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High Incidence of Burnout in Academic Chairpersons of Anesthesiology Should We Be Taking Better Care of Our Leaders?

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High Incidence of Burnout in Academic Chairpersons of Anesthesiology Should We Be Taking Better Care of Our Leaders? ORIGINAL INVESTIGATIONS IN ANESTHESIOLOGY High Incidence of Burnout in Academic Chairpersons of Anesthesiology Should We Be Taking Better Care of Our Leaders? Gilda` sio S. De Oliveira, Jr, M.D.,* Shireen Ahmad, M.D.,† M. Christine Stock, M.D.,‡ Ronald L. Harter, M.D.,# Marcela D. Almeida, M.D.,** Paul C. Fitzgerald, M.S., R.N.,§ Robert J. McCarthy, D.Pharm.ʈ ABSTRACT What We Already Know about This Topic • Burnout among academic chairs has been studied in other Background: Burnout is a work-related psychologic syn- specialties and, when present, diminishes leadership drome characterized by emotional exhaustion, low personal accomplishment, and depersonalization. Methods: By using an instrument that included the MBI- What This Article Tells Us That is New HHS Burnout Inventory, we surveyed academic anesthesiol- ogy chairpersons in the United States. Current level of job • In a survey of 102 chairs of anesthesiology departments, more than half met the criteria for high or moderate burnout satisfaction compared with 1 and 5 yr before the survey, • Risk factors for burnout were low job satisfaction and reduced likelihood of stepping down as chair in the next 2 yr, and a self-reported spousal/significant other support high risk of burnout were the primary outcomes. Results: Of the 117 chairs surveyed, 102 (87%) responded. ␳ ϭ Nine surveys had insufficient responses for assessment of ciation between the modified efficacy scale score ( Ϫ ϭ burnout. Of 93 chairs, 32 (34%) reported high current job 0.303, P 0.003) and likelihood of stepping down. Of 93 satisfaction, which represented a significant decline com- chairs, 26 (28%) met the criteria for high burnout and an pared with that reported for 1 yr (P ϭ 0.009) and 5 yr (P ϭ additional 29 (31%) met the criteria for moderately high 0.001) before the survey. Of 93 chairs, 26 (28%) reported burnout. Decreased current job satisfaction and low self- extreme likelihood of stepping down as a chair in 1–2 yr. reported spousal/significant other support were independent There was no association of age (P ϭ 0.16), sex (P ϭ 0.82), predictors of high burnout risk. or self-reported effectiveness (P ϭ 0.63) with anticipated Conclusion: Fifty-one percent of academic anesthesiology likelihood of stepping down, but there was a negative asso- chairs exhibit a high incidence/risk of burnout. Age, sex, time as a chair, hours worked, and perceived effectiveness were not associated with high burnout; however, low job satisfaction * Instructor, † Associate Professor, ‡ Professor and Chair, § Research Associate, ʈ Research Professor, Department of Anesthe- and reduced self-reported spousal/significant other support siology, Northwestern University Feinberg School of Medicine, Chi- significantly increased the risk. cago, Illinois, # The Jay J. Jacoby, M.D., Ph.D. Professor and Chair, The Ohio State University College of Medicine, Columbus, Ohio, ** Clinical Associate, Department of Psychiatry, The University of cademic anesthesiology chairs in the United States con- Chicago, Chicago, Illinois. A tend with job attributes that can be frustrating and Received from the Department of Anesthesiology, Northwestern eventually lead to emotional exhaustion and burnout. Exam- University Feinberg School of Medicine, Chicago, Illinois. Submitted for publication April 12, 2010. Accepted for publication July 12, ples of these attributes include reporting conflicting relation- 2010. Support was provided solely from institutional and/or depart- ships, responsibility for things over which they have no con- mental sources. trol, and human resource challenges. To understand the Address correspondence to Dr. McCarthy: Department of Anes- emotional impact of these frustrations, it is important to thesiology, Northwestern Memorial Hospital, 251 E. Huron St., F5– 704, Chicago, Illinois 60611. [email protected]. This article may be accessed for personal use at no charge through the ᭜ This article is accompanied by an Editorial View. Please Journal Web site, www.anesthesiology.org. see: Shanafelt T: Burnout in anesthesiology: A call to action. Copyright © 2010, the American Society of Anesthesiologists, Inc. Lippincott ANESTHESIOLOGY 2011; 114:1–2. Williams & Wilkins. Anesthesiology 2011; 114: 181–93 Anesthesiology, V 114 • No 1 181 January 2011 Burnout in Anesthesiology Chairpersons define precisely the vocabulary that describes the results of ducted, and eight programs did not provide the electronic ad- workplace frustration and unhappiness. Burnout is a work- dress of the chairperson. The survey was created using software related psychologic syndrome characterized by