BURNOUT AMONG WOME N PHYSI CI ANS K im T e mple to n, MD Pa - - PowerPoint PPT Presentation

BURNOUT AMONG WOME N PHYSI CI ANS

K im T e mple to n, MD Pa st-pre side nt, Ame ric a n Me dic a l Wo me n’ s Asso c ia tio n Pro fe sso r o f Ortho pa e dic Surg e ry Unive rsity o f K a nsa s-K a nsa s City

BURNOUT AMONG WOME N PHYSI CI ANS

 No t a ll studie s o f b urno ut e va lua te b a se d o n g e nde r  E

xha ustio n a nd e mo tio na l e xha ustio n te nd to b e hig he r a mo ng wo me n

 Do e s this ma ke it e a sie r to ide ntify b urno ut?  I

s it mo re so c ia lly a c c e pta b le fo r wo me n to c o mpla in o f b urno ut?

 Ge nde r diffe re nc e s in inc ide nc e o f b urno ut ne e d a dditio na l

study

I S T HE RE A DI F F E RE NCE ?

 Study o f 1 a c a de mic me dic a l c e nte r a nd its c o mmunity a ffilia te  100 me n a nd 98 wo me n  I

nc o ming PGY-1 a nd PGY-1-4 I M re side nts

 30% o f wo me n, 15% o f me n me t c rite ria fo r b urno ut  Wo me n we re mo re like ly to de mo nstra te e mo tio na l e xha ustio n

(22% vs 9%)

Spa ta ro e t a l 2016

UNI VE RSI T Y OF K ANSAS DAT A BURNOUT , PGY1-3, AND GE NDE R

 T

ho ug h no t q uite sta tistic a lly sig nific a nt, b urno ut is hig he r a mo ng PGY2 re side nts, e spe c ia lly fe ma le s (p=0.076, c hi-sq ua re te st)

I SSUE S T HAT MAY BE T I E D T O WOME N PHYSI CI ANS AND BURNOUT

 Co mmunic a tio n style s/ inte rpe rso na l inte ra c tio ns  I

mpo ste r syndro me / ste re o type pe rc e ptio n

 Ge nde re d e xpe c ta tio ns/ e xte rna l de ma nds  Se xua l ha ra ssme nt/ (un)c o nsc io us g e nde r b ia s

T HE “MOT HE R” T RANSF E RE NCE

 Pro b le m so lve r, pe a c e ma ke r, kind  Diffic ultie s de le g a ting , fixe r, c a re ta ke r  Nurturing  Se lf a b ne g a ting

Do e s this le a d to wo me n spe nding mo re time with pa tie nts? E xpe nding mo re e mo tio na l e ne rg y? Diffic ulty de le g a ting pa tie nt c a re

• r fa mily re spo nsib ilitie s?

“Mo the rly a ppro a c h to pa tie nt c a re is like ly to b e b e st fo r the pa tie nt, b ut pe rha ps c o uld b e pe rso na lly ‘ dra ining ’ to fe ma le (surg e o ns) o ve r time ” (Da hlke e t a l 2018)

COMPASSI ON F AT I GUE I N F E MAL E SURGE ONS

 Physic a l/ e mo tio na l distre ss c a use d b y re pe a te dly c a ring fo r

tho se e xpe rie nc ing tra uma

 Use the Pro QOL  Distrib ute d b y ne wsle tte r to the Ame ric a n Co lle g e o f Surg e o ns  178 Surg e o ns c o mple te d surve y  F

e ma le surg e o ns fro m a ll spe c ia ltie s e xhib ite d sig nific a ntly hig he r le ve ls o f b urno ut a nd c o mpa ssio n fa tig ue c o mpa re d to ma le surg e o ns



Wu, e t.a l, T he Ame ric a n Surg e o n, 2017

I MPOST E R SYNDROME

 F

irst de sc rib e d a mo ng wo me n b ut fo und in b o th wo me n a nd me n

 T

ho se suffe ring fro m impo ste r syndro me b e lie ve the mse lve s le ss inte llig e nt o r c o mpe te nt tha t pe rc e ive d b y o the rs

 F

e a r tha t the y a re inte lle c tua l fra uds, de spite e xc e lle nt e va lua tio ns a nd te st sc o re s

 Pe rso na lity c ha ra c te ristic ? A re sult o f tra ining ? Pa rt o f pro fe ssio na l

ide ntity de ve lo pme nt?

