Rationale and Objectives
Burnout is a psychological syndrome composed of emotional exhaustion, depersonalization, and sense of lack of personal accomplishment, as a result of prolonged occupational stress. The purpose of our study was to determine the prevalence of burnout among current musculoskeletal radiology fellows and to explore causes of emotional stress.
Materials and Methods
A 24-item survey was constructed on SurveyMonkey using the Maslach Burnout Inventory. We identified 82 musculoskeletal radiology fellowship programs. We recruited subjects indirectly through the program director or equivalent.
Results
Fifty-eight respondents (48 male, 10 female) identified themselves as current musculoskeletal radiology fellows and completed the survey. Comparison of the weighted subscale means in our data to the Maslach normative subscale thresholds for medical occupations indicates that musculoskeletal radiology fellows report relatively high levels of burnout with regard to lack of personal accomplishment and depersonalization, whereas emotional exhaustion levels in our sample are within the average range reported by Maslach. Although male musculoskeletal radiology fellows experience relatively high levels in two of the three dimensions of burnout (depersonalization and personal accomplishment), female musculoskeletal radiology fellows experience relatively high burnout across all three dimensions. Job market-related stress and the effort required providing care for dependents significantly affect personal accomplishment. Conversely, imbalances in the work-life relationship and feelings of powerlessness are significantly associated with depersonalization and emotional exhaustion.
Conclusions
Musculoskeletal radiology fellows report relatively high levels of burnout. Because the consequences of burnout can be severe, early identification and appropriate intervention should be a priority.
Introduction
Burnout is a psychological syndrome occurring in human service workers and defined by Maslach along three dimensions: emotional exhaustion, depersonalization, and sense of lack of personal accomplishment . The syndrome is a result of prolonged occupational stress, in which an individual may become increasingly cynical, may become more callous toward those whom they are serving, and may grow increasingly dissatisfied with their accomplishments within the workplace .
The field of radiology, as in every area of medicine in the United States, has undergone rapid changes in the past decade. Radiologists in both the private and academic sectors have been compelled to adapt to the implementation of the Affordable Care Act and accompanying legislation directed at healthcare reform . The resulting effects, such as consolidation in the provider and insurance markets and reduced reimbursement rates, have led to negative personal and work satisfaction for individual physicians .
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Materials and Methods
Human Subjects
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Population and Sampling
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Survey
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Demographics
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Maslach Burnout Inventory
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Stressors
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Radiology as a career
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Financial stress
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Balancing work and life
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Healthcare evolution and job market
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Feelings of powerlessness and isolation
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Open-ended comments
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Statistical Analysis
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Results
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Table 1
Descriptive Statistics for Reduced MBI Subscales for MSK Radiology Fellows, and Comparison to Normative Values for Medical Occupations †
Panel A: Descriptive Statistics for Reduced MBI Subscales and Independent Variables Variable Obs. Number of Items Mean Linearized Std. Error 95% CI Personal accomplishment subscale 58 5 17.73 .49 16.74–18.72 Emotional exhaustion subscale 58 1 2.79 .22 2.35–3.23 Depersonalization subscale 58 1 2.22 .21 1.81–2.63 Gender (unweighted) 58 1 .17 .38 \* Weighted 58 1 .21 .06 .09–.33 Stress measures Financial 58 3 6.14 .27 5.60–6.69 Work-life balance 58 1 2.59 .10 2.40–2.79 Dependent care 58 1 2.08 .12 1.84–2.32 Job market 58 2 4.98 .18 4.63–5.34 Healthcare regulations 58 2 4.08 .18 3.72–4.45 Isolation at work 58 1 1.34 .08 1.17–1.51 Powerlessness at work 58 1 2.08 .11 1.87–2.30 Satisfaction with MSK subfield 58 2 3.52 .28 2.95–4.1
Panel B: Comparison of Reduced MBI Subscale Means for MSK Radiology Fellows to Normative Subscale Means and High Burnout Thresholds for Medical Occupations Variable Number of Items in Full MBI Number of Items in Reduced MBI items Item Weight Item-weighted Subscale Means (MSK Fellows) Normative Subscale Means (Medicine) Normative Subscale Thresholds for High Burnout (Medicine) Personal accomplishment subscale 8 5 1.6 28.37 36.53 ≤33 Emotional exhaustion subscale 9 1 9 25.11 22.19 ≥27 Depersonalization subscale 5 1 5 11.10 7.12 ≥10
CI, confidence interval; MBI, Maslach Burnout Inventory; MSK, musculoskeletal.
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Demographics
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Burnout
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Table 2
Comparison of MSK Radiology Fellows Mean Weighted rMBI Scales, Disaggregated by Sex, to Maslach’s Normative MBI Subscale Thresholds and Sex-disaggregated MBI Subscale Means
Emotional Exhaustion Depersonalization Personal Accomplishment Normative thresholds for high burnout (physicians and nurses) ≥27 ≥10 ≤33 Male Maslach 2010 19.86 7.43 36.29 MSK radiology 24.37 10.73 \* 28.3 \* Female Maslach 2010 20.99 7.02 36.50 MSK radiology 27.90 \* 12.5 \* 28.64 \* Adjusted Wald tests of subscale means (male-female comparisons) F (1, 57) 0.71 0.52 0.05 Prob > F 0.40 0.47 0.83
MBI, Maslach Burnout Inventory; MSK, musculoskeletal; rMBI, reduced Maslach Burnout Inventory.
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Table 3
Correlations Among Reduced MBI Subscales for MSK Fellows, Compared to Correlations Among Full MBI Subscales, Various Occupational Groups †
Emotional Exhaustion Depersonalization Depersonalization .54 \* (.52) Personal accomplishment −.11(−.22) −.17 (−.26)
MBI, Maslach Burnout Inventory; MSK, musculoskeletal.
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Gender and Burnout
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Prevalence of Burnout
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Sources of Burnout
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Regression Analyses
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Table 4
Regression of Reduced MBI Personal Accomplishment, Depersonalization, and Emotional Exhaustion Subscales on Stressors and Subfield Satisfaction †
Independent Variables Model 1 Model 2 Model 3 Personal Accomplishment Subscale Depersonalization Subscale Emotional Exhaustion Subscale Gender 0.149 0.576 0.486 (0.211) (0.675) (0.352) Stress measures Financial stress −0.125 0.017 −0.062 (0.176) (0.347) (0.239) Job market stress 0.348 ** 0.104 0.140 (0.135) (0.258) (0.291) Healthcare regulations −0.167 −0.051 0.031 (0.173) (0.347) (0.320) Work-life balance 0.054 0.386 * 0.690 \\\* (0.105) (0.224) (0.204) Care for dependents 0.323 \\\* −0.180 −0.481 ** (0.105) (0.288) (0.204) Isolation at work 0.063 0.403 0.340 (0.140) (0.265) (0.236) Powerlessness at work 0.171 0.473 ** 0.689 \\\* (0.128) (0.236) (0.199) Satisfaction with MSK radiology subfield 0.094 0.469 \\\* 0.627 \\\* (0.096) (0.137) (0.126) Constant 0.133 −1.073 −1.381 * (0.408) (0.938) (0.822) Observations 58 58 58 R-squared 0.279 0.318 0.532
MBI, Maslach Burnout Inventory; MSK, musculoskeletal.
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Free-text
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Discussion
Why Does Burnout Matter?
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Burnout in MSK Radiology Fellows
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How Do We Put Out the Fire?
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Limitations
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Conclusions
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Appendix. Survey Questions
Demographic Items
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Maslach Burnout Inventory Items
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Potential Sources of Stress
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Career Choice
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Open-Ended Comment
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