Racial and ethnic variations in caregiving-related physical, emotional, and financial strain during COVID-19 among those caring for adult cancer patients.

PURPOSE: Cancer caregiving is shown to be a burdensome experience in typical times. The purpose of this study was to describe cancer caregivers' emotional, physical, and financial strain during the COVID-19 pandemic and compared to preCOVID-19, and explore racial and ethnic variations in caregiver strain. METHODS: We conducted a cross-sectional online survey using Lucid, LLC, incorporating quotas for race, ethnicity, gender and age. Caregivers had to be adults living in the USA and currently providing unpaid care to an adult cancer patient (i.e., during COVID-19) and prior to the pandemic. We assessed the caregivers' emotional, physical, and financial strain and asked them to compare to preCOVID-19 caregiving. Analyses included descriptive and linear regression adjusting for sociodemographic and caregiving-related variables. RESULTS: A total of 285 caregivers met eligibility, and most were nonHispanic white (72.3%) and female (59.6%). Based on a scale of "1: Much lower" to "5: Much higher", the financial, physical and emotional strain/stress experienced by caregivers compared to preCOVID-19 was, on average, 3.52 (SD: 0.82; range: 1-5) for financial strain, 3.61 (SD: 0.86; range: 1-5) for physical strain, and 3.88 (SD: 0.89; range: 1-5) for emotional stress. NonHispanic black caregivers were significantly more likely than nonHispanic white caregivers to indicate that caregiving-related financial strain was higher than preCOVID-19. Moreover, Hispanic caregivers compared to nonHispanic white caregivers reported caregiving-related emotional stress was higher than preCOVID-19. CONCLUSION: These findings suggest a need to be attentive to racial and ethnic variations in emotional and financial strain and provide targeted support in clinical care and via public policy during a public health crisis.

Burnout and Self Care for Palliative Care Practitioners.

Burnout is common in physicians who care for patients with serious illness, with rates greater than 60% in some studies. Risk factors for burnout include working on small teams and/or in small organizations, working longer hours and weekends, being younger than 50 years, burdensome documentation requirements, and regulatory issues. Personal factors that can protect against burnout include mindfulness, exercise, healthy sleep patterns, avoiding substance abuse, and having adequate leisure time. Institutional and work factors that can buffer against burnout include working on adequately staffed teams, having a manageable workload, and minimally burdensome electronic health record documentation.

Burning without burning out: A call to protect the calling of medicine.

Physicians enter the field of medicine with a sense of calling to meet the needs of others. This sense of calling is a source of resilience and strength, inspiring physicians to defer their own needs in service to patients' needs. When this trade-off becomes chronic, as it does in dysfunctional work environments, burnout can result and both physicians and patients suffer negative consequences. Some of the sources of physician distress, like exposure to suffering and involvement in medical errors, are inherent to medical practice, while others are the product of workplace inefficiencies and flaws in how the health care system functions. Individual physicians can cultivate strategies to maintain resilience in the face of medicine's inherent challenges, while health care organizations work to reduce the systemic drivers of burnout and build cultures that support physicians to thrive. In this and next month's issues, we offer eight articles on aspects of physician well-being with the goal of inspiring and empowering individuals and organizations to take action to transform the health care system so that it can better meet the needs of physicians and their patients.

Estimating the Attributable Cost of Physician Burnout in the United States.

Background: Although physician burnout is associated with negative clinical and organizational outcomes, its economic costs are poorly understood. As a result, leaders in health care cannot properly assess the financial benefits of initiatives to remediate physician burnout. Objective: To estimate burnout-associated costs related to physician turnover and physicians reducing their clinical hours at national (U.S.) and organizational levels. Design: Cost-consequence analysis using a mathematical model. Setting: United States. Participants: Simulated population of U.S. physicians. Measurements: Model inputs were estimated by using the results of contemporary published research findings and industry reports. Results: On a national scale, the conservative base-case model estimates that approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States. This estimate ranged from $2.6 billion to $6.3 billion in multivariate probabilistic sensitivity analyses. At an organizational level, the annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7600 per employed physician each year. Limitations: Possibility of nonresponse bias and incomplete control of confounders in source data. Some parameters were unavailable from data and had to be extrapolated. Conclusion: Together with previous evidence that burnout can effectively be reduced with moderate levels of investment, these findings suggest substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians.

Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: a case study.

BACKGROUND: Awareness of the economic cost of physician attrition due to burnout in academic medical centers may help motivate organizational level efforts to improve physician wellbeing and reduce turnover. Our objectives are: 1) to use a recent longitudinal data as a case example to examine the associations between physician self-reported burnout, intent to leave (ITL) and actual turnover within two years, and 2) to estimate the cost of physician turnover attributable to burnout. METHODS: We used de-identified data from 472 physicians who completed a quality improvement survey conducted in 2013 at two Stanford University affiliated hospitals to assess physician wellness. To maintain the confidentially of survey responders, potentially identifiable demographic variables were not used in this analysis. A third party custodian of the data compiled turnover data in 2015 using medical staff roster. We used logistic regression to adjust for potentially confounding factors. RESULTS: At baseline, 26% of physicians reported experiencing burnout and 28% reported ITL within the next 2 years. Two years later, 13% of surveyed physicians had actually left. Those who reported ITL were more than three times as likely to have left. Physicians who reported experiencing burnout were more than twice as likely to have left the institution within the two-year period (Relative Risk (RR) = 2.1; 95% CI = 1.3-3.3). After adjusting for surgical specialty, work hour categories, sleep-related impairment, anxiety, and depression in a logistic regression model, physicians who experienced burnout in 2013 had 168% higher odds (Odds Ratio = 2.68, 95% CI: 1.34-5.38) of leaving Stanford by 2015 compared to those who did not experience burnout. The estimated two-year recruitment cost incurred due to departure attributable to burnout was between $15,544,000 and $55,506,000. Risk of ITL attributable to burnout was 3.7 times risk of actual turnover attributable to burnout. CONCLUSIONS: Institutions interested in the economic cost of turnover attributable to burnout can readily calculate this parameter using survey data linked to a subsequent indicator of departure from the institution. ITL data in cross-sectional studies can also be used with an adjustment factor to correct for overestimation of risk of intent to leave attributable to burnout.

Physician Well-Being: Financial Aspects.

The US health care system has an unequal distribution of physician supply, is poorly accessible in some areas, and has wide disparities in patient health status. The Patient Protection and Affordable Care Act (ACA) was intended to address these issues by providing affordable health insurance coverage, Medicaid expansion, and care delivery system redesign (particularly through physician payment reform). As part of payment reform, the Medicare Access and CHIP Reauthorization Act (MACRA) went into effect in January 2017. Under MACRA, physicians receive payment under the Quality Payment Program (QPP). Starting January 1, 2019, the QPP pays physicians Medicare part B payments based on their 2017 performance via one of two ways: an advanced alternative payment model or the Merit-Based Incentive Payment System (MIPS). Most physicians will be placed in the MIPS. This shift to performance-based payment requires practices to optimize financial aspects of practice management and improve critical workflows and care delivery processes.

The Business Case for Investing in Physician Well-being.

Importance: Widespread burnout among physicians has been recognized for more than 2 decades. Extensive evidence indicates that physician burnout has important personal and professional consequences. Observations: A lack of awareness regarding the economic costs of physician burnout and uncertainty regarding what organizations can do to address the problem have been barriers to many organizations taking action. Although there is a strong moral and ethical case for organizations to address physician burnout, financial principles (eg, return on investment) can also be applied to determine the economic cost of burnout and guide appropriate investment to address the problem. The business case to address physician burnout is multifaceted and includes costs associated with turnover, lost revenue associated with decreased productivity, as well as financial risk and threats to the organization's long-term viability due to the relationship between burnout and lower quality of care, decreased patient satisfaction, and problems with patient safety. Nearly all US health care organizations have used similar evidence to justify their investments in safety and quality. Herein, we provide conservative formulas based on readily available organizational characteristics to determine the financial return on organizational investments to reduce physician burnout. A model outlining the steps of the typical organization's journey to address this issue is presented. Critical ingredients to making progress include prioritization by leadership, physician involvement, organizational science/learning, metrics, structured interventions, open communication, and promoting culture change at the work unit, leader, and organization level. Conclusions and Relevance: Understanding the business case to reduce burnout and promote engagement as well as overcoming the misperception that nothing meaningful can be done are key steps for organizations to begin to take action. Evidence suggests that improvement is possible, investment is justified, and return on investment measurable. Addressing this issue is not only the organization's ethical responsibility, it is also the fiscally responsible one.

