l a i t n Sustaining Women in e Medicine (SWIM) Study d i Preliminary Results f n PRESENTED BY: AIMEE R. EDEN, PHD, MPH o FEBRUARY 23, 2020 C
l a The SWIM Team: i t n e d i f n o C
l a Learning Objectives i t n • Identify factors that are associated with increased rates of burnout among family physicians e • Describe differences and similarities in burnout between female and male family d physicians • Explain the ways in which family physicians and their organizations address i f burnout n o C
l a i t n e d Background i f n o C
l a The Quadruple Aim i t n e d i f n o C
l a What Do We Know? Gender Differences in Burnout i t n • Female family physicians report higher rates of burnout e • Differences in contributing factors d • Family responsibilities • Workplace discrimination i f • Differences in interventions? n • Mentoring o • Not deferring life decisions • Support groups C
l a i t n e The SWIM d Study i f n o C
l a SWIM Project Design i t n e Creation of a Survey of Interviews “playbook” Focus Phase Phase Phase Phase family with sample for groups d physicians of FPs who organizations 4 1 2 3 with female in California responded to use when FPs and Illinois to survey designing i interventions f n May, 2019 Jan-Mar, 2020 Mar-May, 2020 Late 2021 o C
l a Preliminary Survey Results i t n • Total of 2,183 respondents e • Gender: • Just over half burned out (53%) • 58% (1,260) female • 55% of females d • 42% (913) male • 50% of males i • 0.3% (7) non-binary f n • State: • 76% (1,659) from California o • 24% (524) from Illinois C
l a Burnout by Gender & Age i t 70.0% n 60.0% e 50.0% % Burned Out d 40.0% i 30.0% f n 20.0% o 10.0% 0.0% C Under 40 40-49 (n=672) 50-59 (n=546) 60+ (n=422) (n=452) Female (n=1229) 57.2% 54.8% 54.7% 52.1% Male (n=886) 52.3% 54.3% 54.4% 42.4%
l a i t n e Findings: Associations d with Burnout i f n o C
l a Mental & Physical Health and Burnout i t 90.0% n 80.0% e 70.0% 60.0% % burned out d 50.0% i 40.0% f 30.0% n 20.0% o 10.0% 0.0% C Very good Good Poor/Fair Very good Good Poor/Fair Mental Health Physical Health Female Male
l a Household Responsibilities and Burnout i t n Female Male e Primarily responsible for managing child-related activities: d Of those with children, % with primary responsibility 77% 16% i Of those with primary responsibility, % burned out 54% 61% f n Primarily responsible for managing domestic duties: o % with primary responsibility 79% 38% C Of those with primary responsibility, % burned out 56% 54%
l a Work-life balance and Burnout i t n e I have a good work-life balance. Female Male d Disagree ( % do NOT have a good work-life balance ) 46% 38% i Of those who disagree, % burned out 76% 74% f n Agree (% DO have a good work-life balance ) 54% 62% o Of those who agree, % burned out 39% 36% C
l a Practice Site and Burnout i t n Managed care / HMO practice e Hospital/health system-owned medical practice d Government (FQHC, IHS, RHC, etc.) i f n Independently-owned medical practice o Academic health center / faculty practice C 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% % burned out Male Female Linear (Female) Linear (Male)
l a Work Environment and Burnout i t Satisfaction with Practice n 90.0% 80.0% e 70.0% d 60.0% 50.0% i 40.0% f n 30.0% 20.0% o 10.0% C 0.0% Female, satisfied & burned Female, dissatisfied & Male, satisfied & burned out Male, dissatisfied & burned out burned out out Overall Hours Employer Income
l a Organizational Factors and Burnout i t n 80.0% 70.0% e 60.0% d 50.0% 40.0% i f 30.0% n 20.0% o 10.0% 0.0% C Female, Agree & burned out Female, Disagree & burned out Male, Agree & burned out Male, Disagree & burned out I have autonomy to do my job the way I think it should be done. My professional values are well aligned with those of my department leaders. My organization really cares about my well-being. I have an adequate allotment of time with each patient.
