PHYSICIAN BURNOUT IN PEDIATRIC CRITICAL CARE MEDICINE

Objectives: To determine the prevalence of, and factors associated wit h, burnout among pediatric intensivists across a variety of practice s ettings. Design: A population-based survey, using a mailed questionnai re that included a previously validated Burnout Scale. Setting: Privat e and academic pediatric critical care practices, Participants: Respon dents from among all members of the Pediatric Section of the Society o f Critical Care Medicine and all physicians certified in pediatric cri tical care medicine by the American Board of Pediatrics. Measurements and Main Results: The questionnaire consisted of demographic items, va riables noted in the literature as being associated with burnout (e.g. , the individual's perception of how others valued their work, and the use of preventive measures such as regular exercise to relieve stress ), and a validated Burnout Scale. The questionnaire also included ques tions pertaining to past training, practice of other primary specialti es or subspecialties, practice settings, admission responsibilities, a ctual and preferred practice activities, total work effort, academic a ctivities, and causes of stress at work. The Burnout Scale of Pines an d Aronson is a self-diagnosis instrument, consisting of 21 questions u sing a 7-point frequency scale. The total Burnout Score represents an average of the scores for the individual components, Scores of less th an or equal to 3 in our study were classified as ''not burned out.'' S cores of > 3 and less than or equal to 4 were classified as ''at risk. '' Scores of > 4 were classified as ''burned out.'' A total of 883 que stionnaires were mailed; 474 (56%) were respondent returns and 35 ques tionnaires could not be delivered. Primary analyses focused on the 389 respondent attending physicians presently practicing pediatric critic al care medicine at the time of the survey. The average Burnout Score of these attending physicians was 3.1 +/- 0.8; 36% were classified as being at risk for burnout, and 14% were classified as burned out. Ther e was no association between burnout status and the following work con ditions: having fellows; having protected time for research and public ations; frequency of being called at home; frequency of returning to t he hospital when called at home; or call schedule. Respondents classif ied as burned out were significantly more likely than respondents who were classified as not burned out to feel that their work was not valu ed by others. Burned out respondents were less likely than respondents who were not burned out to give the following description: feeling ve ry successful; feeling that their peers viewed them as very successful ; feeling satisfied in their professional life; and routinely exercisi ng or having some other outside interest. Conclusions: We found that a high degree of burnout exists in pediatric critical care medicine, wi th 50% of pediatric intensivists at risk or burned out. Overall, there was no association between Burnout Scores and training, practice spec ialties, or practice settings, nor was there an association with aspec ts of practice that are physically taxing. However, perceptions about the value of their work and feelings of success and satisfaction were highly associated with those respondents classified as burned out. Rou tine exercise (a strategy used by some for stress reduction) was assoc iated with lower Burnout Scores. Further studies are necessary to eval uate the trends that we have reported and to identify causal factors.