 Ma y b e mo re mo tiva te d to pe rfo rm, b ut…  Also mo re like ly to suffe r fro m distre ss, de pre ssio n, a nxie ty

I MPOST E R SYNDROME

 Surve y o f 181 fa mily me dic ine re side nts  90% tho ug ht tha t the y we re re c e iving a de q ua te tra ining  41% o f wo me n vs 24% o f me n sc o re d a s impo ste rs  60% o f wo me n(43% o f me n) wo rrie d a b o ut the ir a b ility to

pra c tic e a fte r re side nc y

 T

ho se with hig h sc o re s o n the I mpo ste r Sc a le we re mo re like ly to b e de pre sse d, a nxio us, a nd ha d lo we r se lf-e ste e m Orie l e t a l 2004

DO RE SI DE NT S ST ART T RAI NI NG WI T H I S?

 We b -b a se d surve y o f 138 me dic a l stude nts  Wo me n we re sig nific a ntly mo re like ly to suffe r fro m I

S

 Hig he r inc ide nc e a mo ng 4th ye a r stude nts  T

ho se with I S we re sig nific a ntly mo re like ly to de mo nstra te e mo tio na l e xha ustio n, c ynic ism, a nd de pe rso na liza tio n

 Wo me n ma na g e d I

S b y wo rking ha rde r, me n b y a vo iding a re a s o f vulne ra b ility

 I

nc re a se risks fo r b urno ut a mo ng wo me n?

Villwo c k e t a l 2016

I MPOST E R SYNDROME QUE ST I ONS

 Ma y re fle c t de ve lo pme nta l pro c e ss during time s o f c ha ng ing o r

c ha ng ing ro le s/ re spo nsib ilitie s

 Do e s this re so lve with time ?  Whic h c o me s first, a nxie ty/ de pre ssio n o r I

S?

 Wha t is the impa c t o n b urno ut?

ST E RE OT YPE PE RCE PT I ON/ T HRE AT

 F

e a r o f c o nfirming a ne g a tive ste re o type b e c a use yo u b e lo ng to a g ro up (e .g ., fe ma le ), e ve n if the ste re o type is no t a c c ura te

 Surve y o f 384 (189 fe ma le ) re side nts within a sing le me dic a l c e nte r  All re side nts (ma le a nd fe ma le ) tho ug ht tha t the pub lic a nd fa c ulty

b e lie ve d me n we re b e tte r physic ia ns

 Wo me n hig he r in ste re o type pe rc e ptio n ha d wo rse psyc ho lo g ic

he a lth

 Ste re o type pe rc e ptio ns did no t impa c t the he a lth o f me n

Sa lle s e t a l 2016

I MPOST E R SYNDROME / ST E RE OT YPE PE RCE PT I ON WOME N RE SI DE NT S

 “F

e e l like (the y) do n’ t kno w a nything b ut a re re spo nsib le fo r… pa tie nts”

 “T

he y ha ve to lo o k like the y kno w e ve rything whe n the y do n’ t”

 Didn’ t kno w ho w to ma inta in c re dib ility with a pa tie nt  “T

he (wo ma n) re side nt is he ld re spo nsib le fo r e ve rything , fro m the e mo tio ns

• f e ve ryb o dy to the b rig htne ss o f the ro o m”

 “Whe n thing s a re n’ t do ne c o rre c tly, no ma tte r who se fa ult it is, wo me n ta ke

it mo re pe rso na lly”

 “Wo me n a re mo re like ly to ta ke c ritic ism to he a rt”  “We fe e l we ha ve to b e ‘ supe rwo ma n’ ”  “Ma ny de a l with impo ste r syndro me ”  Inte rna l o r e xte rna l pre ssure s?