l a i t n e Addressing d Burnout i f n o C
l a Personal Steps Taken to Address Burnout i 60% t n 50% 40% e 30% d 20% 10% i f 0% n o C Female (n=1252) Male (n=899)
l a Organizational Support for Physician Wellbeing i t 40% n 35% e 30% d 25% 20% i f 15% n 10% o 5% C 0% Appropriate Access to Flexible Protected Formal No support Flexible paid Lactation Exercise Scribe Other ratio of behavioral work hours time to wellness for worker time off room room physicians to health complete program well-being nurses/MAs services non-clinical tasks Female (n=1130) Male (n=810)
l a Personal Steps vs. Organizational Support i 95% t n 90% e d 85% i f 80% n 75% o C 70% Personal steps to address burnout taken Organizational support for worker well-being Female Male
l a i t n e d In their words i f n o C
l a “When medicine went “The amount of EHR documentation has i corporate we physicians lost more than anything reduced the joy of t our autonomy and the patients medical practice and has markedly n became the company’s not infringed on my personal life unless one ours. Hence the satisfaction can accept mediocre work which I refuse to e with our profession decreased do. Also not being in control of the time I and the burdens of can spend with patients is a major documentation increased.” d problem”– Male, 60-69 – Male, 60-69 i f n “We need to stop focusing on what physicians can do o themselves about burnout and focus on changing the system in which we practice. It’s not sustainable to be C forced to increase “productivity” by increasing the number of patient visits in a day. We all know our complex patient visits last well over 15 minutes.” – Male, 30-39
l a “It changes throughout your career. When I was “My greatest stress comes a new doctor with young kids, the stress was i from wanting desperately to about taking care of kids, managing my t go down to part time to marriage and establishing myself as a n spend time with my young physician. Now my kids are grown and although children, and [be] more you still worry about your kids, I find it is the e involved in their lives.” environment of medicine that is the challenge.” – Female, 30-39 – Female, 50-59 d i f n “The system needs to value our time outside of the 15-20 min o visits, the unpaid hours of work is demeaning and adds to the feeling of no value on our work especially with the complex C patients. [We] need health care systems to see the benefit of paying for well trained MAs and nurses to do a lot of the busy work MDs so that could be delegated.” – Female, 40-49
l a Interviews & Focus Groups i t n • Interviews in progress e • 32 interviewed so far • 45 – 75 minutes each d • Goal: up to 80 interviews with both male & female, burned out and non-burned out, physicians i • To learn about what contributes to burnout for them and what they and their organizations do f to reduce/prevent burnout n • Focus group planning complete o • Illinois: March 2020 • California: May 2020 C • Goal: up to 4 focus groups with 5-9 female physicians each • To learn about the most effective ways to reduce burnout
l a Questions? i t n • Aimee R. Eden aeden@theabfm.org e • Yalda Jabbarpour yjabbarpour@aafp.org d i f • Vince Keenan vkeenan@iafp.com n • Shelly Rodrigues srodrigues@familydocs.org o C
l Table1. Demographic and Practice Characteristics of Family Physician Survey Participants (N=2169) a Demographic and Personal Characteristics n (%) Practice Characteristics n (%) Gender (n = 2169) Practice Site (n = 1941) Female 1257 (58.0%) Hospital/health system-owned medical practice i 477 (24.6%) t Male 912 (42.0%) Independently-owned medical practice 352 (18.1%) Age (n = 2146) Managed care / HMO practice 328 (16.9%) n Under 40 459 (21.4%) Academic health center / faculty practice 176 (9.1%) 40 - 49 681 (31.7%) Government 435 (22.4%) e 50 - 59 567 (26.4%) Workplace clinic 18 (0.9%) 60 or Older 439 (20.5%) Other 155 (8.0%) d Degree Type (n = 2169) Practice Size (n = 1930) DO 216 (10.0%) Solo practice 132 (6.8%) MD 1953 (90.0%) 2-5 providers 449 (23.3%) i f Race (n = 1930) 6-20 providers 555 (28.8%) American Indian or Alaska Native 8 (0.4%) >20 providers 794 (41.1%) n Asian 463 (24.0%) Practice Setting (n = 1935) Black or African American 84 (4.4%) Urban (250,000+ population) 985 (50.9%) o Native Hawaiian or Other Pacific Islander 22 (1.1%) Micropolitan (20,000-250,000 population) 681 (35.2%) White 1195 (61.9%) Large Rural (2,500-19,999 population) 221 (11.4%) C Other 158 (8.2%) Small Rural/Remote (<2,500 population) 48 (2.5%) Ethnicity (n = 1910) Practice Ownership (n = 1932) Hispanic or Latino 237 (12.4%) No official ownership stake 1197 (62.0%) Non-Hispanic 1673 (87.6%) Self-employed as a contractor 82 (4.2%) Burnout (n = 2115) Partial owner or shareholder 449 (23.2%) Yes 1124 (53.1%) Sole owner 133 (6.9%) No 991 (46.9%) Other 71 (3.7%)
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