Abstract
Objective
Participants and Methods
Results
Conclusion
Abbreviations and Acronyms:
DP (depersonalization), EE (emotional exhaustion)Participants and Methods
Study Population
American Association for Public Opinion Research. Standard definitions. Final disposition of case codes and outcome rates for surveys. 2011. http://www.aapor.org/AM/Template.cfm?Section=Standard_Definitions2&Template=/CM/ContentDisplay.cfm&ContentID=3156. Accessed May 4, 2012.
Study Measures
Burnout
Work-Home Conflict
Career Satisfaction
Career Stage
United States Office of Personnel Management. Career Patterns: A 21st Century Approach to Attracting Talent. http://www.opm.gov/hcaaf_resource_center/careerpatterns/CPGuideV1.pdf. Accessed October 1, 2012.
Statistical Analyses
Results
Characteristic | Career stage, No. (%) | P value | ||
---|---|---|---|---|
Early (0-10 y) (n=1583) | Middle (11-20 y) (n=1634) | Late (≥21 y) (n=3906) | ||
Sex | <.001 | |||
Male | 858 (54.2) | 1055 (64.6) | 3208 (82.1) | |
Female | 725 (45.8) | 579 (35.4) | 698 (17.9) | |
Age (y), median | 38 | 49 | 61 | <.001 |
Children | <.001 | |||
Yes | 1120 (70.8) | 1375 (84.2) | 3520 (90.1) | |
No | 463 (29.2) | 258 (15.8) | 386 (9.9) | |
Specialty | <.001 | |||
Surgical | 360 (23.1) | 416 (26.2) | 1035 (27.2) | |
Primary care | 410 (26.3) | 350 (22.1) | 817 (21.5) | |
Internal medicine and pediatric subspecialty | 243 (15.6) | 272 (17.1) | 714 (18.8) | |
Other | 546 (35.0) | 549 (34.6) | 1238 (32.5) | |
Primary practice setting | <.001 | |||
Private practice | 801 (51.9) | 962 (60.2) | 2235 (58.9) | |
Academic medical center | 425 (27.6) | 320 (20.0) | 716 (18.9) | |
Veterans’ hospital | 36 (2.3) | 33 (2.1) | 112 (3.0) | |
Active military practice | 27 (1.8) | 23 (1.4) | 14 (0.4) | |
Not in practice or retired | 5 (0.3) | 5 (0.3) | 68 (1.8) | |
Other | 248 (16.1) | 255 (16.0) | 649 (17.1) | |
Hours worked per week, mean (SD) | 52.5 (16.2) | 54.6 (16.0) | 50.2 (16.5) | <.001 |
Nights on call per week, mean (SD) | 1.9 (2.1) | 2.5 (2.4) | 2.3 (2.5) | <.001 |
Experienced work-home conflict in past 3 wk | <.001 | |||
Yes | 921 (58.5) | 839 (51.7) | 1377 (35.5) | |
No | 654 (41.5) | 783 (48.3) | 2502 (64.5) | |
How most recent conflict resolved | <.001 | |||
Resolved in favor of work | 552 (36.7) | 533 (34.4) | 887 (24.3) | |
Resolved in favor of personal | 191 (12.7) | 176 (11.4) | 355 (9.7) | |
Able to resolve to meet both | 763 (50.7) | 840 (54.2) | 2405 (65.9) |
Work Hours, Call, and Work-Home Conflicts
Burnout
Variable | Career stage, No. (%) | P value | ||
---|---|---|---|---|
Early (0-10 y) (n=1583) | Middle (11-20 y) (n=1634) | Late (≥21 y) (n=3906) | ||
Burnout indices | ||||
High emotional exhaustion | 629 (39.9) | 763 (47.0) | 1289 (33.4) | <.001 |
High depersonalization | 569 (36.2) | 557 (34.4) | 933 (24.2) | <.001 |
Burned out | 798 (50.5) | 876 (53.9) | 1566 (40.4) | <.001 |
Dimensions of professional satisfaction | ||||
Satisfied with work-life balance | <.001 | |||
Yes | 695 (44.0) | 638 (39.3) | 2101 (54.0) | |
No | 883 (56.0) | 986 (60.7) | 1791 (46.0) | |
Satisfied with choice to become a physician | <.001 | |||
Yes | 986 (62.4) | 1037 (63.9) | 2955 (76.1) | |
No | 594 (37.6) | 585 (36.1) | 928 (23.9) | |
Satisfied with specialty choice | <.001 | |||
Yes | 1098 (69.4) | 1075 (66.3) | 2847 (73.4) | |
No | 483 (30.6) | 547 (33.7) | 1033 (26.6) | |
Recommend career in medicine to children | .002 | |||
Yes | 594 (53.3) | 711 (51.9) | 1982 (57.0) | |
No | 520 (46.7) | 659 (48.1) | 1494 (43.0) | |
Moderate or greater likelihood of reducing clinical hours within next 12 mo | <.001 | |||
Yes | 178 (20.8) | 219 (20.9) | 1004 (31.6) | |
No | 677 (79.2) | 831 (79.1) | 2176 (68.4) | |
Primary reason for considering reducing clinical work hours | <.001 | |||
Missing/No/Slight chance of reducing hours | 1229 | 1301 | 2784 | |
Frustration w/Medicare and insurance issues | 25 (7.1) | 62 (18.6) | 170 (15.2) | |
Spend more time with family | 190 (53.7) | 109 (32.7) | 327 (29.1) | |
