hypothesized stress mitigators included enhanced purpose and feeling valued by one's organization. Multilevel linear regression tested associations of variables with overall stress and stress summary scores. RESULTS: In 2373 physicians in 17 organizations (median response rate of 32%), mean stress summary score was 9.1 (SD 2.6). Stress was highest among women (stress summary score, 9.4 [SD 2.5] vs 8.7 [SD 2.6] in men; P <.001), inpatient physicians (stress summary score, 9.4 [SD 2.8] vs 8.9 [SD 2.5] in outpatient physicians; P <.001), early- and mid-career physicians (stress summary score, 9.5 [SD 2.6] vs 8.6 [SD 2.5] in late-career physicians; P <.001), and physicians in critical care (stress summary score, 10.8), emergency departments (10.2), and hospital medicine (10.1). Increases in perceived anxiety/depression (regression coefficient, 0.30), workload (0.28), and fear (0.14) were associated with higher overall stress (P values <.001). Increases in feeling valued were associated with lower stress summary scores (regression coefficient, -0.67; P <.001) and explained 11% of stress summary score variance at the physician level and 31% of variance at the organizational level. CONCLUSION: Mental health support, modulation of workload, and noting physicians' organizational value should be explored as means to reduce COVID-related stress.