emotional ex- (Survey Monkey; SurveyMonkey Inc., Portland, OR). To en- haustion, low personal accomplishment, and depersonaliza- sure confidentiality of the participants, the survey was set up to tion.1 Emotional exhaustion is the subjective sense of fatigue delink the responses to the respondents’ e-mail addresses. The or stupor related to one’s work. Low personal accomplish- participants who did not respond to the electronic questionnaire ment is a feeling of frustration with work-related achieve- were mailed a copy of the survey with a self-addressed return ments. Depersonalization is a person’s attempt to separate envelope addressed to the primary investigator. himself or herself from his or her work as a defense mecha- The questionnaire was divided into five parts. Open-ended nism. Burnout syndrome differs from depression because it is and multiple choice questions were used. Likert scales were used specific to the work environment, whereas depression ex- to quantify respondents’ level of agreement with a statement. tends to both one’s professional and personal life. The first section consisted of 11 questions designed to capture Burnout syndrome was first characterized in the early demographic information about the chairperson: age, sex, time 1970s.1 Clinical manifestations are often nonspecific and of service as a chair, size of department by number of faculty, include fatigue, sleep and eating disorders, headache, and division chiefs, residents and fellows, amount of work hours per emotional instability. The validated instrument most com- week, percentage of time dedicated to patient care, administra- monly used to study burnout is the MBI-HHS Burnout tive duties, research, and whether his or her medical school had 1 Inventory (MBI), which uses a composite score that takes a support group for chairs. The second part of the survey re- into consideration the three subscales based on questions quired the chairperson to select from among 15 potential stres- relating to emotional exhaustion, depersonalization, and re- sors those that have affected the department; also, one question duced personal accomplishment. Burnout syndrome is con- assessed the degree to which these factors affected the chairs. sidered present when the responder demonstrates high scores They were asked to rank the factors on a five-point scale from in emotional exhaustion and depersonalization and a low “not at all” to “extreme amount.” Current job satisfaction was score in personal accomplishment. assessed, as were job satisfaction perceived 1 and 5 yr prior (if The prevalence of burnout is higher among individuals appropriate) and likelihood the chair would resign in the next whose job involves interactions with people (e.g., physicians, 1–2 yr (ranging from “not likely” to “extremely likely” using a 2 nurses, and social workers). Evolving changes in health care, five-point scale). Chairs were also asked to rate their job satisfac- including decrease in physician services reimbursement, tion in their position at 1 and 5 yr before the survey but were not challenges with the Accreditation Council for Graduate expected to answer these questions if they had not been in the Medical Education, and difficulties with faculty retention, position for that length of time. The chairpersons were then generate stress for the department chair that can potentially questioned regarding satisfaction relating to the balance of per- 3 predispose him or her to develop burnout. Burnout has sonal and professional life using a five-point scale, ranging from 3–5 been studied in academic chairs of other specialties. “very satisfied” to “very dissatisfied.” The third portion of the 3 Gabbe et al. concluded that the psychologic well-being of survey assessed the chairpersons’ opinion regarding their profes- the chairs of academic departments of obstetrics and gyne- sional life using a modified self-efficacy scale.6 The sum of these cology affected the quality of leadership they provided in responses was calculated, ranging between a low of 7 and a teaching, patient care, and administration. maximum of 35. Respondents also ranked their effectiveness as The purpose of this study was to evaluate work-related a chair on a scale ranging from 0 (representing “least effective”) stress and personal factors associated with professional burn- to 100 (representing “most effective”). out in chairs of anesthesiology departments. We designed a The fourth part of the survey included 12 questions from the cross-sectional survey that was adapted from those used in MBI–Human Services Survey (HSS).1–7 The full MBI–HSS the previously mentioned studies of other medical subspe- 3–5 involves 22 questions: 5 assessing depersonalization, 9 assessing cialties to evaluate whether the trends observed in other emotional exhaustion, and 8 assessing personal accomplish- departments would also apply to chairpersons of anesthesi- ment.
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