Declining reimbursement for clinical care | 29 (8.2) | 32 (9.6) | 108 (9.6) | |
Pursue admin/leadership opportunities | 29 (8.2) | 47 (14.1) | 106 (9.4) | |
Pursue research/education opportunities | 42 (11.9) | 15 (4.5) | 43 (3.8) | |
Other | 39 (11.0) | 68 (20.4) | 368 (32.8) | |
Moderate or greater likelihood of leaving current practice within 2 y | <.001 | |||
Yes | 539 (34.1) | 405 (24.9) | 1541 (39.6) | |
No | 1041 (65.9) | 1222 (75.1) | 2350 (60.1) | |
What the physician would do if he/she left the current practice | <.001 | |||
Missing/No/slight chance of leaving current practice | 1048 | 1234 | 2393 | |
Look for diff practice and continue to work as | 423 (79.1) | 202 (50.5) | 355 (23.5) | |
Look for diff job in medicine and leave medicine | 41 (7.7) | 75 (18.8) | 167 (11.0) | |
Leave medicine altogether to pursue different | 26 (4.9) | 56 (14.0) | 81 (5.4) | |
Retire | 4 (0.7) | 22 (5.5) | 736 (48.6) | |
Other | 41 (7.7) | 45 (11.3) | 174 (11.5) |

Variable | Odds ratio (95% CI) | P value |
---|---|---|
Early career (0-10 y) | 0.75 (0.64-0.89) | <.001 |
Late career (≥21 y) | 0.74 (0.65-0.85) | <.001 |
Have children | 0.63 (0.54-0.73) | <.001 |
Hours worked per week (for each additional hour) | 1.02 (1.01-1.02) | <.001 |
Nights on call per week (for each additional night) | 1.03 (1.002-1.05) | .03 |
Surgical specialty | 0.71 (0.60-0.83) | <.001 |
Internal medicine or pediatrics subspecialty | 0.72 (0.60-0.86) | <.001 |
Academic practice | 0.63 (0.55-0.73) | <.001 |
Recent work-home conflict | 2.47 (2.20-2.77) | <.001 |
Most recent work-home conflict resolved in favor of personal responsibility | 1.29 (1.07-1.54) | .006 |
Most recent work-home conflict resolved in favor of work responsibility | 2.13 (1.87-2.43) | <.001 |
Career Satisfaction
Variable | Odds ratio (95% CI) | P value |
---|---|---|
Career satisfaction | ||
Late career (≥21 y) | 1.56 (1.35-1.81) | <.001 |
Have children | 1.33 (1.13-1.57) | <.001 |
Academic practice | 1.63 (1.39-1.92) | <.001 |
Recent work-home conflict | 0.78 (0.68-0.89) | <.001 |
Most recent work-home conflict resolved in favor of personal responsibility | 0.79 (0.65-0.97) | .02 |
Most recent work-home conflict resolved in favor of work responsibility | 0.79 (0.69-0.91) | <.001 |
Burned out | 0.24 (0.21-0.28) | <.001 |
Satisfaction with work-life balance | ||
Male (vs female) | 1.37 (1.18-1.60) | <.001 |
Married or partnered (vs single or widowed) | 1.33 (1.08-1.63) | .007 |
Early career (0-10 y) | 1.33 (1.10-1.60) | .003 |
Late career (≥21 y) | 1.24 (1.06-1.46) | .007 |
Hours worked per week (for each additional hour) | 0.95 (0.94-0.95) | <.001 |
Nights on call per week (for each additional night) | 0.94 (0.92-0.97) | <.001 |
Recent work-home conflict | 0.34 (0.30-0.38) | <.001 |
Most recent work-home conflict resolved in favor of work | 0.43 (0.37-0.50) | <.001 |
Burned out | 0.33 (0.29-0.37) | <.001 |
Intent to Reduce Clinical Work Hours or Leave Medicine
Discussion
Conclusion
Supplemental Online Material
- Supplemental Appendix
References
- Job satisfaction in general practice: implications for prescribing.Soc Sci Med Med Psychol Med Sociol. 1980; 14A: 495-499
- Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty.JAMA. 1985; 254: 2775-2782
- Better outcome means more job satisfaction: pilot project in Winnipeg and Halifax to enhance physician-patient communication.Can Fam Physician. 1999; 45: 218-220
- Physician and patient satisfaction as factors related to the organization of internal medicine group practices.Med Care. 1985; 23: 1171-1178
- Is professional satisfaction of general internists associated with patient satisfaction.J Gen Intern Med. 2000; 15: 122-128
- Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study.Health Psychol. 1993; 12: 93-102
- Understanding physicians' intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health.Health Care Manage Rev. 2001; 26: 7-19
- Burnout and career satisfaction among American surgeons.Ann Surg. 2009; 250: 463-471
