Provider burnout: Implications for our perinatal patients
Introduction
Neonatology is a profession with demanding work schedules, intense interpersonal interactions, frequent complex and high-stakes decisions in the face of uncertainty, and rapidly developing new technologies. Many neonatologists chose this career because they were inspired by the potential to make a meaningful and longstanding difference in the lives of the patients and their families, but the modern practice environment now makes professional satisfaction more challenging. Neonatologists, along with physicians as a whole, are burdened by decreasing autonomy, reduced time at the bedside, and increasing barriers to balancing work and personal responsibilities. It is not surprising that burnout in physicians is much higher than in the general working population and remains high despite increasing recognition of its effects.1
Burnout is a work-related, reversible syndrome primarily consisting of emotional exhaustion and/or depersonalization. It is inversely related to well-being, professional fulfillment, and compassion satisfaction.2, 3, 4 The prevalence of neonatologist burnout is not well described, but is estimated to be 20–30%.4, 5, 6 Although some drivers of burnout may be independent of specialization, neonatologists may experience unique drivers of burnout. For example, neonatologist exposure to the suffering and death of infants – a painful and unsettling experience – may cause emotional labor and moral distress, leading to compassion fatigue and emotional exhaustion.4,7 Furthermore, the complexities of working with families of critically ill babies can be taxing and ethically challenging.8
Burnout is identified through survey instruments, most commonly the Emotional Exhaustion and Depersonalization subscales of the Maslach Burnout Inventory (MBI).9 The Emotional Exhaustion subscale consists of 9 prompts (i.e. “I feel emotionally drained from my work.”), and the Depersonalization subscale consists of 5 prompts (i.e. “I've become more callous toward people since I took this job.”). Both are scored on a 7-point Likert scale from “Never” (0) to “Every day” (6). A score of ≥27 for Emotional Exhaustion or ≥10 for Depersonalization is typically considered indicative of burnout symptoms. However, there are a myriad of alternative burnout inventories and scoring methods represented in the literature, each with different lengths and markers of psychometric validity as outlined in Table 1.
Although there has been suspicion that variability in assessment methods reduces the ability to draw conclusions,21 the relationship between burnout and quality of care in the published literature – regardless of assessment tool – is well-established.22
Section snippets
Individual factors and work-life integration
Although burnout is a work-related syndrome, the work responsibilities of a physician interact heavily with family life and personal identity, and these domains are firmly related to physician well-being as illustrated in Fig. 1.23,24
Work-home conflict is a perceived need to fulfill work and personal responsibilities simultaneously, resulting in a requirement to prioritize one over the other. Such conflicts are highly prevalent (with 44–62% of physicians and their partners reporting such
Provider consequences
Physician burnout contributes to a variety of adverse effects at the physician, patient, and organization levels, with links to physician suicidality, alcohol abuse, and broken relationships.45, 46, 47, 48 Suicidal ideation is strongly associated with burnout, and suicide rates among physicians are higher than the general population, with up to 5.7 times the risk among female physicians.45,49 Although the prevalence of alcohol abuse within pediatric specialties is lower than the average for all
Individual resilience
Despite the well-documented descriptions of burnout and its relation to quality of care, few interventions to build resilience have been rigorously tested in clinical trials. Psychological research has consistently shown that experiencing positive emotions is central to building resilience and improves sense of purpose and recovery after emotional upheavals or other secondary trauma.70 Though not studied in NICU care, randomized controlled trials of meditation suggest that positive emotion is
Conclusion
In conclusion, healthcare provider burnout is highly prevalent, including among neonatologists. Physician well-being is critical to high quality patient care and organizational success, necessitating interventions to reverse this trend. Organizational interventions that can effectively reduce burnout and promote well-being include developing physician-leaders, cultivating community and organizational culture, improving practice efficiency, and optimizing administrative policies. In neonatology,
Disclosures
The authors report no conflicts of interest, including no proprietary or commercial interest in any product mentioned or concept discussed in the article.
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2023, Nursing OutlookDrivers of medical errors in the neonatal intensive care unit (NICU): A qualitative analysis
2023, Journal of Neonatal NursingCitation Excerpt :Other themes at the organizational level included heavy workloads and limited, experienced staffing. These themes can commonly lead to burnout, which has been implicated in medical errors of NICU patients (Tawfik and Profit, 2020). In addition to reduced quality of care, burnout in the neonatology field has also led to increased suicidality, intentions to leave the field, and substance use (Tawfik and Profit, 2020).
Devaluing babies: neonatal implications of proposed changes in pediatric residency training
2023, Journal of PerinatologyHospital Work Conditions and the Mediation Role of Burnout: Residents and Practicing Physicians Reporting Adverse Events
2023, Risk Management and Healthcare PolicyThe value of mindfulness in the nicu
2022, Mindfulness in the Birth Sphere: Practice for Pre-conception to the Critical 1000 Days and Beyond
From the Stanford University School of Medicine.
Supported in part by the Stanford Maternal and Child Health Research Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD084679-01, Profit/Sexton Co-PI).
Summary: Burnout is highly prevalent in neonatology, and associates with negative outcomes for providers, patients, and organizations. Individual interventions include resilience and mindfulness training rooted in positive psychology. Organizational interventions include developing physician-leaders, cultivating community and organizational culture, improving practice efficiency, and optimizing administrative policies.