Burnout and its correlates in emergency physicians: four years' experience with a wellness booth.

OBJECTIVE: To measure the degree of burnout among emergency physicians (EPs) and to identify and rank predictive factors. METHODS: Using the Maslach Burnout Inventory as well as a 79-item questionnaire, a cross-sectional survey was conducted for physician registrants at the Annual Scientific Assemblies of the American College of Emergency Physicians from 1992 to 1995. Degrees of burnout were stratified into low, moderate, and high ranges. Univariate and stepwise multiple regression analyses were conducted to identify and rank correlates to burnout scores. RESULTS: Of 1,272 registrants taking the inventory, 60% registered in the moderate to high burnout ranges. Twenty-one correlates were identified. These were classified broadly in terms of negative perceptions of self, negative practice habits and attitudes, and unhealthy lifestyles. The most highly ranked correlates were: self-recognition of burnout, lack of job involvement, negative self-assessment of productivity, dissatisfaction with career, sleep disturbances, increased number of shifts per month, dissatisfaction with specialty services, intent to leave the practice within 10 years, higher levels of alcohol consumption, and lower levels of exercise. Age and years of practice were not significant predictors of burnout. Projected attrition rates were 7.5% over 5 years and 25% over 10 years. CONCLUSIONS: Elevated levels of burnout exist among a substantial percentage of surveyed EPs. However, there is evidence for a "survivor" category of practitioners for whom burnout either does not develop or is a reversible process. The projected attrition rate over 5 and 10 years appears to be no greater than that of the average medical specialty.

Burnout dimensions and voluntary and involuntary turnover in a health care setting.

This study explores the three dimensions of the Maslach Burnout Inventory (MBI) and investigates their relationship to actual turnover in a hospital. Employees who left had significantly higher burnout on all three dimensions than those who stayed with the organization but only two of these dimensions, emotional exhaustion and personal accomplishment, were significantly related to whether the departure was voluntary or involuntary. Interestingly, the employees who left voluntarily had higher emotional exhaustion scores and lower sense of personal accomplishment than those who were terminated.

The Open System Interconnection as a building block in a health sciences information network.

The interconnection of integrated health sciences library systems with other health sciences computer systems to achieve information networks will require either custom linkages among specific devices or the adoption of standards that all systems support. The most appropriate standards appear to be those being developed under the Open System Interconnection (OSI) reference model, which specifies a set of rules and functions that computers must follow to exchange information. The protocols have been modularized into seven different layers. The lowest three layers are generally available as off-the-shelf interfacing products. The higher layers require special development for particular applications. This paper describes the OSI, its application in health sciences networks, and specific tasks that remain to be undertaken.

Team building and the problem of regression: the personal management interview as an intervention.

This article describes the characteristics of a Personal Management Interview (PMI) and reports the results of its implementation in 16 different organizational contexts. Based upon Group Behavior Inventory and personal interview data collected from 208 participants (135 experimental and 71 comparison group members), the results show that the implementation of regular PMIs can prevent the regression or fade-out which often occurs after off-site team-building sessions.

Management development and change in a demanding health care environment.

The problems facing many US health care organizations may prove critical for survival for many of them. Outlines the nature of the problems: increased patient demand, tensions among personnel, technological innovation, cost-conscious purchasers of care, the need to improve cost-efficiency, and barriers to change within organizations. This last presents a number of problems that may often seem intractable and are peculiar to this type of organization.

Antibody titers to hepatitis B surface antigen among vaccinated emergency physicians: three years' experience with a wellness booth.

STUDY OBJECTIVE: To determine antibody titers to hepatitis B surface antigen (anti-HBsAg) among previously vaccinated emergency physicians and to assess the degree of compliance with Centers for Disease Control and Prevention (CDC) postvaccination guidelines. METHODS: A descriptive analysis was performed of anti-HBsAg titer determinations and vaccination surveys among a self-selected group of emergency physicians attending the annual scientific assembly of the American College of Emergency Physicians in 1995, 1996, or 1997. RESULTS: Of 943 participants, titer levels were found to be protective in 768 (81%), borderline in 45 (5%), and nonreactive in 130 (14%). A total of 337 participants (36%) had not obtained postvaccination titer determinations, as advised by the CDC. More than 50% reported an occupational exposure to blood products within the previous 2 years. CONCLUSION: Despite their high risk for exposure to blood products, many previously vaccinated emergency physicians were not in compliance with CDC postvaccination guidelines.