- Physician burnout: a potential threat to successful health care reform.JAMA. 2011; 305: 2009-2010
- Physician discontent: challenges and opportunities.JAMA. 2003; 290: 941-946
- Physician career satisfaction across specialties.Arch Intern Med. 2002; 162: 1577-1584
- Physician Characteristics and Distribution in the U.S.American Medical Association, Chicago, IL2012
- Burnout and satisfaction with work-life balance among U.S. physicians relative to the general U.S. population.Arch Intern Med. 2012; 172: 1377-1385
American Association for Public Opinion Research. Standard definitions. Final disposition of case codes and outcome rates for surveys. 2011. http://www.aapor.org/AM/Template.cfm?Section=Standard_Definitions2&Template=/CM/ContentDisplay.cfm&ContentID=3156. Accessed May 4, 2012.
- Maslach Burnout Inventory Manual.3rd ed. Consulting Psychologists Press, Palo Alto, CA1996
- Validity of the Maslach Burnout Inventory for family practice physicians.J Clin Psychol. 1986; 42: 488-492
- A meta-analytic examination of the correlates of the three dimensions of job burnout.J Appl Psychol. 1996; 81: 123-133
- The discriminant validity of burnout and depression: a confirmatory factor analytic study.Anxiety Stress Coping. 1994; 7: 357-373
- On the clinical validity of the Maslach Burnout Inventory and the Burnout Measure.Psychol Health. 2001; 16: 565-582
- Resident burnout.JAMA. 2004; 292: 2880-2889
- Burnout and self-reported patient care in an internal medicine residency program.Ann Intern Med. 2002; 136: 358-367
- Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns.Acad Med. 2006; 81: 82-85
- Relationship between work-home conflicts and burnout among American surgeons: a comparison by sex.Arch Surg. 2011; 146: 211-217
- Work-home conflicts have a substantial impact on career decisions that affect the adequacy of the surgical workforce.Arch Surg. 2012; 147: 933-939
- Career satisfaction, practice patterns and burnout among surgical oncologists: report on the quality of life of members of the Society of Surgical Oncology.Ann Surg Oncol. 2007; 14: 3043-3053
- Career satisfaction of US women physicians.Arch Intern Med. 1999; 159: 1417-1426
- Burnout and career-choice regret among family practice physicians in early practice.Fam Pract Res J. 1994; 14: 213-222
- The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program.Arch Intern Med. 2005; 165: 2601-2606
United States Office of Personnel Management. Career Patterns: A 21st Century Approach to Attracting Talent. http://www.opm.gov/hcaaf_resource_center/careerpatterns/CPGuideV1.pdf. Accessed October 1, 2012.
- Econometric Analysis.7th ed. MacMillan, New York, NY1993
- Physician Workforce: Projections and Research Into Current Issues Affecting Supply and Demand.US Dept of Health and Human Services, Rockville, MD2008
- Physician Supply and Demand: Projections to 2020.US Dept of Health and Human Services, Rockville, MD2006
- Some hidden costs of faculty turnover in clinical departments in one academic medical center.Acad Med. 2009; 84: 32-36
- Is job satisfaction u-shaped in age?.J Occup Organ Psychol. 1996; 69: 57-81
- Identity and the Life Cycle.WW Norton & Co, New York, NY1980
- A causal model of voluntary turnover among nursing personnel in long-term psychiatric settings.Res Nurs Health. 1998; 21: 415-427
- The theories of turnover: causes, effects, and meaning.Res Soc Organizations. 1982; 1: 75-128
- Physician response to surveys: a review of the literature.Am J Prev Med. 2001; 20: 61-71
- Changes in career satisfaction among primary care and specialist physicians, 1997-2001.JAMA. 2003; 289: 442-449
Article Info
Footnotes
For editorial comment, see page 1347
Dr Boone is currently with the Office of the Associate Vice President, Health Affairs, University of Chicago, Chicago, IL.
Grant Support: Funding for this study was provided by the American Medical Association, Mayo Clinic Department of Medicine Innovation Award, and the Mayo Clinic Department of Medicine Program on Physician Well-being.