Table 3.
Themes identified from written responses to the question, “What are things your training program can do to improve your physician wellness and/or reduce burnout?”*
| Theme and Code | n (%)† | Exemplar Quote |
|---|---|---|
| Program or institution | ||
| Protected academic development | 87 (23) | “Set up guidelines for what responsibilities should NOT be assigned to the fellow, as they have little educational value and simply take advantage of the fellow to do busy work.” 449 |
| “Fewer mandatory educational conferences or protected time to attend them.” 333 | ||
| Perks (free food, coffee, parking, and activities) | 71 (19) | “Free food and counseling sessions to deal with stress at workplace.” 228 |
| “Improve or additional on-site gym access, financial support for childcare, some kind of activity for spouses, free and nutritious food.” 69 | ||
| Program leadership | 44 (12) | “Increase microaggressions awareness.” 478 |
| “Meet with the fellows and actually change aspects of the program, which has not been done to a large degree. All of the programs decisions seem designed to maximize attendings work satisfaction.” 352 | ||
| Mental health/emotional support | 24 (6) | “Offer assistance with wellness. Allowing easy access to mental health services, including coverage for shift. More resources for wellness.” 103 |
| “Hearing attendings experience with burnout.” 116 | ||
| Physical activity | 23 (6) | “Having an on-site gym would be hugely beneficial.” 258 |
| “Free yoga sessions.” 35 | ||
| Financial | 22 (6) | “Do anything to actually reduce the burdens of training and raising a family (for many of us, anyway) on a salary that compels us to moonlight to make ends meet. Negotiate for meals at every hospital.” 114 |
| “Provide additional financial support for educational costs (study aids, board examination costs, publication fees).” 207 | ||
| Resources related to children/family | 19 (5) | “Help fellows obtain spots in the on-site daycare program. There is a 1-yr waitlist. Residents and fellows should have preferred access given the hours worked and pay received.” 134 |
| “Improve parental and maternity leave to at least the standard of the rest of the University.” 343 | ||
| Back up provider | 10 (3) | “No real organization. If you want to go to a conference or have a family emergency, you are left begging other fellows for coverage and always must make it up.” 222 |
| “Establish a sick call system.” 348 | ||
| Clinical | ||
| Reduce physician workload | 86 (23) | “Divide tasks more equitably, have the fellows more integrated into the team, rather than triaging the ICU 24/7.” 71 |
| “Cap length of a particular rotation at 4 wk. Reduce frequency of overnight call.” 78 | ||
| More flexibility in work | 58 (16) | “Standardizing time off and schedule so that sleep/wake cycles can regulate for longer periods of time. For example, I do not need a reduction in the amount of call but if it was more patterned and predictable, I could likely help plan better.” 275 |
| “Limit bleed of work in home life.” 204 | ||
| Involve more care providers | 38 (10) | “Increase clinical staff support or limit (cap) number of patients/procedures/etc. for academic teams.” 198 |
| “Hire more fellows and institute a night float system.” 131 | ||
| Assistance with administrative burden | 31 (8) | “Decreased the number of patients required to be seen (especially in clinic). Simplify the billing system.” 318 |
| “Provide ancillary resources like people that can set up our patients with sleep studies, pulmonary rehab, etc.” 29 | ||
| Make attending physicians more available to provide care | 9 (2) | “Prioritize physician wellness among the faculty. It’s hard to imagine improving fellow burnout when the faculty appear burned out.” 474 |
| “Have dedicated attendings to each service that are not responsible for nonclinical duties at the same time, allowing us to be more efficient and get the day done in a reasonable time.” 15 | ||
| Organizational culture | ||
| Professional interpersonal interactions/team building | 33 (9) | “Community building, listen to feedback on how to improve.” 157 |
| “Improve relations between fellowships.” 97 | ||
| Appreciation | 32 (9) | “Frequent recognition of fellow contributions to division/department objectives and patient care.” 204 |
| “Anything that makes me feel valued will probably reduce my sense of burnout.” 485 | ||
| Clear communication | 20 (5) | “Clear delineation of fellows’ clinical role.” 319 |
| “More clearly defined roles for fellows and APP’s.” 192 | ||
| More autonomy | 6 (2) | “Support fellows in decisions if justification is found reasonable.” 310 |
| “More autonomy.” 34 |
Definition of abbreviation: APP = advance practice provider; 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 = 375). The total exceeds 100% because of multiple themes referenced per response.