Table 2.
Themes identified from written responses to the question, “What factors of your training/practice, if any, do you feel pose a threat to your physician wellness and/or increase your burnout?”*
| Theme and Code | n (%)† | Exemplar Quote |
|---|---|---|
| Clinical burden | ||
| Workload | 207 (49) | “Combination of frequency of overnight call with length of harder clinical rotations.” 78 |
| “12 continuous days of 12 h a day ICU.” 220 | ||
| Administrative burden | 82 (19) | “Billing and EMR, documentation.” 262 |
| “Amount of documentation in electronic medical record.” 26 | ||
| Patient responsibility | 63 (15) | “High pressure environment without room for errors.” 427 |
| “Ratio of patients to provider.” 1 | ||
| Emotional toll | 54 (13) | “Taking care of dying patients without an emotional outlet to address this.” 104 |
| “Futile care in the ICU.” 5 | ||
| Clinical resources | 49 (12) | “Clinic-related issues such as outside records, follow-up, phone calls.” 310 |
| “Limited clinic nursing support.” 185 | ||
| Individual factors | ||
| Work–life | 52 (12) | “Not having enough truly free time away from the hospital.” 139 |
| “Having to take lots of work home.” 323 | ||
| Personal health concerns | 34 (8) | “Lack of time for self-maintenance.” 365 |
| “Chronic sleep deprivation.” 384 | ||
| Finances | 27 (6) | “The debt the debt the debt.” 14 |
| “Financial insecurity.” 426 | ||
| Resources for child health | 8 (2) | “Lack of any structured maternity leave.” 119 |
| “Lack of childcare.” 264 | ||
| Team culture | ||
| Leadership issues | 85 (20) | “Emphasis on hospital and institutional priorities over individual learning.” 87 |
| “Reporting same problems to the program leadership without changes.” 290 | ||
| Interpersonal relationships | 54 (13) | “Poor interpersonal/professional interactions (hostile environment).” 132 |
| “Feeling like a scribe for attendings, midlevels being given more priority than trainees.” 297 | ||
| Lack of appreciation | 44 (10) | “Being made to feel like a workhorse instead of someone who is respected.” 497 |
| “Lack of recognition by attendings and staff.” 236 | ||
| Communication | 17 (4) | “Unclear expectations.” 463 |
| “Challenges in responding to feedback.” 68 | ||
| Program resources | ||
| Protected time | 47 (11) | “Simultaneous “protected” time that doesn’t really exist in which to produce other research work in an academic setting.” 379 |
| “Pressure to complete research/academic production to get an academic job while balancing clinical responsibilities.” 4 | ||
| Educational inefficiency | 38 (9) | “Rotations with poor education: Service ratio.” 373 |
| “Lack of program leadership emphasis on importance of clinical care, education, QI efforts (as opposed to significant emphasis on research accomplishments).” 229 | ||
| Career development | 37 (9) | “The lack of care by mentors/superiors.” 328 |
| “Limited opportunity for creative work or growth.” 414 | ||
| Lack of perks‡ | 8 (2) | “Not enough free food.” 63 |
| “No place to rest at work.” 175 | ||
| Limited autonomy | ||
| Schedule | 39 (9) | “Lack of control/planning for our schedule and work hours.” 383 |
| Flexibility | “Lack of control over one’s schedule.” 120 | |
| Autonomy | 36 (9) | “The lack of autonomy in my program has significantly decreased the amount of satisfaction that I get from work.” 72 |
| “Essentially, a lack of control over medical decision despite bearing the burdens of malpractice risk.” 310 |
Definition of abbreviations: EMR = electronic medical record; ICU = intensive care unit.
*
Italicized numbers with quotes represent fellow identification numbers.
†
Fellow responses reported as the frequency of theme mention (n) as a percentage of total responses (N = 423). The total exceeds 100% because of multiple themes referenced per response.
‡
Perks included free food, coffee, parking, and activities.