I MPOST E R SYNDROME / ST E RE OT YPE PE RCE PT I ON SE NI OR WOME N PHYSI CI ANS

 Wo me n a re he ld to hig he r sta nda rds b y the mse lve s a nd o the rs  No ma tte r whe re the y we re (e a rlie r in the ir c a re e rs) the y we re

e xpe c te d to b e so me whe re e lse (e .g ., wo rk vs ho me )

 F

e lt (a nd c o ntinue to fe e l) g uilty a b o ut no t do ing wha t o the r mo the rs did (e .g ., pic king up kids fro m sc ho o l, b a king c o o kie s)

 Wo me n physic ia ns a re no t a llo we d to sho w e mo tio ns (“c a n’ t c ry

in the o ffic e ”)

 “Wo me n sho uld sta nd up fo r the mse lve s a nd the ir wo rk”

HARASSME NT / DI SCRI MI NAT I ON

 Syste ma tic re vie w a nd me ta -a na lysis  177 a rtic le s re vie we d (1987-2011)  6 c o untrie s, inc luding the US a nd Ca na da  Hig he r pre va le nc e o f ha ra ssme nt a nd g e nde r disc rimina tio n a mo ng fe ma le

physic ia ns

 Ge nde r disc rimina tio n mo st c o mmo n fo rm o f a b use a mo ng re side nts (pre va le nc e

66.6%), fo llo we d b y ve rb a l a b use (58%), a nd se xua l ha ra ssme nt (36%)

 Mo st c o mmo n pe rpe tra to rs we re se nio r physic ia ns  I

nc re a se s risks fo r de pre ssio n a nd a nxie ty

 Mo re “in-g ro up”/ ”o ut-g ro up”, ra the r tha n g e nde r-b a se d F na is e t a l 2014

GE NDE R-BASE D DI SCRI MI NAT I ON

 Surve y thro ug h Assn o f Wo me n Surg e o ns  Mo st e xpe rie nc e d o r o b se rve d g e nde r-b a se d disc rimina tio n  60% fro m me n, 40% fro m wo me n  Supe rio rs, pe e rs, suppo rt sta ff, pa tie nts  Wo me n le ss like ly to spe a k up  De c re a se d c a re e r sa tisfa c tio n

Bruc e e t a l 2015

DAT A OUT SI DE OF ME DI CI NE …

 Na tio na l sa mple s o n the impa c t o f pe rc e ive d disc rimina tio n (PD)

in the wo rkpla c e , b a se d o n ra c e , se x, a g e , fa mily o b lig a tio n, a nd se xua l o rie nta tio n

 PD c o rre spo nde d with le ss e ng a g e me nt a nd mo re b urno ut  T

his psyc ho lo g ic withdra wa l indire c tly re sulte d in physic a l withdra wa l (i.e ., la te ne ss, a b se nte e ism, a nd inte nt to q uit)

Vo lpo ne e t a l 2013

GE NDE R BI AS- WOME N RE SI DE NT S

 “I

t’ s still a ‘ ma n’ s wo rld’ , a nd wo me n ha ve to wo rk ha rde r to pro ve the mse lve s”

 “Sta ff a ssume tha t the ma le is the mo re se nio r re side nt”  “I

t’ s o fte n po inte d o ut to fe ma le re side nts if the y a re the o nly o ne in the ir pro g ra m-no t ne g a tive b ut sho uldn’ t ma ke a diffe re nc e ”

 Re c o g nize d a s unc o nsc io us b e ha vio r, BUT  “I

t’ s the little thing s tha t re a lly a dd up to c re a te stre ss”

