Fig. 1
Conceptual illustration of burnout, satisfaction, and wellness. These constructs share many common elements, but each also has unique aspects. For example, wellness includes an emphasis on physical health, whereas satisfaction includes more concepts related to practice logistics. All three constructs influence each other and are substantially correlated
Table 1
Demographics of the survey sample as compared with national resident/fellow averages
|
Survey sample |
National population |
P | |
|---|---|---|---|
|
Total responses |
3300 |
124,409 | |
|
Sex | |||
|
Male |
1604 (48.6%) |
65,472 (52.6%) |
4.96e‑5 |
|
Female |
1650 (50%) |
55,021 (44.2%) |
3.83e-10 |
|
Not answered |
46 (1.3%) |
3916 (3.1%) |
2.40e‑9 |
|
Level of training | |||
|
PGY1 |
41.7% |
25.8% |
4.23e-86 |
|
PGY2 |
16.8% |
23% |
1.13e-10 |
|
PGY3 |
17.8% |
22% |
3.02e‑8 |
|
PGY4 or above |
23.7% |
29.2% |
3.41e-11 |
|
Financial debt | |||
|
None |
15.2% |
19% |
1.70e‑7 |
|
Under $50,000 |
13.5% |
* | |
|
$50,000–$100,000 |
10.4% |
* | |
|
$100,001–$200,000 |
20.9% |
27.5% |
4.55e-17 |
|
$200,001–$300,000 |
26.0% |
26.7% |
1 |
|
$300,001–$400,000 |
10.9% |
* | |
|
Over $400,000 |
3.2% |
* | |
|
Specialty type | |||
|
Medical specialty |
1992 (60.4%) |
74,759 (60.1%) |
1 |
|
Surgical specialty |
673 (20.4%) |
25,419 (19.7%) |
1 |
|
Hospital-based |
631 (19.4%) |
24,231 (19.5%) |
1 |
National data are from the 2015 ACGME Data Book and AAMC Debt Fact Card. P-values are from a binomial exact test, Bonferroni corrected for multiple testing
Fig. 2
Overall satisfaction with current clinical practice environment, from a sample of 3300 US residents and fellows. The vast majority of resident/fellow respondents were ‘very’ or ‘somewhat’ satisfied
Fig. 3
Factors ranked by survey respondents as likely to influence their satisfaction and/or as particularly functional or dysfunctional. Each stacked bar identifies the percentage of respondents who ranked an item as highly impactful (top 2/7) or non-impactful (bottom 2/7). Original item wording is given in questions 7 and 10–13 of the survey (Electronic Supplemental Appendix 1). a respondents’ report of workplace factors’ likelihood of impacting satisfaction. b factors in respondents’ personal lives that they perceived as (un)stable. c factors that respondents felt were high/low life priorities. d the degree to which respondents perceived problems in the domains they identified as high priority. e the degree to which specific workplace factors interfered with satisfaction and education
Table 2
Correlates of satisfaction (output of generalized linear regression) in a nationally representative sample of residents and fellows
|
Coefficient |
SE |
z |
P >|z| | |
|---|---|---|---|---|
|
Can rely on support staff |
0.065 |
0.003 |
18.9 |
5.41e-76 |
|
EHR improves quality of healthcare |
0.023 |
0.003 |
7.2 |
5.21e-13 |
|
Mental health is the most stable |
0.173 |
0.028 |
−6.2 |
4.75e-10 |
|
Receiving feedback does not interfere with satisfaction |
0.096 |
0.028 |
−3.4 |
8.01e-04 |
|
Filling out insurance/disability forms completely interferes with satisfaction |
0.128 |
0.028 |
−4.5 |
6.10e-06 |
Regression coefficients have been rescaled to the 0–1 range, and standard errors scaled proportionately. In all cases, a larger coefficient means that an increase in that variable implies greater satisfaction. Self-perception of stable mental health and a perception of high burden from paperwork/disability forms were the strongest predictors of satisfaction
EHR electronic health record
Table 3
Factors associated with perceived interference in resident/fellow education and job satisfaction from completing disability/insurance paperwork
|
Coefficient |
SE |
P(>|t|) | |
|---|---|---|---|
|
Sex | |||
|
Female |
−0.236 |
0.067 |
4.71e-04 |
|
Not stated |
−0.101 |
0.289 |
0.726 |
|
Age (base: 25–34 years) | |||
|
18–24 years |
−0.097 |
0.325 |
0.766 |
|
35–44 years |
0.227 |
0.123 |
0.065 |
|
45+ years |
0.180 |
0.367 |
0.624 |
|
Training setting (base: university) | |||
|
Academic clinic |
−0.128 |
0.131 |
0.327 |
|
Multi-specialty group |
0.792 |
0.413 |
0.055 |
|
Private practice |
0.363 |
0.346 |
0.293 |
|
Community |
0.074 |
0.091 |
0.413 |
|
VA/Military |
0.645 |
0.300 |
0.032 |
|
Other |
0.556 |
0.418 |
0.184 |
|
Year in training |
0.115 |
0.023 |
5.53e-07 |
|
Debt (base: no debt) | |||
|
<$50,000 |
−0.060 |
0.124 |
0.630 |
|
$50,000–100,000 |
−0.161 |
0.130 |
0.216 |
|
$100,000–200,000 |
0.098 |
0.115 |
0.394 |
|
$200,000–300,000 |
−0.004 |
0.109 |
0.973 |
|
$300,000–400,000 |
−0.054 |
0.131 |
0.679 |
|
>$400,000 |
0.015 |
0.210 |
0.944 |
|
Specialty group (base: hospital-based) | |||
|
Medical outpatient |
−1.009 |
0.110 |
<2e-16 |
|
Surgical |
−0.965 |
0.124 |
8.75e-15 |
Negative coefficients correspond to negative emotion, i.e. to finding paperwork more burdensome