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Quality Improvement/Patient Safety: Primary & Subspecialty Outpatient Quality Improvement

QI 6: Primary & Subspecialty Outpatient QI Group 1

262 - Physician Stress and Burnout in a Large Suburban Pediatric Multi-Specialty Outpatient Practice

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 262
Publication Number: 262.452

Suzanne Kaseta, New York Medical College, Rock Tavern, NY, United States; Allen J. Dozor, New York Medical College, Valhalla, NY, United States; Kimberly Palmer, Boston Children's Health Physicians, Midddletown, NY, United States; Emily Sheboy, Boston Children's Health Physicians, valhalla, NY, United States; sankaran Krishnan, Boston Children's Health Physicians/New York Medical College, Valhalla, NY, United States

Presenting Author(s)

Suzanne Kaseta, MD, MMM (she/her/hers)

Chief Medical Officer, Boston Children's Health Physicians, Clinical Assistant Professor
New York Medical College
Valhalla, New York, United States

Background: Provider wellness and burnout are important concerns and may be associated with increased risk of medical errors, increased provider turnover, and increased risk of negative provider health outcomes. A recent national survey reported that 63% of physicians had at least one burnout manifestation. There are reports exploring stress and burnout in hospital-based pediatrics, but there are limited data in the outpatient setting. We report preliminary data on a comprehensive evaluation and intervention program in a pediatric multi-specialty practice.

Objective: To assess provider stress and burnout using validated surveys and individual non-structured interviews followed by customized recommendations for potential changes.

Design/Methods: Pediatric subspecialists responded anonymously to two widely used survey instruments – the Maslach Burnout Inventory (MBI) and the Mini Z survey 2.0. Surveys were followed by non-structured interviews of individual providers with a LCSW to address specific concerns, division culture, personal resilience, as well as generation of “wish-lists.” Anonymous results including common themes, strengths, weaknesses, and suggestions for changes were shared with each division chief.

Results: Survey responses and outcomes are reported on 64 subspecialists in 7 pediatric subspecialties (Table 1). Responses to the MBI domains were as follows: Emotional Exhaustion: low-44%, moderate-31%, high-25%; Depersonalization: low-73%, moderate-19%, high-8%; Sense of Personal Accomplishment: low-17%, moderate-22%, high-61%. 66% of providers were “engaged”, 11% were “overextended”, 8% were “ineffective”, 6% were “overextended, ineffective”, 5% were “overextended, disengaged”; and 2 providers (3%) were assessed as “burnout.” Based on the Mini Z, work environment was described as “joyful” by 11%, “very supportive” by 2%, work-rate and EHR "reasonable" by 0%; 30% reported symptoms of burnout. Common themes of the interviews were: "excessive time spent on administrative duties", “not appreciated”, "EMR not user-friendly", “lack of adequate staffing”, "inefficient workflow in main office", “lack of timely resolution of IT issues.” Recommendations were made to division chiefs to address these issues. Figure 1 demonstrates there no significant differences between subspecialties. Follow-up surveys will be conducted after 12 months to reassess wellbeing.

Conclusion(s): Outpatient pediatric subspecialists experience varying levels of stress and burnout. Organizational assessment of burnout using standardized surveys and interviews can drive action toward reducing burnout and improving wellbeing.