HARASSME NT WOME N RE SI DE NT S

 Utilize d q ue stio ns fro m the AAMA g ra dua tio n surve y to surve y

re side nts

 L

• w inc ide nc e o f b e sub je c te d to humilia tio n, o ffe nsive

c o mme nts, e mb a rra ssme nt

 Sta tistic a lly sig nific a nt re la tio nship to sympto ms o f b urno ut a mo ng

tho se who ha d ne g a tive e xpe rie nc e s

 No sig nific a nt diffe re nc e s b e twe e n me n a nd wo me n

GE NDE R BI AS-SE NI OR PHYSI CI ANS

 “Bullie d”, ha ra sse d e a rly in the ir c a re e rs  “Yo u just g e t o ve r it”  Unc le a r if/ ho w this impa c ts de ve lo pme nt o f b urno ut

I MPACT OF WORK

• L

I F E I NT E GRAT I ON

 Study o f ho spita lists a nd o utpa tie nt g e ne ra l inte rnists  40-50%no te d wo rk-ho me c o nflic t in the pre c e ding 3 we e ks  Re so lve d in fa vo r o r wo rk 30%  Re so lve d in fa vo r o f ho me 10-12%  50-60% me t b o th ne e ds

Re sults no t stra tifie d b y physic ia n g e nde r

Ro b e rts e t a l 2014

WORK HOME CONF L I CT (WHC)

 Surve y o f physic ia ns a nd the ir e mplo ye d pa rtne rs  WHC within the pre vio us 3 we e ks we re e xpe rie nc e d b y

physic ia ns 44.3% the ir e mplo ye d pa rtne rs 55.7 %

 50% o f physic ia ns did no t think tha t wo rk le ft suffic ie nt time fo r pe rso na l/ fa mily life  I

nc ide nc e o f b urno ut Physic ia ns 47.1 % with re c e nt WHC vs. 26.6 % witho ut Pa rtne rs 42.4% with a nd 23.8% witho ut re c e nt WHC

Dyrb ye e t a l 2013

I MPACT OF SUPPORT

 25 rura l fe ma le fa mily physic ia ns  I

de ntifie d stra te g ie s fo r wo rk-life b a la nc e

 Suppo rtive re la tio nships with pa rtne rs, pa re nts, me mb e rs o f the

c o mmunity

 Ma inta ine d c le a r b o unda rie s a ro und the ir wo rk life to pro vide

suffic ie nt time fo r pa re nting , re c re a tio n, e tc .

 T

he issue is no t the pre se nc e o f sig nific a nt o the r b ut whe the r tha t pe rso n, o r o the rs, pro vide suppo rt Phillips e t a l 2016

I MPACT OF PARE NT HOOD

 On-line surve y o f physic ia n mo m g ro up  5782 to ta l re spo nde nts (a t a ll sta g e s o f the ir c a re e rs)  66.3% re po rte d g e nde r disc rimina tio n, a nd 35.8% re po rte d ma te rna l

disc rimina tio n

 Of tho se re po rting ma te rna l disc rimina tio n, 89.6% re po rte d disc rimina tio n

b a se d o n pre g na nc y o r ma te rnity le a ve , a nd 48.4% re po rte d disc rimina tio n b a se d o n b re a stfe e ding -mo st c o mmo n, disre spe c tful c o mme nts fro m suppo rt sta ff

 Ma te rna l disc rimina tio n wa s a sso c ia te d with hig he r se lf-re po rte d b urno ut

(45.9% b urno ut in tho se with ma te rna l disc rimina tio n vs 33.9% b urno ut in tho se witho ut)

Ade so ye e t a l 2017

I MPACT OF PARE NT HOOD

 Surve y o f physic ia ns in Ge rma ny fo und tha t wo me n physic ia ns

with c hildre n we re mo re like ly to suffe r e mo tio na l e xha ustio n

 HOWEVE

R, re la tio nship to c o lle a g ue s a nd suppo rt fro m tho se mo re se nio r (“supe rio r”) ha d a n e ve n g re a te r impa c t o n e mo tio na l e xha ustio n risk (fo r b o th ma le s a nd fe ma le s)