Burnout, associated comorbidities and coping strategies in French community pharmacies-BOP study: A nationwide cross-sectional study.

BACKGROUND: Work-related stress and burnout syndromes are unfortunately common comorbidities found in health professionals. However, burnout syndrome has only been partly and episodically assessed for community pharmacists whereas these professionals are exposed to patients' demands and difficulties every day. Prevalence of burnout, associated comorbidities and coping strategies were assessed in pharmacy teams (pharmacists and pharmacy technicians) in French community pharmacies. METHODS: This online survey was performed by emails sent to all French community pharmacies over 3 months. The survey assessed the prevalence of burnout (Maslach Burnout Inventory-MBI-questionnaire), anxiety, depression and strategies for coping with work-related stress. RESULTS: Of the 1,339 questionnaires received, 1,322 were completed and useable for the analysis. Burnout syndrome was detected in 56.2% of respondents and 10.5% of them presented severe burnout syndrome. Severe burnout syndrome was significantly associated with men, large urban areas and the number of hours worked. Depression and anxiety were found in 15.7% and 42.4% of respondents, respectively. These co-morbidities were significantly associated with severe burnout syndrome. Higher MBI scores were significantly associated with medical consultations and medicinal drug use. Conversely, respondents suffering from burnout syndrome declared they resorted less to non-medical strategies to manage their work-related stress (leisure, psychotherapy, holidays and time off). CONCLUSION: This study demonstrated that community pharmacists and pharmacy technicians presented high prevalence of burnout syndrome, such as many healthcare professionals. Unfortunately, burnout syndrome was associated with several comorbidities (anxiety, depression and alcohol abuse) and the consumption of health resources. The psychological suffering of these healthcare professionals underlines the necessity to deploy a strategy to detect and manage burnout in community pharmacy.

Potential Association Between Physician Burnout Rates and Operating Margins: Specialty-Specific Analysis.

Physician burnout rates have increased across most specialties betweer 2011 and 2014, and there may be an association with financial metrics. WE examined the ordinal ranking of operating margins for each physician spe. cialty from the University of Vermont Medical Center and the correspond. ing physician burnout ranking according to previously published data Physician specialties were categorized into one of four groups accordinc to high or low operating margin and burnout. Radiology, dermatology, otolaryngology, emergency medicine, family medicine, anesthesia, anc neurology were consistently categorized by high operating margin and high burnout rank. Our study provides a framework to explore the impaci of financial metrics on specialty-specific satisfaction and burnout. This information is relevant to the way hospital administrators guide revenue streams, medical students select specialties, and the extent to which physicians pursue their careers.

Assessment of the Personal Losses Suffered by Correctional Officers due to Burnout Syndrome.

BACKGROUND: Professional burnout is defined as a state of depletion and loss of motivation accompanied by different mental and physical symptoms. OBJECTIVE: To assess personal losses suffered by correctional officers due to burnout. METHODS: This cross-sectional study conducted between June and December 2012 included 201 correctional officers in two Bulgarian prisons. The mean age of the whole group was 41.2 (SD 8.0) years. The respondents was mostly male (56.7%), married (72.6%), had a secondary educational level (61.7%), and 76.1% of them had been in current prison work over 5 years. RESULTS: The demographic characteristics had no influence on the occurrence of burnout but there was a correlation between level of burnout and the number of sick-leaves, the need for medical help, and the expenses spent on medications. Officers affected by burnout took more sick-leaves and this affected adversely their remuneration as they lost 3.1% of their annual wages. Their expenses spent on user fees for medical services were 3 times higher. Their monthly expenses spent on medications were 3.14 times higher than those of people without the burnout syndrome. CONCLUSION: The high level of burnout has a negative personal economic effect on the prison employees.

Nursing performance under high workload: a diary study on the moderating role of selection, optimization and compensation strategies.

AIMS: The aim of this study was to investigate whether selective optimization with compensation constitutes an individualized action strategy for nurses wanting to maintain job performance under high workload. BACKGROUND: High workload is a major threat to healthcare quality and performance. Selective optimization with compensation is considered to enhance the efficient use of intra-individual resources and, therefore, is expected to act as a buffer against the negative effects of high workload. DESIGN: The study applied a diary design. Over five consecutive workday shifts, self-report data on workload was collected at three randomized occasions during each shift. Self-reported job performance was assessed in the evening. Self-reported selective optimization with compensation was assessed prior to the diary reporting. METHODS: Data were collected in 2010. Overall, 136 nurses from 10 German hospitals participated. Selective optimization with compensation was assessed with a nine-item scale that was specifically developed for nursing. The NASA-TLX scale indicating the pace of task accomplishment was used to measure workload. Job performance was assessed with one item each concerning performance quality and forgetting of intentions. RESULTS: There was a weaker negative association between workload and both indicators of job performance in nurses with a high level of selective optimization with compensation, compared with nurses with a low level. Considering the separate strategies, selection and compensation turned out to be effective. CONCLUSION: The use of selective optimization with compensation is conducive to nurses' job performance under high workload levels. This finding is in line with calls to empower nurses' individual decision-making.

Job characteristics and burnout: The moderating roles of emotional intelligence, motivation and pay among bank employees.

This study investigated the prediction of burnout from job characteristics, emotional intelligence, motivation and pay among bank employees. It also examined the interactions of emotional intelligence, motivation, pay and job characteristics in the prediction of burnout. Data obtained from 230 (Males = 127, Females = 103) bank employees were analysed using Pearson's Product Moment Correlation and multiple regression analysis. Results showed that theses variables jointly and separately negatively predicted burnout components. The results further indicated that emotional intelligence, motivation and pay separately interacted with some job characteristic components to negatively predict some burnout components. The findings imply that emotional intelligence, motivation and pay could be considered by counsellors when designing interventions to reduce burnout among bank employees.

[The sociological survey of syndrome of professional burnout in physicians of obstetrics department].

The syndrome of emotional burnout is a condition of emotional, psychic, physical exhaustion developed as a result of chronic unresolved stress at working place. The development of the given syndrome is specific for altruistic professions where care of people prevails (social workers, physicians, medical nurses, teachers, etc.). In ICD-10 the syndrome of burnout is described under rubric Z.73.0 as "a state of total exhaustion". Nowadays, physicians and other medical workers found oneself least socially protected in social economic and professional aspects. This is conditioned by low level of salary, significant decreasing of quality of life, increasing of professional responsibility and also by intensification of contradictions between professional and moral duty and possibilities of rendering of medical care to population. The recent studies demonstrate that this condition can be developed in 30-50% of physicians. Also, it is established that age, marital status, had no effect on emotional burnout. The emotional burnout is developing in more degree in females than in males. Also, females are lacking relationship between motivation (satisfaction with remuneration of labor) and development of syndrome in the presence of relationship between significance of work as motivation for activities, satisfaction with professional progression. Those who experience deficiency of autonomy ("super-controlled personalities") are more subjected to burnout. The study was carried out to determine syndrome of professional burnout in physicians of obstetrics department of large (160 beds) obstetric institution the Yakurskaia municipal clinical hospital with purpose offurther implementation of measures of prevention and correction. The presence of syndrome of burnout effects negatively on both psychophysical general state of particular workers and functioning of medical institution on the whole.