Ric hte r e t a l 2014

WORK / HOME I NT E RACT I ON SE NI OR PHYSI CI ANS

 Suppo rtive fa mily e a se s te nsio n a nd impro ve s jo b sa tisfa c tio n  Ha ving c hildre n is pro b le ma tic fo r I

MGs, if the y ha ve no fa mily in the US to a ssist with c hildc a re

 Diffic ult c ho ic e s to ra ise c hildre n a nd ha ve a c a re e r  Ma y ne e d to sa c rific e pro g re ssio n a t wo rk fo r b e tte r q ua lity o f life  T

his ma y o r ma y no t impro ve a s c hildre n b e c o me o lde r

 T

he re ne e ds to b e fle xib ility in fa mily c a re / le a ve struc ture to a ddre ss issue s with a g ing pa re nts, spo use s/ pa rtne rs, e xte nde d fa mily, e tc .

COPI NG ST RAT E GI E S

 Surve y o f re side nts  No g e nde r-b a se d diffe re nc e s in a c c e pta nc e , ta king a c tio n, o r

po sitive re fra ming

 Giving up, de nia l, a nd sub sta nc e use lo w fo r b o th g e nde rs  Wo me n mo re like ly to use e mo tio na l suppo rt (po sitive ) a nd se lf-

b la me (ne g a tive )

 Se lf b la me ma y b e the prima ry drive r- c a use o r re sult o f b urno ut?

Due to pe rc e ive d e xpe c ta tio ns? Due to le ss c o nfide nc e ?

Spa ta ro 2016

COPI NG- SE NI OR PHYSI CI ANS

 “Do n’ t se t a n una tta ina b le hig h b a r fo r yo urse lf a nd the n b e a t

yo urse lf up fo r no t me e ting it”

 “Do n’ t strive fo r pe rfe c tio n”  F

ind time fo r yo urse lf, e xe rc ise , se lf-c a re

ROL E OF ME NT ORS

 L

a c k o f fe ma le me nto rs, e spe c ia lly in ma le -do mina te d fie lds (e .g ., surg e ry)

 L

e a ve s physic ia ns witho ut like -se xe d a dvo c a te s

 Ma y ma ke fe ma le tra ine e s le ss c e rta in a b o ut ho w to a dvo c a te

fo r the mse lve s, a c hie ve wo rk-life inte g ra tio n, c ho o se a c a re e r pa th, e tc .

Da hlke e t a l 2018

SOCI AL SUPPORT

 Na tio na l surve y o f US surg e ry re side nts  L

• we r le ve ls o f b urno ut a mo ng tho se with a struc ture d me nto ring

pro g ra m

 Pre ve ntio n o r e a rly ide ntific a tio n o f b urno ut?

E lmo re e t a l 2016

SOCI AL SUPPORT / ME NT ORI NG- WOME N RE SI DE NT S

 Ne e d “g o o d” de pa rtme nt c ulture tha t pro vide s suppo rt  Me nto rs/ a dviso rs o r ha ving a struc ture d me nto ring pro g ra m to pro vide a

suppo rt syste m-e spe c ia lly wo me n to disc uss wo rk-life inte g ra tio n; ma y b e diffic ult in spe c ia ltie s/ pro g ra ms with fe w wo me n

 “E

nc o ura g e wo me n to vo ic e ho w the y fe e l a nd wha t the y ne e d- no t just wha t we think the y sho uld fe e l o r ne e d”

 Ge tting to kno w o the r fe ma le re side nts, who unde rsta nd a nd suppo rt the m

thro ug h “e ve nts fo r wo me n tha t a re c ro ss-pro g ra m a nd g o a l-o rie nte d” o r to “b lo w o ff ste a m”

 Oppo rtunitie s to “kno w wha t life will b e like a fte r re side nc y”  Ma y he lp to de c re a se stre ss during pro fe ssio na l ide ntity de ve lo pme nt,

c o nfro nt impo ste r syndro me / ste re o type pe rc e ptio n, disc uss wo rk/ ho me inte ra c tio n, pro vide le a de rship de ve lo pme nt o ppo rtunitie s

T HANK YOU!